Intervention to reduce unnecessary dispensing of short-acting {beta}-agonists in patients with asthma.
BACKGROUND
Several clinical studies have suggested that the overuse of short-acting beta-agonists (SABAs) and the underuse of inhaled corticosteroids are prevalent and may compromise patient health and increase the use of scarce health-care resources.


OBJECTIVE
To examine the impact of an intervention designed to reduce SABA metered-dose inhaler (MDI) overdispensing on asthma-related drug and healthcare utilization endpoints in a mail order pharmacy benefit population.


METHODS
Retrospective pre- and postintervention analysis was conducted on all new SABA prescriptions indicating a quantity more than 1 SABA MDI per month and on asthma patients who were continuously enrolled in the Medco Health Solutions prescription benefit program from July 1, 2006, to June, 30, 2007 (preintervention), and July 1, 2007, to June 30, 2008 (postintervention). The intervention involved a written or verbal request to the prescriber to reduce the quantity of SABA MDIs dispensed to less than 1 SABA MDI per month if determined appropriate by the prescriber. Effectiveness of the intervention on asthma-related drug and health-care utilization outcomes were measured in the overall Medco pharmacy population and in asthma patients receiving more than 1 SABA MDI per month.


RESULTS
The percentage of new SABA prescriptions dispensed for more than 1 SABA MDI per month was significantly reduced during year 2 (22.9% vs 9.7%, p < 0.01). Of the 1835 asthma patients who received more than 1 SABA MDI per month in year 1, 1230 (67%) received fewer than 1 SABA MDI per month during year 2. The incidence of asthma-related hospitalizations, emergency department visits, and oral corticosteroid use did not significantly change from year 1 to year 2.


CONCLUSIONS
This analysis shows that an intervention can succeed in reducing the overdispensing of quick-relief medication without compromising asthma control. Further investigation is warranted to better understand the interplay between reduction in excessive SABA use and improved clinical outcomes.
Pulmonary Therapeutic Resource Center, Medco Health Solutions, Inc., Liberty Lake, WA 99019, USA. mark_wong@medco.com
Mark D
MD
Wong
R Thomas
RT
Manley
Glen
G
Stettin
William
W
Chen
Luis M
LM
Salmun
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy* / Q000191:economics; D015331:Cohort Studies; D017046:Cost Savings; D016208:Databases, Factual; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010595:Pharmacists; D012189:Retrospective Studies
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists