Cross-sectional analysis of the relationship between national guideline recommended asthma drug therapy and emergency/hospital use within a managed care population

Abstract

Background: Nationally recognized clinical guidelines provide recommended therapies for the treatment of asthma. Research demonstrating the impact of guideline recommended drug therapy on utilization [emergency department (ED) and hospitalizations] is beneficial when considering these guidelines for managing asthmatics within a managed care setting.

Objective: The purpose is to determine the relationship between ED/hospital claims and selected asthma drug therapies as recommended by the National Asthma Education Program Expert Panel and the National Heart, Lung, and Blood Institute/ World Health Organization Workshop.

Methods: The analysis is a retrospective, cross-sectional study within a managed care organization (MCO), serving 359,464 patients in the state of Florida. Asthma patients from all lines of business (Medicaid, Medicare, commercial) were stratified into subgroups based on the type of drug therapy utilized. Members included were those identified as having at least one prescription filled for an asthma medication between January 1, 1995 and June 30, 1995 and at least six consecutive months of enrollment within the health plan. Pharmacy and medical claims data were collected over a 1.5-year study period (January 1, 1995 through June 30, 1996) to assure follow-up on utilization was at a minimum 6 months and maximum 1.5 years. Outcomes were measured based on patient utilization of tertiary medical services (asthma-related ED and hospital visits) through claims.

Results: Total membership within the Florida MCO, reflected 359,464 members of whom 5.2% were identified as asthmatic. The asthma members were reviewed based on pharmacy claims data, identifying 26.2% of the members utilizing inhaled corticosteroids concomitantly with a short-acting beta2-agonist. Upon further review of this subset, 85% were utilizing short-acting beta2-agonists in quantities at or below recommended dosages. Patients not utilizing the beta2-agonist therapy according to the recommended dosing guidelines had a significantly higher incidence (P = .001) of ED and hospital use. The remaining asthma population was reviewed, identifying 33.2% of the members utilizing short-acting beta2-agonists alone. This subset revealed 97.6% were utilizing therapy according to the beta2-agonist dosing guidelines. Patients not utilizing the beta2-agonist therapy according to dosing guidelines had a significantly higher incidence (P = .016) of ED and hospital use.

Conclusion: Assessment of asthma therapy in a managed care population demonstrates that there is a lower proportionate use of the ED and hospital in those patients treated in accordance to the asthma guideline recommendations.