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Inhaled corticosteroid adherence and emergency department utilization among Medicaid-enrolled children with asthma
George Rust1, Shun Zhang, Joshua Reynolds
1Morehouse School of Medicine, National Center for Primary Care, Atlanta, USA. grust@msm.edu
Insights
Medication adherence for childhood asthma is low among Medicaid patients, impacting health outcomes. Improving adherence to inhaled corticosteroids can reduce emergency visits and hospitalizations.
Area of Science:
- Pediatric Pulmonology
- Health Services Research
- Real-World Evidence
Background:
- Asthma is a leading chronic illness in children covered by Medicaid.
- Inhaled corticosteroids (ICS) are crucial for long-term asthma control.
- Understanding adherence and outcomes in this population is vital.
Purpose of the Study:
- To evaluate real-world adherence to inhaled corticosteroid therapy.
- To assess the impact of adherence on asthma-related outcomes in children.
- To analyze data from a multi-state Medicaid population.
Main Methods:
- Retrospective study using 2007 Medicaid claims data.
- Included children aged 5-12 years with asthma in 14 southern states.
- Adherence measured by controller-to-total asthma drug claims ratio over 90 days post-initial ICS prescription.
Main Results:
- Only 33.4% of children achieved optimal adherence (ratio >0.5).
- Poor adherence was linked to a 21% increased risk of emergency department visits.
- Inadequate adherence correlated with a 70% higher risk of hospital admission.
Conclusions:
- Real-world adherence to long-term asthma controller medications is low in this low-income, diverse population.
- Adherence significantly impacts asthma-related healthcare utilization.
- Medicaid programs can serve as a tool for monitoring medication adherence and ED visits.
Objectives:
Asthma is the most prevalent chronic disease among children enrolled in Medicaid. This study measured real-world adherence and outcomes after an initial prescription for inhaled corticosteroid therapy in a multi-state Medicaid population.
Methods:
We conducted a retrospective study among Medicaid-enrolled children aged 5-12 years with asthma in 14 southern states using 2007 Medicaid Analytic eXtract file claims data to assess adherence and outcomes over the 3 months following an initial prescription drug claim for inhaled corticosteroids (ICS-Rx). Adherence was measured by the long-term controller-to-total asthma drug claims ratio.
Results:
Only one-third of children (33.4%) with an initial ICS-Rx achieved a controller-to-total drug ratio >0.5 over the next 90 days. Children for whom long-term control drugs represented less than half of their total asthma drug claims had a 21% higher risk of emergency department (ED) visit (adjusted odds ratio (AOR) 1.21 [95% CI 1.14, 1.27]), and a 70% higher risk of hospital admission (AOR 1.70 [95% CI 1.45, 1.98]) than those with a controller-to-total asthma drug ratio >0.5.
Conclusion:
Real-world adherence to long-term controller medications is quite low in this racially diverse, low-income segment of the population, despite Medicaid coverage of medications. Adherence to long-term controller therapy had a measurable impact on real-world outcomes. Medicaid programs are a potential surveillance system for both medication adherence and ED utilization.
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