Treatment of Medicaid patients with asthma: comparison with treatment guidelines using disease-based drug utilization review methodology.
OBJECTIVE
To compare asthma drug therapy in the Iowa Medicaid population with international treatment guideline recommendations and relate differences to patient outcomes.


METHODS
Data on asthma drug therapy and respiratory-related medical services (clinic visits, emergency visits, hospital admissions) were abstracted from prescription claims and diagnostic codes of adult Iowa Medicaid patients with asthma (n = 1029).


RESULTS
About two-thirds of the population received a prescription for a short-acting beta 2-agonist during the study period. Patients with greater daily use of short-acting beta 2-agonists had more clinic visits (p = 0.004), likely related to illness severity. Almost one-third (29.3%) of 58 patients receiving a prescription of salmeterol did not receive the recommended prescription of a short-acting beta 2-agonist inhaler in the 6-month period. About one-half of patients who should have been prescribed inhaled corticosteroids according to the international guidelines did not receive such a prescription in the 6-month study period. Increased use of inhaled corticosteroids was associated with fewer (p = 0.04) emergency visits.


CONCLUSIONS
Suboptimal asthma treatment in the Iowa Medicaid population, especially in regard to the use of inhaled corticosteroids as preventive therapy, was evident after comparison with treatment guidelines. Increased daily use of inhaled corticosteroids was associated with positive patient outcomes in accordance with guideline recommendations. Educational efforts to improve closer adherence to international guidelines both in prescribing practices and patient compliance with medication for asthma management should be undertaken.
Laumann
J M
JM
College of Pharmacy and Health Sciences, Drake University, Des Moines, IA 50311, USA.
Bjornson
D C
DC
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D003625:Data Collection; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D007484:Iowa; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D014481:United States
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents