title: Adherence to Immunoprophylaxis Regimens for Respiratory Syncytial Virus Infection in Insured and Medicaid Populations.
abstract: BACKGROUND
  Immunoprophylaxis is the only pharmaceutical intervention for mitigating respiratory syncytial virus (RSV) infection. Patient level data on adherence to American Academy of Pediatrics (AAP) immunoprophylaxis recommendations are limited. This study characterizes adherence to AAP guidelines in privately insured and Medicaid populations.
  
  
  METHODS
  We performed a retrospective birth cohort study of 211 174 privately insured children in Northern California; and 458 837 publicly insured children in Tennessee born between January 1, 1996 and December 31, 2008. Adherence to the AAP guideline was defined for eligible infants as the number of doses of RSV immunoprophylaxis administered over the number recommended for 4 mutually exclusive eligibility groups: chronic lung disease, prematurity <29 weeks, prematurity <32 weeks, and other eligibility.
  
  
  RESULTS
  We identified 3456 California (Kaiser Permanente Northern California [KPNC]) and 12 251 Tennessee (Tennessee Medicaid [TennCare]) infants meeting AAP eligibility criteria. Immunoprophylaxis administration increased over the study period, from 15% for all eligible groups in 1998 to 54% in 2007. Adherence was highest among babies with chronic lung disease (KPNC 67% and TennCare 55%). Nonadherence (0% adherence) was greatest among infants of African American mothers (adjusted odds ratio [AOR] = 1.32; 95% confidence interval [CI] = .98-1.78); those with mothers with less than a high school education (AOR = 1.58; CI = 1.09-2.30) in KPNC; and in infants of Hispanic mothers in TennCare (AOR = 1.65; CI = 1.24-2.20). In KPNC, 0.11% of ineligible term infants and 5% of ineligible premature infants received immunoprophylaxis; the corresponding proportions in TennCare were 1% and 11%.
  
  
  CONCLUSIONS
  Overall adherence with AAP guidelines has increased over time. Considerable overuse and underuse of immunoprophylaxis are evident with identifiable risk groups to target for improvement.
authors.affiliation: Kaiser Permanente Medical Care Program Kaiser Permanente, Perinatal Research Unit, Division of Research, Oakland, and Department of Inpatient Pediatrics, Kaiser Permanente Medical Center, Walnut Creek, California;
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Escobar
authors.affiliation: Center for Asthma and Environmental Health Sciences Research, Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine Department of Biostatistics.
authors.forename: Tebeb
authors.initials: T
authors.lastname: Gebretsadik
authors.affiliation: Department of Pediatrics Center for Asthma and Environmental Health Sciences Research, Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine.
authors.forename: Kecia
authors.initials: K
authors.lastname: Carroll
authors.affiliation: Kaiser Permanente, Perinatal Research Unit, Division of Research, Oakland, and.
authors.forename: Sherian Xu
authors.initials: SX
authors.lastname: Li
authors.affiliation: Kaiser Permanente, Perinatal Research Unit, Division of Research, Oakland, and.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Walsh
authors.affiliation: Center for Asthma and Environmental Health Sciences Research, Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine Department of Biostatistics.
authors.forename: Pingsheng
authors.initials: P
authors.lastname: Wu
authors.affiliation: Center for Asthma and Environmental Health Sciences Research, Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Ed
authors.initials: E
authors.lastname: Mitchel
authors.affiliation: Center for Asthma and Environmental Health Sciences Research, Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine.
authors.forename: Chantel
authors.initials: C
authors.lastname: Sloan
authors.affiliation: Center for Asthma and Environmental Health Sciences Research, Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine.
authors.forename: Tina
authors.initials: T
authors.lastname: Hartert