Effectiveness of an asthma management program in reducing disparities in care in urban children.
OBJECTIVE
To examine differences in the effectiveness of a program to reduce use of health care services in urban-dwelling black and Hispanic children as a way to understand the origins of disparities.


METHODS
We examined hospitalization rates, emergency department (ED) visits, outpatient visits (OPVs), and bronchodilator and inhaled corticosteroid (ICS) prescriptions in 2,362 children receiving Medicaid who were enrolled in an asthma management program (Easy Breathing) from June 1, 1998, through May 31, 2001. We used generalized estimating equations to fit multivariate marginal Poisson regression models, controlling for sex, ethnicity, asthma severity, and secular trends.


RESULTS
Hospitalization rates were high and decreased 53% for black children and 33% for Hispanic children after the intervention. The ED visits decreased for Hispanic children, and OPVs decreased for both black and Hispanic children after Easy Breathing. The ICS prescription rates increased, with a decrease in the bronchodilator to ICS ratio from 5.81 to 2.16 in black children and from 4.74 to 2.17 in Hispanic children. Hispanic children filled more prescriptions for bronchodilators and ICSs (odds ratio, 1.29; 95% confidence interval, 1.05-1.59; P = .01; and odds ratio, 1.55; 95% confidence interval, 1.14-2.11; P = .005; respectively) 3 and 12 months after Easy Breathing. Black children were more likely than Hispanic children not to fill any asthma prescription. A total of 12% of children filled no asthma prescriptions.


CONCLUSIONS
Hispanic children seek more medical services than black children, whereas black children fill fewer prescriptions for bronchodilators and ICSs than Hispanic children. Easy Breathing reduces overall hospitalizations and OPVs in black and Hispanic children and asthma-specific ED visits in Hispanic children; the benefits of Easy Breathing are different in Hispanic and black children.
Cloutier
Michelle M
MM
Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut, USA. mclouti@ccmckids.org
Jones
Gloria A
GA
Hinckson
Vanessa
V
Wakefield
Dorothy B
DB
D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001249:Asthma / Q000208:ethnology / Q000628:therapy*; D044383:Black People / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003237:Connecticut; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data; D015397:Program Evaluation; D012041:Regional Medical Programs; D014505:Urban Population / Q000706:statistics & numerical data; D001741:Black or African American