A Retrospective Study Looking at the Incidence of Healthcare Services Utilization
among Pediatric Age Group Asthma Patients and Correlation to their Prescription
Refill.
Judith Flores, MD, FAAP 1, Mani K.C Vindhya, MD 2, Ana Nieto, MD 1, Diana
Villanueva, RN MS 1 and Naveena Vindhya, MD 3. 1 Pediatrics, Lutheran Medical center,
Brooklyn, NY, 11220 ; 2 Anesthesiology, Yale University, New Haven, CT, 06520 and 3
Pediatrics, Westchester Medical Center, Valhalla, NY, 10595 .
Objective
Despite national initiatives to improve asthma medical treatment, the pattern of use of
health care services remains high. The primary objective is to study the Incidence of
Inpatient hospitalizations, ER visits and unscheduled office visits by pediatric age group
patients and its correlation to pharmacy visits and the class of medication refill in
patients with mild to moderate asthma. And identifying potential points of intervention
for increasing patient compliance.
Methods
Study Subjects: 375 Pediatric Subjects
Age range 0 - 18 years
Design: Population-based longitudinal and cross-sectional analyses.
Subjects were children 0 to 18 years of age enrolled continuously over one year
(n = 375) in a community based setting. Percent of enrollees filling prescriptions for
asthma medications and fill rates by medication class and its correlation to their
subsequent healthcare services utilization were measured. Medication class was broadly
divided into two classes (beta agonists and steroids/anti-inflammatory). Each beta
agonist refill was scored as one negative point and each steroid refill as one positive
point thus a total score derived for each subject, thus categorizing subjects into three
groups a negative, positive and a zero group
Statistical analysis
Paired t Test was done between the three derived groups. Pearson's inverse correlation
was done between total score and the number of pharmacy visits.
Results
Between 2002 Jan to 2002 Dec, of 1219 pharmacy visits, 878 visits were by the high
beta-agonist users (negative group) (n=278) as compared to 230 pharmacy visits by the
combined inhaled anti-inflammatory and beta-agonist users (zero group) (n=66)
(p=0.04). The total primary care physician visits between the negative group and zero
groups were 588 and 186 (p=0.01) respectively. There was a strong inverse correlation
between number of pharmacy visits by each subject and their total score (p=0.0001).
Med
Score
0
≥+1
≤-1
Total Hosp
Visits
66
200
31
78
278
674
n
Out Pt
Visits
186
73
588
ED
Visits
10
5
71
In Pt
Admissions
4
0
13
Total Pharm
Visits
230
111
878
Population Distribution
0
≥+1
≤-1
Total Hosp Visits
PC Visits
800
700
700
600
600
500
500
0
400
≥+1
300
≤-1
0
400
≥+1
300
≤-1
200
200
100
100
0
0
total visits
PC
ED Visits
Inpt Admissions
14
80
70
12
60
10
0
50
40
30
≥+1
8
≤-1
6
20
4
10
2
0
0
≥+1
≤-1
0
ED
ADM
Pharm visits
1000
900
800
700
600
500
400
300
200
100
0
0
≥+1
≤-1
TOTAL PHRAM,VISITS
Conclusion
The proportion of children using asthma medications increased substantially during the
study period, but the use of inhaled anti-inflammatory medication per patient remained
low even for those using large amounts of inhaled beta-agonists. Subsequently their
pharmacy visits and visits to primary care physician increased substantially. These
findings suggest that inhaled anti-inflammatory medication use in children with asthma
fell short of national guidelines resulting in significant rise in healthcare services
utilization and thus healthcare costs.
Tackling an epidemic like asthma needs multi modal approach. As evidenced from the
study and from day to day experience pharmacies form a crucial point in the cross roads
between physicians, hospitals and patients. The conventional role of pharmacies should
expand towards specially trained community pharmacies to involve active patient
education and increase patient compliance and adherence to see a positive change in the
clinical and economic outcome measures in asthma patients.