title: Medicaid's beta 2-agonist recipients and their treatment by national standards.
abstract: OBJECTIVE
  To determine whether Connecticut's Medicaid high-dose beta 2-agonists (HDB) users (> 1 canister/mo) are receiving medications according to National Institutes of Health (NIH) asthma guidelines, and to compare healthcare utilization between HDB users and patients receiving no more than one canister of a short-acting beta 2-agonist per month.
  
  
  METHODS
  All Connecticut Medicaid pharmacy claims from April to December 1998 were examined. Subjects were included if they had an asthma diagnosis and were excluded if they had chronic obstructive pulmonary disease. The percentage of HDB users not receiving long-term-control medication; receiving low doses of a long-term-control medication; and receiving oral, nebulized, or long-acting beta 2-agonists was determined. Healthcare utilization between HDB users and patients receiving no more than one canister of a short-acting beta 2-agonist per month was also compared.
  
  
  RESULTS
  Of 1599 profiles included, 14% (n = 223) were HDB users. Twenty-five percent of these patients did not receive a long-term-control medication, and 35% received low doses of a long-term-control medication. Claims for oral, nebulized, and long-acting beta 2-agonists were submitted for 4%, 29%, and 22% of HDB users, respectively. More claims for short courses of oral corticosteroids were submitted for HDB users than for patients receiving no more than one canister of a short-acting beta 2-agonist per month (n = 1376) (1.99 +/- 3.60 vs. 0.39 +/- 1.07 mean +/- SD; p < 0.001). HDB users visited their physicians' offices an average of 4.72 +/- 24.08 times per month compared with an average of 2.40 +/- 14.4 office visits per month for patients receiving no more than one canister of a short-acting beta 2-agonist (p = 0.04).
  
  
  CONCLUSIONS
  A high proportion of Connecticut's Medicaid HDB users are not receiving medications according to NIH guidelines. HDB users were significantly more likely to receive short courses of oral corticosteroids and required significantly more office visits than patients receiving no more than one canister of a short-acting beta 2-agonist per month. Intervention programs designed to improve adherence to the guidelines will be developed.
authors.affiliation: School of Pharmacy, University of Connecticut, Storrs, CT, USA. preddy@harthosp.org
authors.forename: P
authors.initials: P
authors.lastname: Reddy
authors.forename: E T
authors.initials: ET
authors.lastname: Kelly
authors.forename: M E
authors.initials: ME
authors.lastname: Kophazi
authors.forename: E A
authors.initials: EA
authors.lastname: Geary
authors.forename: J D
authors.initials: JD
authors.lastname: Markelon
authors.forename: K J
authors.initials: KJ
authors.lastname: Welter
mesh_terms: D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000188:drug therapy / Q000378:metabolism / Q000517:prevention & control*; D019468:Disease Management; D004358:Drug Therapy / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000592:standards; D008509:Medication Systems / Q000592:standards*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D018343:Receptors, Adrenergic, beta-2 / Q000378:metabolism; D012189:Retrospective Studies; D014481:United States
chemical_list: D000318:Adrenergic beta-Agonists; D018343:Receptors, Adrenergic, beta-2