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Evaluation of a physician-focused educational intervention on medicaid children with asthma
Euni Lee1, Diane L McNally, Ilene H Zuckerman
1Center for Minority Health Services Research, Department of Clinical and Administrative Pharmacy Sciences, School of Pharmacy, Howard University, 2300 Fourth Street NW, Washington, DC 20059-0001, USA. eunlee@howard.edu
Insights
A physician education intervention reduced asthma quick-relief medication use by 26% in pediatric Medicaid patients. However, it did not significantly impact long-term asthma control drugs or reduce emergency visits and hospitalizations.
Area of Science:
- Pharmacoeconomics
- Pediatric Asthma Management
- Health Services Research
Background:
- The 1990 Omnibus Budget Reconciliation Act mandated drug utilization reviews to curb inappropriate medication use.
- Pediatric asthma in Pennsylvania's Medicaid program is linked to substantial healthcare utilization and costs.
Purpose of the Study:
- To assess the impact of a physician-focused educational intervention on asthma medication prescribing patterns and healthcare utilization among pediatric Medicaid beneficiaries.
Main Methods:
- A pre- and postintervention study design evaluated children aged 5-18 in Pennsylvania Medicaid.
- The intervention involved mailing educational packets to physicians, including patient drug profiles, guidelines, and educational materials.
- Primary outcomes measured changes in asthma drug utilization, particularly among high-users of short-acting beta-agonists (SAB).
Main Results:
- The intervention decreased high-use of quick-relief medications by 26% without altering long-term control drug use.
- 82% of recipients showed improved salmeterol utilization, either by adding SAB or discontinuing salmeterol.
- No significant changes were observed in asthma-related emergency department visits or hospitalizations.
Conclusions:
- Physician feedback indicated the educational materials were useful, but the intervention showed limited success in improving pharmacologic management and no effect on health outcomes.
- Mailed educational materials can influence prescribing behavior, but a more comprehensive approach may be needed to improve patient health outcomes.
Background:
The 1990 Omnibus Budget Reconciliation Act mandated drug utilization review in response to inappropriate drug use. In the Pennsylvania Medicaid program, pediatric asthma is associated with high healthcare utilization and cost.
Objective:
To determine the effects of a physician-focused educational intervention on asthma drug use and healthcare utilization.
Methods:
Pre- and postintervention comparison design was used in children 5-18 years of age who were enrolled in the Pennsylvania Medicaid fee-for-service program from July 1, 1998, to March 31, 1999 (preintervention), and July 1, 1999, to March 31, 2000 (postintervention). The intervention packet included patients' drug profiles, medical history, monograph with national asthma management guidelines, and patient education materials to physicians. Main outcome measures are changes in asthma drug utilization among high-users of short-acting beta(2)-agonists (SAB).
Results:
The intervention focused on 2 asthma drug use criteria: (1) high-use of quick-relief medication and (2) use of salmeterol without the availability of a quick-relief medication. The intervention reduced quick-relief medication use by 26% among patients with higher use without significant changes in long-term control drugs. In addition, 82% of the recipients evaluated had a positive change in salmeterol utilization as either having an SAB inhaler added after the intervention or salmeterol discontinued after the intervention. There was no significant change in asthma-related emergency department visits or hospitalizations.
Conclusions:
Although the physician responders agreed on the usefulness of the educational materials, the results suggest that the intervention had limited success in improving the pharmacologic management and no effect on the health outcomes. We believe that mailed educational materials to physicians can be effective to change prescribing behavior; however, a more multifaceted intervention may be necessary to improve health outcomes.
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