Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, 84105, Beer-Sheva, Israel.
Clalit Health Services, Beer-Sheva, Israel.
Sci Rep. 2020 Nov 5;10(1):19155. doi: 10.1038/s41598-020-76280-2.
Global Initiative for Asthma 2019 guidelines recommend to avoid strengthening patients' reliance on relievers since they increase exacerbation risk. Our aim was to examine the association between reliever inhalers overuse and all-cause healthcare utilization (HCU). A retrospective study among Clalit Health Services (CHS) adult enrollees (n = 977) for 2012-2017. Reliever inhalers overuse was defined as consistent prescription refills of ≥ 3 canisters annually. Adherence to controllers was calculated using the proportion of days covered. HCU included: hospitalizations, diagnostic and surgical procedures, medications, emergency room (ER) visits, and clinic visits. 27% of the study population (n = 264) consistently refilled ≥ 3 relievers prescriptions annually, and had higher adherence to controllers (0.38 vs. 0.24, p < 0.001). Their total 6-year HCU costs were not higher than that of others ($5,550 vs. $5,562, p = 0.107). Most HCU components [including hospitalization (p = 0.405) and ER visits (p = 0.884)] were comparable; however, medication costs were higher ($1734 vs. $1504, p < 0.001). A multivariable ordered-logit model revealed that frequent and regular use of relievers was not associated with higher HCU costs (OR = 0.82, 95% CI 0.62-1.09, p = 0.175). Higher adherence to maintenance and reliever therapy (OR = 2.18, 95% CI 1.44-3.28, p < 0.001), other controllers (OR = 3.30, 95% CI 2.11-5.16, p < 0.001), and nebulized SABAs and SAMAs (OR = 1.08, 95% CI 1.02-1.14, p = 0.007) was associated with higher costs. Overuse of reliever inhalers was prevalent and associated with higher adherence to controllers, yet not associated with higher all-cause HCU. This highlights the need to examine the sources of elevated usage in order to develop intervention strategies to optimize pharmaceutical therapy of asthma patients.
全球哮喘倡议 2019 年指南建议避免增强患者对缓解药物的依赖，因为这会增加加重风险。我们的目的是研究过度使用缓解药物与全因医疗保健利用（HCU）之间的关联。这是一项针对克里夫兰诊所健康服务（Clalit Health Services，CHS）成年参保者（n=977）的回顾性研究，时间范围为 2012-2017 年。过度使用缓解药物定义为每年持续处方补充≥3 罐。控制器的依从性使用覆盖率来计算。HCU 包括住院、诊断和手术程序、药物、急诊室（ER）就诊和诊所就诊。研究人群中有 27%（n=264）的人每年持续补充≥3 罐缓解药物处方，且对控制器的依从性更高（0.38 对 0.24，p<0.001）。他们的六年总 HCU 成本并不高于其他人（5550 美元对 5562 美元，p=0.107）。大多数 HCU 成分[包括住院治疗（p=0.405）和 ER 就诊（p=0.884）]相似；然而，药物费用较高（1734 美元对 1504 美元，p<0.001）。多变量有序逻辑模型显示，频繁和定期使用缓解药物与更高的 HCU 成本无关（OR=0.82，95%CI 0.62-1.09，p=0.175）。更高的维持和缓解治疗（OR=2.18，95%CI 1.44-3.28，p<0.001）、其他控制器（OR=3.30，95%CI 2.11-5.16，p<0.001）和雾化 SABA 和 SAMAs（OR=1.08，95%CI 1.02-1.14，p=0.007）的使用与更高的成本相关。过度使用缓解药物很普遍，且与更高的控制器依从性相关，但与全因 HCU 无关。这突出表明需要检查使用增加的来源，以便制定干预策略，优化哮喘患者的药物治疗。
