The quality of asthma care among adults with substance-related disorders and adults with mental illness.
OBJECTIVE
The purpose of this study was to investigate whether the presence of substance-related disorders or mental illness may affect the quality of medication management in asthma care.


METHODS
Claims from 1999 for adult Medicaid patients with persistent asthma from five states were analyzed. Sample sizes ranged from 1,207 to 5,815. The adjusted odds of meeting two quality-of-care measures for asthma were calculated: the Health Effectiveness Data and Information Set (HEDIS) measure of filling a single prescription for a controller medication and a non-HEDIS measure of achieving a ratio of long-term controller medications to total asthma medications of > or = .5.


RESULTS
Odds of achieving the HEDIS measure were lower for patients with substance-related or schizophrenia disorders in two states (range of odds ratio [OR]=.69, 95% confidence interval [CI]=.53-.90, to OR=.81, 95% CI=.69-.96), but the odds increased for patients with depressive disorders in two states (OR=1.34, CI= 1.12-1.61; OR=1.37, CI=1.05-1.77) and for patients with bipolar disorder in one state (OR=1.69, CI=1.13-2.55). Odds of achieving the ratio measure were lower for patients with substance-related disorders in four states (range of OR=.63, CI=.47-.88, to OR=.75, CI=.62-.92) and higher for patients with depressive disorders, although only in one state (OR=1.25, CI=1.03-1.53).


CONCLUSIONS
Patients with substance-related disorders and those with schizophrenia disorders may be receiving lower-quality asthma care, whereas patients with some other forms of mental illness may be receiving higher-quality care. Further studies are needed to identify the determinants of high-quality asthma care and the validity of quality measures based on administrative data in these populations.
Baxter
Jeffrey D
JD
Center for Health Policy and Research, University of Massachusetts Medical School, 333 South St., Shrewsbury, MA 01545, USA. jeff.baxter@umassmed.edu
Samnaliev
Mihail
M
Clark
Robin E
RE
D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D011787:Quality of Health Care; D019966:Substance-Related Disorders / Q000150:complications*; D014481:United States / Q000453:epidemiology; D055815:Young Adult