Use of Inhaled Anti-inflammatory Medication in Children With Asthma in Managed Care Settings

Adams, Robert; Fuhlbrigge, Anne L.; Finkelstein, Jonathan A.; Lozano, Paula; Livingston, James M.; Weiss, Kevin B.; Weiss, Scott T.

doi:10.1001/archpedi.155.4.501

Cited by 59 publications

(40 citation statements)

References 30 publications

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“…Younger age was also associated with severe exacerbations in the study by Covar et al 8 Previous studies have found that predictors of experiencing severe exacerbations are being treated with inhaled corticosteroids, 28 having had previous histories of ED visits or hospitalizations, 13,[29][30][31] or having had treatment in the past with oral corticosteroids. 30 The previous fi ndings that treatment with inhaled corticosteroids is a predictor of severe 2007 NAEPP recommendations for assessing risk and impairment separately.…”

Section: Discussionmentioning

confidence: 87%

Predictors of Symptoms Are Different From Predictors of Severe Exacerbations From Asthma in Children

Tantisira

et al. 2011

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Section: Discussionmentioning

confidence: 87%

Predictors of Symptoms Are Different From Predictors of Severe Exacerbations From Asthma in Children

Tantisira

et al. 2011

Chest

Self Cite

121

114

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“…Previous studies have identified variables associated with asthma care processes or outcomes by measuring the characteristics of patients and clinicians. 3,18,[20][21][22][23][24] However, research that evaluates variables from practice sites or that combines variables from practice sites, clinicians, and patients is uncommon, perhaps because of the complexity of identifying the interrelationships among these entities, then collecting and linking data from multiple classes of respondents.…”

Section: Major Findingsmentioning

confidence: 99%

Cultural Competence Policies and Other Predictors of Asthma Care Quality for Medicaid-Insured Children

et al. 2004

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ABSTRACT.Objective. More than half of Medicaid enrollees are now in managed care. Scant information exists about which policies of practice sites improve quality of care in managed Medicaid. Children with asthma are a sentinel group for Medicaid quality monitoring because they are at elevated risk for adverse outcomes. The objective of this study was to identify practice-site policies and features associated with quality of care for Medicaid-insured children with asthma.Methods. A prospective cohort study with 1-year follow-up was conducted in 5 health plans in California, Washington, and Massachusetts. Data were collected via telephone interviews with parents at baseline and 1 year, surveys of practice sites and clinicians, and computerized databases. The practice site survey asked about policies to promote cultural competence, the use of several types of reports to clinicians, support for self-management of asthma, case management and care coordination, and access to and continuity of care. Quality of care was evaluated on the basis of 5 measures: 1) preventive medication underuse based on parent report; 2) the parent's rating of asthma care; 3) the 1-year change in the child's asthma physical status based on a standardized measure; 4) preventive medication underprescribing based on computerized data; and 5) the occurrence of a hospitalbased episode.Results. Of the 1663 children in the study population, 67% had persistent asthma at baseline based on parent report of symptoms and medications. At 1-year followup, 65% of the children with persistent asthma were underusing preventive medication based on parent report. In multivariate analyses, patients of practice sites with the highest cultural competence scores were less likely to be underusing preventive asthma medications based on parent report at follow-up (odds ratio Poor and minority children are at elevated risk for asthma hospitalization, and many do not receive appropriate outpatient treatment. [1][2][3][4] In general, Medicaid-insured children may receive worse care than privately insured children, even when they are in the same health plans. 5 Scant information exists to help clinicians and policy makers understand how to improve health care quality effectively for children in managed Medicaid arrangements. 6 Clinicians who treat Medicaid-insured children need better information about which practice-site policies most enhance quality of care for this vulnerable group. Three general categories of practice-site policies are those that are tailored to low-income populations, chronic care policies, and primary care elements. Policies that are tailored to low-income populations attempt to promote cultural competence, 7-9 communication, and empowerment. Policies described in the Chronic Care Model include self-management support, decision support, clinical information systems, delivery system design, health care organization, and community resources. 10 Primary care elements have been defined as first-contact care (commonly called access), longitudinality (...

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“…Information on this relationship was deduced from one of several outcomes measured in the body of the study. Those few studies that primarily analyzed this relationship were two studies by Kozyrskyj et al [5,6], one study Adams et al [7] one study by Hong & Shepherd [8] and one study by Finkelstein et al [9]. The studies and their findings are described in detail below according to theme.…”

Section: Impact Of Family Incomementioning

confidence: 99%

“…The study by Adams et al (2001) looked at asthma medication usage patterns by age, sex, and health care organization. The 13,352 children in this study were enrolled in one of 4 U.S. managed care organizations (MCO's) that participated in the PAC-PORT II study, which was a multi-center pediatric asthma trial of strategies to improve pediatric asthma health outcomes [7].…”

Section: Type Of Insurance Provider Plan or Cost-sharing Mechanismmentioning

confidence: 99%

“…The 13,352 children in this study were enrolled in one of 4 U.S. managed care organizations (MCO's) that participated in the PAC-PORT II study, which was a multi-center pediatric asthma trial of strategies to improve pediatric asthma health outcomes [7]. The data reported came from 4 types of care delivery systems as follows:…”

Section: Type Of Insurance Provider Plan or Cost-sharing Mechanismmentioning

confidence: 99%

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Health insurance, access to prescription medicines and health outcomes in children

Ungar

Ariely²

2005

Expert Review of Pharmacoeconomics & Outcomes Research

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SUMMARYEnsuring optimal access to medications has received increasing attention as health care systems struggle with increasing costs. Although this has been studied extensively in adults, there has been little investigation in pediatric populations, which have different health care needs. A literature review was conducted to examine the evidence regarding the relationship between insurancemediated access to prescription medicines and outcomes in children. Twelve studies were classified according to i) uninsured versus insured, ii) type of insurance provider and iii), impact of family income. The studies demonstrated that insurance coverage and low cost-sharing are both essential to facilitate access to medications. Increased access was consistently observed for insured compared to uninsured children. Access to prescription drugs frequently differed by type of health provider organization. Adequate family income was an important determinant of access to and receipt of prescriptions. Moreover, income-indexed insurance coverage may increase unmet need. Compared to the literature on access to prescription medicines and health outcomes in adults, there have been few studies in children. Further research relating pharmaceutical policies to pediatric health outcomes is needed to strengthen the quality of policy decision-making regarding access to prescription medicines for children.

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Use of Inhaled Anti-inflammatory Medication in Children With Asthma in Managed Care Settings

Abstract: There may be differences in the use of preventive asthma medication in children that are affected by age, sex, and health care organization. Few children with frequent symptoms are using controllers regularly, as is recommended by national guidelines.

Cited by 59 publications

References 30 publications

Predictors of Symptoms Are Different From Predictors of Severe Exacerbations From Asthma in Children

Predictors of Symptoms Are Different From Predictors of Severe Exacerbations From Asthma in Children

Cultural Competence Policies and Other Predictors of Asthma Care Quality for Medicaid-Insured Children

Health insurance, access to prescription medicines and health outcomes in children

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