title: Real-time asthma outreach reduces excessive short-acting β2-agonist use: a randomized study.
abstract: BACKGROUND
  Excessive use of short-acting β2-agonists (SABA) indicates impaired asthma control.
  
  
  OBJECTIVE
  To determine whether real-time outreach to excessive SABA users reduces SABA canister dispensings.
  
  
  METHODS
  After real-time determination of a seventh SABA canister dispensing in the prior 12 months by using informational pharmacy technology, 12 to 56 year old patients with physician-coded asthma and inhaled corticosteroid dispensing were block randomized by prior asthma specialist care and medication step-care level into intervention (n = 1001) and control groups (n = 998). Intervention included real-time letter notification to patients and an electronic message to their physician with management suggestions, including facilitated allergy referral for patients without prior asthma specialist care. The control group received this organization's standard asthma care management without research contact. Frequency of the seventh SABA canister dispensing in the follow-up year was the primary outcome.
  
  
  RESULTS
  Compared with controls, intervention patients reached 7 SABA canister dispensings less frequently (50.7% vs 57.1%; risk ratio 0.89 [95% CI, 0.82-0.97]; P = .007) and later (hazard ratio 0.80 [95% CI, 0.71-0.91; P < .001). SABA canister dispensings (mean ± SD) were less in intervention (7.5 ± 4.9 canisters) than controls (8.6 ± 5.3 canisters) (rate ratio 0.87 [95% CI, 0.82-0.93]; P < .001). The intervention reduced the risk of ≥7 SABA canister dispensings in patients without specialist care compared with patients with specialist care in the prior 3 years (P < .001) (P = .04 for interaction by prior specialist care). Visits to allergists were more frequent for intervention patients (30.9%) than for control patients (16.8%) (risk ratio 1.83 [95% CI, 1.54-2.16]; P < .001). Asthma exacerbations were unaffected.
  
  
  CONCLUSIONS
  A novel administrative-based asthma outreach program improves markers of asthma impairment in patients without prior asthma specialist care and is adaptable to managed care organizations with electronic medical records.
authors.affiliation: Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif. Electronic address: robert.s.zeiger@kp.org.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Zeiger
authors.affiliation: Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif.
authors.forename: Michael
authors.initials: M
authors.lastname: Schatz
authors.affiliation: Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif.
authors.forename: Qiaowu
authors.initials: Q
authors.lastname: Li
authors.affiliation: Genentech Inc, South San Francisco, Calif.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Solari
authors.affiliation: Genentech Inc, South San Francisco, Calif.
authors.forename: James L
authors.initials: JL
authors.lastname: Zazzali
authors.affiliation: Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif.
authors.forename: Wansu
authors.initials: W
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology; D002648:Child; D003159:Community-Institutional Relations; D004363:Drug Utilization; D057286:Electronic Health Records; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists
keywords: Administrative data; Allergist; Asthma control; Exacerbations; Impairment; Inhaled corticosteroids; Long-acting β(2)-agonists; Managed care organization; Oral corticosteroids; Persistent asthma; Risk; Short-acting β(2)-agonists