A Longitudinal Examination of the Asthma Medication Ratio in Children with Medicaid

Abstract

Background/Objective: An efficient and accurate strategy for identifying children with asthma at high risk exacerbation is needed. The objective of this study is to conduct a longitudinal examination of the asthma medication ratio (AMR) (#of controller medication claims/(# of controller medication claims + # of rescue medication claims)) in Medicaid-funded children with asthma. This measure has the potential to be a near real-time risk assessment tool. Study Design:We conducted a retrospective analysis of 2013-2014 TruvenHealth Medicaid data. We analyzed pharmacy and medical claims for a cohort of children with asthma. We identified patients age 2-17 yrs with at least one claim for an inhaled corticosteroid. We calculated an AMR for rolling 3-month periods and examined the proportion who were classified as low risk (AMR>.5), high risk (AMR<.5) and no medication claims (no asthma medication claims). Using logistic regression, we tested how the AMR predicted severe exacerbations.Results: 214,452 eligible children were identified. The mean age is 7.8 yrs. 8-9% had a high risk AMR in any given period. High risk AMR is associated with increased odds of a severe exacerbation in the subsequent 3 months (compared to all other children) (OR 1.7-1.9 depending on time period evaluated). Conclusions:In this analysis of Medicaid insured children with asthma, we found that the AMR is a reliable predictor of exacerbations. This will inform the development of an AMR-based risk assessment and communication intervention.

Parent Preferences for Methods and Content of Mobile Technology–Based Asthma Medication Adherence Intervention

“…The AMR (number of controller medication claims/[number of controller medication claims 1 number of reliever medication claims]) is an emerging asthma risk assessment tool that can estimate the risk of an ED visit or hospitalization for an asthma exacerbation on the basis of pharmacy dispensing data. 13,[15][16][17][18] Individual clinical providers or case managers could then use mobile technology to communicate with parents of identified high-risk children. Ideally, this system would prevent exacerbations or reduce the severity of exacerbations by identifying declining controller medication adherence or increasing rescue medication use early.…”

Impact of a pharmaceutical care incentive program on the asthma medication ratio among pediatric patients with persistent asthma enrolled in a Medicaid program

“…Based on the estimated AMR, it is reasonable to suggest that Medicaid pediatric patients with persistent asthma in Texas HSR 11 may be at high risk for poor asthma control, nonadherence, and increased incidence of hospitalizations or ED visits. [22][23][24] This finding suggests a window 1 controller medication that are not captured with the HEDIS criteria are most likely patients who have a claim for an asthma control therapy during an acute viral illness but do not have a recurrence. This potential bias was minimized in our study by reinforcing the criterion of at least 1 controller medication with at least 1 subsequent asthma pharmacy claim to be considered a persistent asthma case.…”

“…The use of pharmacy claims for controller medications to capture persistent asthma cases has been shown to have face validity. 24 However, it should be noted that using pharmacy claims for controller medications does not correlate perfectly with the HEDIS criteria to identify persistent asthma cases. 24 Persistent asthma cases identified with the definition of at least…”

Asthma attacks in children are always preceded by poor asthma control: myth or maxim?

“…Very poorly controlled asthma may pose a higher attack risk than not well controlled asthma [ 61 ]. Increased use of rescue medications has also been associated with increased attack risk [ 62 , 63 ].…”