哮喘联盟

   摘要
   目的:哮喘是医疗救助登记儿童最常见的慢性疾病。本研究测量多国医疗救助人口中在初始处方吸入糖皮质激素治疗后的依从性和结果。
   方法：本研究为回顾性研究，纳入来自14个美国南方诸州的5-12岁医疗救助登记的哮喘儿童，使用2007医疗救助计划的索赔文档数据来评价随访3个月时间里初始处方吸入糖皮质激素儿童的依从性和结果。 依从性是通过长期哮喘控制的药物比来测量的。
   结果：在这90天里，只有三分之一初始吸入糖皮质激素治疗的儿童达到长期控制的药物比例>0.5。那些长期控制药物少于总体哮喘控制药物一半的儿童，与长期哮喘控制药物率>0.5的儿童相比，急诊室就诊风险增加了21% (校正比值比 (AOR) 1.21 [95% CI 1.14, 1.27])。入院风险增加了70%(AOR 1.70 [95% CI 1.45, 1.98])。
   结论：尽管医疗补助覆盖药物治疗范围，但长期控制药物的依从性在这个多种族的低收入人群中是相当低的。长期控制治疗的依从性对现实生活的影响是可测量的。医疗补助计划是药物治疗依从性和急诊室利用率的一个潜在的监视系统。
 

（苏楠 审校）
J Asthma. 2013 Jun 20. [Epub ahead of print]

 

Inhaled corticosteroid adherence and emergency department utilization among Medicaid-enrolled children with asthma.
 

Rust G, Zhang S, Reynolds J.
 

Abstract
OBJECTIVES:Asthma is the most prevalent chronic disease among children enrolled in Medicaid. This study measured real-world adherence and outcomes after an initial prescription for inhaled corticosteroid therapy in a multi-state Medicaid population.
METHODS: We conducted a retrospective study among Medicaid-enrolled children aged 5-12 years with asthma in 14 southern states using 2007 Medicaid Analytic eXtract file claims data to assess adherence and outcomes over the 3 months following an initial prescription drug claim for inhaled corticosteroids (ICS-Rx). Adherence was measured by the long-term controller-to-total asthma drug claims ratio.
RESULTS: Only one-third of children (33.4%) with an initial ICS-Rx achieved a controller-to-total drug ratio >0.5 over the next 90 days. Children for whom long-term control drugs represented less than half of their total asthma drug claims had a 21% higher risk of emergency department (ED) visit (adjusted odds ratio (AOR) 1.21 [95% CI 1.14, 1.27]), and a 70% higher risk of hospital admission (AOR 1.70 [95% CI 1.45, 1.98]) than those with a controller-to-total asthma drug ratio >0.5.
CONCLUSION: Real-world adherence to long-term controller medications is quite low in this racially diverse, low-income segment of the population, despite Medicaid coverage of medications. Adherence to long-term controller therapy had a measurable impact on real-world outcomes. Medicaid programs are a potential surveillance system for both medication adherence and ED utilization.
 

J Asthma. 2013 Jun 20. [Epub ahead of print]