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Underuse of controller medications among children with persistent asthma in the Ohio medicaid population: evolving
Stephen E Wilson1, Anthony Leonard, Charles Moomaw
1Division of General Internal Medicine, Department of Internal Medicine, College of Medicine, University of Cincinnati, Ohio, USA. Stephen.Wilson@uc.edu
Insights
Asthma controller medication use was low in Ohio Medicaid children, with a concerning increase in racial disparities by 2001. Urban residence also impacted access to certain asthma medications.
Area of Science:
- Pediatric Pulmonology
- Health Services Research
- Pharmacoeconomics
Background:
- Asthma morbidity and mortality rates are rising despite advancements in care.
- Underutilization of controller medications is a significant factor contributing to poor asthma outcomes.
- Effective asthma management relies on consistent controller medication use.
Purpose of the Study:
- To assess the prevalence of asthma controller medication underuse among children enrolled in Ohio Medicaid.
- To investigate potential racial disparities in asthma controller medication claims.
- To identify factors associated with inadequate controller medication utilization.
Main Methods:
- Retrospective analysis of Ohio Medicaid fee-for-service claims data from 1997-2001.
- Identification of children with persistent asthma using Health Employer Data Information System (HEDIS) criteria.
- Multivariable logistic regression and generalized estimating equations to analyze controller medication claims and risk factors.
Main Results:
- Controller medication claims increased from 53% in 1997 to 67% in 2001, indicating persistent underuse.
- A significant racial disparity emerged by 2001, with fewer African American children claiming controller medications (64.8% vs. 67.8%).
- Leukotriene antagonists (LTAs) drove this racial difference, with urban residents less likely to have LTA claims.
Conclusions:
- Asthma controller medication use remains suboptimal in the studied pediatric Medicaid population.
- Widening racial disparities in controller medication claims were observed over the study period.
- Geographic variations in Leukotriene Antagonist (LTA) claims contributed to the observed racial inequities in asthma care.
Background:
Despite innovations in asthma care, morbidity and mortality have increased significantly. Underuse of controller medications is a major contributor to increased morbidity and mortality.
Objective:
To determine the extent of underuse of asthma controller medications among Ohio Medicaid children and to determine if there are racial differences in controller medication claims.
Methods:
We conducted a retrospective analysis of Ohio Medicaid claims data. The source data included all institutional, medical service, and pharmacy claims for fee-for-service patients between January 1, 1997, and December 31, 2001. We identified children with persistent asthma using Health Employer Data Information System criteria. The primary outcome was a controller medication claim. We used multivariable logistic regression to identify risk factors for underutilizing asthma controller medications and applied generalized estimating equations to account for repeated measures.
Results:
The proportion of children with claims for a controller medication increased from 53% in 1997 to 67% in 2001. Although there were no racial differences in medication claims in 1997, a smaller proportion of African American children had a claim for a controller medication in 2001 (64.8% vs 67.8%, P < .001). Leukotriene antagonists (LTAs) were driving this difference. Individuals residing in urban areas were significantly less likely to have claims for LTAs when compared with those who resided in nonurban areas.
Conclusions:
Overall use of asthma controller medications among Ohio Medicaid children was poor. There was a widening racial difference in controller medication claims over the 5-year study. Regional differences in LTA claims were driving this racial difference.
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