Lang D M, Sherman M S, Polansky M
Department of Medicine, Allegheny University of the Health Sciences, Philadelphia, Pa, USA.
Arch Intern Med. 1997 Jun 9;157(11):1193-200.
Guidelines from the National Heart, Lung, and Blood Institute, Bethesda, Md, have encouraged more frequent use of inhaled steroids in asthma management.
To determine (1) whether prescription rates for inhaled steroids have increased compared with prescriptions for bronchodilators and (2) significant associations of demographic factors with bronchodilator-inhaled steroid prescription ratios and with rates of inhaled steroid prescriptions.
Cross-sectional analysis of monthly bronchodilator and inhaled steroid prescription rates, numbers and types of asthma care providers, and demographic factors.
Philadelphia, Pa.
Using univariate and multivariate analyses, bronchodilator and inhaled steroid prescription rates were determined for 45 ZIP codes and studied for associations with race and ethnicity, poverty, educational attainment, marital status, gender, total numbers of asthma drug prescriptions, and numbers and types of asthma care providers.
Monthly bronchodilator-inhaled steroid prescription ratios increased from July 1991 to June 1993 (P < .001). Prescription rates for inhaled steroids and inhaled bronchodilators declined, but rates for oral bronchodilators (beta-agonists and theophylline) increased. By stepwise multiple regression, higher bronchodilator-inhaled steroid prescription ratios and lower inhaled steroid prescription rates were each significantly associated with ZIP codes in which greater proportions of residents lacked a high school diploma (P < .001); associations that approached statistical significance were found for higher bronchodilator-inhaled steroid ratios and fewer asthma care providers (P = .05) and for lower inhaled steroid prescription rates and lower proportions of asthma specialists (P = .04).
In Philadelphia, a gap exists between optimal asthma drug prescribing and actual prescribing patterns that has widened from July 1991 to June 1993. Underuse of inhaled steroids is most closely associated with lower educational attainment, suggesting that interventions that include addressing the special asthma care needs of a low-literacy population will be required to achieve the goals of the National Asthma Education Program.
位于马里兰州贝塞斯达的美国国立心肺血液研究所发布的指南鼓励在哮喘管理中更频繁地使用吸入性类固醇。
确定（1）与支气管扩张剂处方相比，吸入性类固醇的处方率是否有所增加；（2）人口统计学因素与支气管扩张剂 - 吸入性类固醇处方比率以及吸入性类固醇处方率之间的显著关联。
对支气管扩张剂和吸入性类固醇的月处方率、哮喘护理提供者的数量和类型以及人口统计学因素进行横断面分析。
宾夕法尼亚州费城
使用单变量和多变量分析，确定了45个邮政编码区域的支气管扩张剂和吸入性类固醇处方率，并研究了其与种族和民族、贫困程度、教育程度、婚姻状况、性别、哮喘药物处方总数以及哮喘护理提供者的数量和类型之间的关联。
1991年7月至1993年6月，支气管扩张剂 - 吸入性类固醇月处方比率有所增加（P <.001）。吸入性类固醇和吸入性支气管扩张剂的处方率下降，但口服支气管扩张剂（β受体激动剂和茶碱）的处方率上升。通过逐步多元回归分析，较高的支气管扩张剂 - 吸入性类固醇处方比率和较低的吸入性类固醇处方率均与居民中高中文凭比例较高的邮政编码区域显著相关（P <.001）；在较高的支气管扩张剂 - 吸入性类固醇比率与较少的哮喘护理提供者（P =.05）以及较低的吸入性类固醇处方率与较低比例的哮喘专科医生（P =.04）之间发现了接近统计学意义的关联。
在费城，最佳哮喘药物处方与实际处方模式之间存在差距，且该差距在1991年7月至1993年6月间有所扩大。吸入性类固醇的使用不足与较低的教育程度密切相关，这表明需要采取包括满足低文化水平人群特殊哮喘护理需求在内的干预措施，以实现国家哮喘教育计划的目标。
