Nestor A, Calhoun A C, Dickson M, Kalik C A
Physician Corporation of America, Department of Pharmaceutical Care, Miami, FL, USA.
Ann Allergy Asthma Immunol. 1998 Oct;81(4):327-30. doi: 10.1016/S1081-1206(10)63124-9.
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.
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.
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.
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.
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.
全国公认的临床指南为哮喘治疗提供了推荐疗法。在考虑在管理式医疗环境中管理哮喘患者的这些指南时，研究证明指南推荐的药物治疗对利用率（急诊科就诊和住院）的影响是有益的。
目的是确定急诊科/住院索赔与美国国家哮喘教育计划专家小组以及美国国家心肺血液研究所/世界卫生组织研讨会推荐的选定哮喘药物疗法之间的关系。
该分析是在一个为佛罗里达州359,464名患者服务的管理式医疗组织（MCO）内进行的回顾性横断面研究。来自所有业务线（医疗补助、医疗保险、商业保险）的哮喘患者根据所使用的药物治疗类型分层为亚组。纳入的成员是那些在1995年1月1日至1995年6月30日期间至少有一张哮喘药物处方被填充且在健康计划内连续登记至少六个月的人。在1.5年的研究期（1995年1月1日至1996年6月30日）内收集药房和医疗索赔数据，以确保对利用率的随访最短为6个月，最长为1.5年。通过索赔根据患者对三级医疗服务（与哮喘相关的急诊科就诊和住院）的利用率来衡量结果。
佛罗里达州MCO的总成员数为359,464名成员，其中5.2%被确定为哮喘患者。根据药房索赔数据对哮喘成员进行审查，确定26.2%的成员同时使用吸入性糖皮质激素和短效β2激动剂。对该亚组进一步审查发现，85%的人使用短效β2激动剂的剂量处于或低于推荐剂量。未按照推荐给药指南使用β2激动剂疗法的患者急诊科就诊和住院的发生率显著更高（P = 0.001）。对其余哮喘人群进行审查，确定33.2%的成员仅使用短效β2激动剂。该亚组显示97.6%的人按照β2激动剂给药指南使用疗法。未按照给药指南使用β2激动剂疗法的患者急诊科就诊和住院的发生率显著更高（P = 0.016）。
对管理式医疗人群中的哮喘治疗进行评估表明，按照哮喘指南建议接受治疗的患者中，急诊科就诊和住院的比例较低。
