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Recent Practice Patterns and Variations in Children Hospitalized for Asthma Exacerbation in Japan
Yusuke Okubo1,2,3, Kenta Horimukai4, Nobuaki Michihata5
1Department of Epidemiology, University of California, Fielding School of Public Health, Los Angeles, California, USA, sunning_dale@yahoo.co.jp.
Insights
Antibiotic prescribing for childhood asthma exacerbations decreased significantly from 2010-2018. Wide variations in adjunctive treatments like mucolytics were observed across hospitals, indicating a need for comparative research.
Area of Science:
- Pediatric pulmonology
- Health services research
- Pharmacotherapy
Background:
- Antibiotic overuse is a concern in adult asthma exacerbations.
- Limited data exists on antibiotic and adjunctive therapy variations in pediatric asthma care.
- Understanding treatment patterns in children is crucial for optimizing care.
Purpose of the Study:
- To evaluate trends in health resource utilization for pediatric asthma hospitalizations.
- To identify variations in treatment practices across hospitals and regions.
- To classify distinct treatment patterns at the hospital level.
Main Methods:
- Retrospective observational study of Japanese children hospitalized for asthma (2010-2018).
- Analysis of initial treatment patterns and variations using mixed-effects generalized linear models.
- Hierarchical cluster analysis to classify hospital-level treatment variations.
Main Results:
- Antibiotic use decreased from 47.2% (2010) to 26.9% (2018).
- Use of antitussives, antihistamines, and methylxanthine declined; mucolytics and ambroxol increased.
- Treatment variations were more pronounced at the hospital level than regional levels, forming 6 distinct clusters.
Conclusions:
- Significant variations exist in antibiotic and adjunctive treatments for pediatric asthma across hospitals.
- Progress has been made in reducing inappropriate antibiotic use.
- Further research is needed on the comparative effectiveness of adjunctive asthma therapies in children.
Background:
High antibiotic prescribing rates for adults with an asthma exacerbation have been reported in developed countries, but few studies have assessed the variation of antibiotic and adjunctive treatment in the routine care of children.
Objective:
We evaluated the trends in health resource utilization for children hospitalized for asthma exacerbation, ascertained the variations of practices across hospitals and geographic location, and classified these different patterns at hospital levels.
Methods:
Using data on Japanese children hospitalized for asthma exacerbation with no indication of bacterial infection during 2010-2018, we conducted a retrospective observational study to assess the trends in initial treatment patterns and their variations. Mixed-effect generalized linear models were used to investigate the treatment trends. Hierarchical cluster analyses were performed to classify the treatment variations across hospitals.
Results:
Overall, 54,981 children were eligible for the study. Proportions of antibiotic use decreased from 47.2% in 2010 to 26.9% in 2018. Similarly, utilization of antitussives, antihistamines, and methylxanthine showed decreasing trends over the period, whereas the use of mucolytics and ambroxol increased. These treatment variations were more considerable in hospital levels than in 47 prefecture levels. Hierarchical cluster analyses classified these patterns into 6 groups, mostly based on mediator release inhibitor, ambroxol, and antitussives.
Conclusions:
Wide variations in antibiotics and adjunctive treatments were observed across hospital levels. Our findings support the improvement in reducing inappropriate antibiotic use and highlight the need for comparative effectiveness research of the adjunctive treatments among children hospitalized for asthma.
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