Association between common asthma therapies and recurrent asthma exacerbations in children enrolled in a state Medicaid plan

Camargo, Carlos A.; Ramachandran, Sulabha; Lewis, Barbara; Legorreta, Antonio P.

doi:10.2146/ajhp060256

Cited by 67 publications

(65 citation statements)

References 32 publications

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“…BUKSTEIN [23] CAMARGO [22] HERNDON [26] ELKOUT [25] those who were less adherent [21][22][23]26]. RUST et al [21] (q=8) observed this protective effect only if adherence was measured as controller-to-total ratio.…”

Section: Objective Adherence Measurementsmentioning

confidence: 97%

Medication adherence and the risk of severe asthma exacerbations: a systematic review

et al. 2014

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The benefits of drug therapy for asthma have been well established, but adherence to treatment is poor, and this might be associated with an increased risk of asthma exacerbations. The aim of this study was to review the literature on the association between adherence to asthma controller treatment and risk of severe asthma exacerbations in children and adults.A systematic literature search was performed in PubMed, Embase and Web of Science, from inception until January 2014. Studies were included if data on the association between medication adherence and severe asthma exacerbations were presented. Quality was assessed using a modified version of the Newcastle-Ottawa Scale.The search yielded 2319 unique publications, of which 23 met the inclusion criteria and underwent data extraction and quality scoring. High levels of heterogeneity across studies with regard to adherence and exacerbation measurements, designs and analysis precluded a formal meta-analysis. Although effect measures varied widely, good adherence was associated with fewer severe asthma exacerbations in highquality studies.Good adherence tended to be associated with lower risk of severe asthma exacerbations. Future studies should use standardised methodology to assess adherence and exacerbations, and should consider inhaler competence.@ERSpublications High-quality studies indicated that better adherence is associated with fewer severe asthma exacerbations

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Section: Objective Adherence Measurementsmentioning

confidence: 97%

Medication adherence and the risk of severe asthma exacerbations: a systematic review

et al. 2014

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“…Анализ историй болезни 10 896 детей с бронхи-альной астмой в возрасте до 8 лет (из них 6918 детей 4 лет и менее) показал, что применение будесонида через небулайзер (Пульмикорт ® суспензии) в тече-ние 12 мес после обострения заболевания значи-тельно снижает риск повторных обострений астмы по сравнению с использованием других схем терапии [32]. Включение небулизированного будесонида в те-рапию обострений бронхиальной астмы значительно улучшает функцию легких [33], а также способству-ет уменьшению сроков госпитализации при тяжелом обострении [34].…”

Section: мультитриггерная обструкция и диагностика бронхиальной астмыunclassified

Recurrent bronchial obstruction and asthma in children during the first five years of life

Ivanova¹

2016

Ross. vestn. perinatol. pediatr.

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Рецидивирующая обструкция бронхов и бронхиальная астма у детей первых пяти лет жизни Н. А. ИвановаВоенно-медицинская академия им. С. М. Кирова, Санкт-Петербург, Россия Recurrent bronchial obstruction and asthma in children during the first five years of life N. A. IvanovaKirov Military Medical Academy, Saint-Petersburg, Russia Высокая частота рецидивирующей обструкции бронхов у детей раннего и дошкольного возраста обусловлена как мор-фофункциональными особенностями респираторного тракта у детей данной возрастной группы, так и высокой частотой острых респираторных инфекций. Диагностика бронхиальной астмы у детей до пяти лет представляет объективные трудно-сти. Не у всех детей с рецидивирующей вирусиндуцированной обструкцией развивается в дальнейшем бронхиальная астма. Тем не менее использование анализа семейного и личного аллергологического анамнеза, особенностей клинических про-явлений заболевания, ответа на противовоспалительную терапию (при наличии показаний) позволяет установить диагноз бронхиальной астмы в любом возрасте и назначить базисную терапию в соответствии со степенью тяжести заболевания. Ключевые слова: дети до пяти лет, рецидивирующая обструкция бронхов, бронхиальная астма. 61: 5: 64-69. DOI: 10.21508/1027 61: 5: 64-69. DOI: 10.21508/ -4065-2016 The high rate of recurrent bronchial obstruction in toddlers and preschoolers is due to both the morphofunctional characteristics of the respiratory tract in these age groups and the high incidence of acute respiratory infections. The diagnosis of asthma presents objective difficulties in children aged less than 5 years. Not all children with recurrent virus-induced obstruction can further develop asthma. Nevertheless, an analysis of a family and personal history of allergy, the clinical manifestations of the disease, and a response to anti-inflammatory therapy, if indicated, can diagnose asthma at any age and use basic therapy in relation to the severity of the disease. Для цитирования: Иванова Н. А. Рецидивирующая обструкция бронхов и бронхиальная астма у детей первых пяти лет жизни. Рос вестн пе-ринатол и педиатр

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“…Medication possession ratio (MPR) is one such measure used to calculate medication adherence. For the purposes of this study, MPR is calculated as the days of antiasthmatic medication supply dispensed divided by the number of days in the observation period (#365) minus the number of days in the hospital [22][23][24][25] . Previous studies have shown that medication adherence measurement for the entire study period, when used as a denominator, predicts hospitalization and healthcare costs in a more appropriate manner compared to adherence measures considering the period between the first and last refill [22,26,27] .…”

Section: Medication Adherencementioning

confidence: 99%

Physician Payment Incentives and Associated Healthcare Utilization Outcomes in Medicaid Enrolled Asthmatic Children

Patel¹,

Balkrishnan²,

Suh³

2016

ijps

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Chang, et al.: Healthcare Utilization in Children with AsthmaVery few studies have captured the differences in the outcomes of Medicaid patients between fee-for-service and capitation plan. This study measures the impact of fee-for-service vs. capitation plan on the healthcare utilization and medication adherence in asthmatic children enrolled in Medicaid. A retrospective cohort study was utilized to analyze Medicaid data from 8 states. The data were comprised of medical records such as healthcare utilization, medication and eligibility records of 6435 Medicaid enrolled asthmatic children that had newly started pharmacotherapy for asthma. Quantile regression was used to study medication adherence and Poisson regression was used to determine healthcare utilization. Patients in fee-for-service plans were significantly associated with higher medication adherence rates (p<0.05). Compared to patients in fee-for-service plans, patients in capitation plans had 52% (p<0.05) more hospitalizations, 52% fewer outpatient visits and 32% (p<0.05) more emergency department visits. Medicaid programs primarily use capitation based managed care plans for keeping a check on the healthcare costs. Yet, these plans might not be that cost-effective for the long-term management of asthma. Hence, the policy makers and third party payers should consider disease specific needs of children in order to achieve improved access to care and medication for better management of a particular disease.

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Association between common asthma therapies and recurrent asthma exacerbations in children enrolled in a state Medicaid plan

Cited by 67 publications

References 32 publications

Medication adherence and the risk of severe asthma exacerbations: a systematic review

Medication adherence and the risk of severe asthma exacerbations: a systematic review

Recurrent bronchial obstruction and asthma in children during the first five years of life

Physician Payment Incentives and Associated Healthcare Utilization Outcomes in Medicaid Enrolled Asthmatic Children

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