title: Prescription fill patterns in underserved children with asthma receiving subspecialty care.
abstract: BACKGROUND
  Children with asthma receiving specialty care have been found to have improved asthma outcomes. However, these outcomes can be adversely affected by poor adherence with controller medications.
  
  
  OBJECTIVE
  To analyze pharmacy fill patterns as a measure of primary adherence in a group of underserved minority children receiving allergy subspecialty care.
  
  
  METHODS
  As part of a larger 18-month nebulizer use study in underserved children (ages 2-8 years) with persistent asthma, 53 children were recruited from an urban allergy practice. Pharmacy records were compared with prescribing records for all asthma medications.
  
  
  RESULTS
  Allergist controller prescriptions were written in 30-day quantities with refills and short-acting β-agonists (SABAs) with no refills. Only 49.1% of inhaled corticosteroid (ICS), 49.5% of combination ICS and long-acting β-agonist, and 64.5% of leukotriene modifier (LTM) initial and refill prescriptions were ever filled during the 18-month period. A mean of 5.1 refills (range, 0-14) for SABAs were obtained during 18 months, although only 1.28 SABA prescriptions were prescribed by the allergist. Mean times between first asthma prescription and actual filling were 30 days (range, 0-177 days) for ICSs, 26.6 days (range, 0-156 days) for LTMs, and 16.8 days (range, 0-139 days) for SABAs.
  
  
  CONCLUSIONS
  Underserved children with asthma receiving allergy subspecialty care suboptimally filled controller prescriptions, yet filled abundant rescue medications from other prescribers. Limiting albuterol prescriptions to one canister without additional refills may provide an opportunity to monitor fill rates of both rescue and controller medications and provide education to patients about appropriate use of medications to improve adherence.
authors.affiliation: Division of Pediatric Pulmonology and Allergy, University of Maryland, Baltimore, Maryland, USA. mbolling@peds.umaryland.edu
authors.forename: Mary E
authors.initials: ME
authors.lastname: Bollinger
authors.forename: Kim E
authors.initials: KE
authors.lastname: Mudd
authors.forename: Adam
authors.initials: A
authors.lastname: Boldt
authors.forename: Van Doren
authors.initials: VD
authors.lastname: Hsu
authors.forename: Mona G
authors.initials: MG
authors.lastname: Tsoukleris
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Butz
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000486:Allergy and Immunology / Q000706:statistics & numerical data*; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use; D009330:Nebulizers and Vaporizers; D010349:Patient Compliance; D013038:Specialization / Q000706:statistics & numerical data*; D035862:Vulnerable Populations / Q000706:statistics & numerical data*
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D020024:Leukotriene Antagonists