title: Provision of pneumococcal prophylaxis for publicly insured children with sickle cell disease.
abstract: BACKGROUND
  It is recommended that children younger than 5 years with sickle cell disease (SCD) take daily prophylactic antibiotics to prevent pneumococcal infections; however, how much prophylactic medication they actually are dispensed is unclear.
  
  
  OBJECTIVE
  To measure the amount of prophylactic antibiotics dispensed to young children with SCD and to investigate factors associated with increased delivery of medication.
  
  
  METHODS
  Retrospective longitudinal study conducted January 1995 through December 1999 using Tennessee and Washington State Medicaid administrative claims and encounter data. Children (N = 261) who had 1 inpatient or 2 outpatient claims or encounters listing an International Classification of Diseases, Ninth Revision, Clinical Modification code for SCD, were younger than 4 years at study entry (mean age, 1.4 years), and were continuously enrolled in Medicaid for a 1-year period.
  
  
  METHODS
  Number of days during a 365-day period covered by prescription fills for a penicillin or macrolide antibiotic, or for trimethoprim-sulfamethoxazole.
  
  
  RESULTS
  In a 365-day period, patients were dispensed a mean of 148.4 (SD, 121.3; median, 114; interquartile range [IQR], 39-247) days of prophylactic medication. The total amount of medication dispensed varied widely: 10.3% of patients received none and 21.5% received more than 270 days of medication. In a 365-day period, a mean of 12.7 (SD, 10.5; range, 0-40) prophylactic prescriptions were filled per patient. The median prescription duration was 10 days. In a multivariate linear regression model adjusting for state, sex, age at study entry, inclusion year, residence in urban community, outpatient inclusion encounter, required prescription co-payment, and number of outpatient visits for nonpreventive care, each preventive visit was associated with 12.0 (95% confidence interval [CI], 2.3-21.7) additional days of prophylactic antibiotics, and each emergency department visit was associated with 10.0 (95% CI, 1.2-18.8) additional days.
  
  
  CONCLUSIONS
  Publicly insured children with SCD may receive inadequate antibiotic prophylaxis against pneumococcal infections, placing them at increased risk of morbidity and mortality; however, increased numbers of outpatient visits for preventive care are associated with improved provision of prophylactic antibiotics.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle 98195-7183, USA. colinsox@u.washington.edu
authors.forename: Colin M
authors.initials: CM
authors.lastname: Sox
authors.forename: William O
authors.initials: WO
authors.lastname: Cooper
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Koepsell
authors.forename: David L
authors.initials: DL
authors.lastname: DiGiuseppe
authors.forename: Dimitri A
authors.initials: DA
authors.lastname: Christakis
mesh_terms: D000755:Anemia, Sickle Cell / Q000150:complications / Q000191:economics / Q000628:therapy; D019072:Antibiotic Prophylaxis / Q000191:economics / Q000706:statistics & numerical data*; D002662:Child Health Services / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D002675:Child, Preschool; D017723:Drug Utilization Review / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D011008:Pneumococcal Infections / Q000517:prevention & control*; D012189:Retrospective Studies; D013714:Tennessee; D014861:Washington