Underutilization of controller and rescue medications among older adults with asthma requiring hospital care.
BACKGROUND
Asthma causes serious morbidity in older people, but pharmacologic therapy in older people with asthma has never been studied, at least in part because of the difficulty of defining asthma in this population.


OBJECTIVE
To determine if older persons enrolled in Medicaid and hospitalized with an exacerbation of asthma receive appropriate outpatient asthma care.


METHODS
Descriptive pharmacoepidemiology of a group of older adults with asthma.


METHODS
The Tennessee Medicaid Program.


METHODS
Persons aged 65 and older, enrolled in the Tennessee Medicaid program, identified through Medicaid's computerized database as having a hospital care visit for asthma in 1992 and who had their diagnosis confirmed by chart review.


METHODS
Medication utilization.


RESULTS
The source population included 93,686 persons aged 65 or older enrolled in the Tennessee Medicaid program. The group meeting study criteria included 512 patients with chronic asthma who had a hospital care visit for an asthma exacerbation. Eighty-one percent of these 512 persons with an asthma hospitalization confirmed by chart review were classified as having moderate to severe or potentially fatal asthma. These patients had had a median of 15 outpatient visits in the previous year, and more than half of them had an outpatient visit in the 14 days before their hospitalization. However, among those with moderate to severe or near fatal asthma only 25% filled prescriptions for inhaled corticosteroids, whereas 52% were taking theophylline, the most commonly prescribed asthma medication in this group. There was also high use of antibiotics (29%) and low use of rescue corticosteroids (5%) before the hospital care visit, despite frequent medical encounters.


CONCLUSIONS
Despite widespread promulgation of the National Asthma Education Prevention Program guidelines, our study suggests that providers caring for indigent older subjects with moderate to severe or potentially fatal asthma were not following these guidelines. There was significant underutilization of inhaled anti-inflammatory agents, beta-agonists, and rescue corticosteroids in this population despite frequent outpatient medical care visits.
Hartert
T V
TV
Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-2650, USA.
Togias
A
A
Mellen
B G
BG
Mitchel
E F
EF
Snowden
M S
MS
Griffin
M R
MR
D000280:Administration, Inhalation; D000284:Administration, Oral; D000287:Administration, Topical; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002908:Chronic Disease; D017723:Drug Utilization Review; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D019983:Guideline Adherence; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013714:Tennessee; D013806:Theophylline / Q000627:therapeutic use; D014481:United States
D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D005938:Glucocorticoids; D013806:Theophylline