Recent Practice Patterns and Variations in Children Hospitalized for Asthma Exacerbation in Japan

Abstract

<b><i>Background:</i></b> 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. <b><i>Objective:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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. <b><i>Conclusions:</i></b> 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.

Antibiotic Use in Paediatric Patients Hospitalized with Acute Severe Asthma

“…However, definitions of indications and retrospective tools to exclude these patients vary. Okubo et al only included patients with no indication of bacterial infection and Jewell et al excluded patients where the additional discharge diagnosis suggested pneumonia or other bacterial infections [11,19]. To base the analysis on GINA guidelines and determine universal and comparatively objective criteria, we defined use of antibiotics without clear indication as prescription of antibiotics despite low to very low risk of bacterial infection (CrP < 2 mg/dL), no radiographic evidence of pneumonia and no other indication for antibiotics (urinary tract infection, sinusitis etc).…”

“…In the before mentioned study, the prescription of antibiotics seemed to be stable over 10 years. Controversially, Canadian and Japanese data show a decrease of antibiotic use for asthma over time as well as a decrease in age 16 19 . Whereas the rate of prescribed antibiotics in the Japanese cohort was 45% in 2010 for hospitalized patients with asthma, this decreased to 27% in 2018, emphasizing that prescription patterns are due to local habits.…”

Development of a set of quality indicators in paediatric and perinatal care in Japan with a modified Delphi method

“…Open access like Japan, where limited paediatric and perinatal QIs exist and care quality remains unvalidated. [9][10][11][12] The hospital information system is a rich data source for QI calculation, but differing vendor data structures pose challenges requiring extensive preparation efforts. 13 Alternatively, administrative databases with standardised data structures offer an efficient, population-based approach to monitoring care quality and have been used to compare QIs in prior studies.…”

Hospitalisierungen, klinische Charakteristika und Antibiotikagabe bei akutem, schweren Asthma im Alter von 6 bis 17 Jahren

“…Der Anteil von Antibiotika-Verschreibung bei hospitalisierten PatientInnen mit Asthma sank von 45% im Jahr 2010 auf 27% im Jahr 2018. 34,35 Trotz effektiven medikamentösen Asthmatherapien, die für die Altersgruppe von 6 bis 17 Jahren empfohlen werden, kommt es immer wieder zu Re-Hospitalisierungen. Eine Studie aus Frankreich stellte fest, dass 27% von 727…”