Prescription Fill Adherence in Pediatric Asthma: Are Privately Insured Children at Increased Risk?

Adherence in asthma is a complex issue, which remains a major barrier to achieving control of symptoms and preventing morbidity. In children, there is a paucity of literature regarding risk factors for nonadherence to obtaining prescriptions. The aim of this study was to measure the first-fill rate of newly prescribed asthma medications for new patients presenting to a pediatric subspecialty asthma clinic, determine potential risk factors for not filling medication, and evaluate change in lung function at follow-up. We collected data on prescription refill rates, lung function, and clinic return rates in patients presenting for the first time to our clinic. We collected data on 77 children with persistent asthma encompassing 140 new prescriptions. A 2-sided Fischer's exact test was used with categorical variables to analyze variables, which may influence filling prescriptions and follow-up. A one-sided paired Student's t-test was used to analyze improvement in lung function between visits. The overall prescription fill rate was 83.5% (117/140). We found that patients with public insurance were statistically more likely to fill inhaled asthma medications than those with private insurance (P = 0.0133). Despite higher rates of filling medications, those with public insurance had a trend toward being significantly less likely to return for their follow-up appointment (P = 0.058). Those who filled their inhaled controller medications [inhaled corticosteroids (ICSs) or ICS/long-acting beta-agonist (LABA)] and followed up had a statistically significant improvement in forced expiratory volume in 1 s (P = 0.04), while those who did not fill their inhaled controller medications had no significant change (P = 0.31). Our data suggest that children with private insurance are at risk for nonadherence related to filling inhaled asthma medication prescriptions. In addition, patients who fill their inhaled controller medications had improved lung function, irrespective of other traditional assessments of adherence.