title: The Effect of Asthma Clinical Guideline for Adults on Inhaled Corticosteroids PrescriptionTrend: A Quasi-Experimental Study.
abstract: In order to increase inhaled corticosteroid (ICS) use and to reduce hospitalization, emergency department visits and ultimately the economic burden of asthma, "Korean Asthma Management Guideline for Adults 2007" was developed. To assess the guideline effects on physician's ICS prescription for asthma, we conducted segmented regression and multilevel logistic regression using National Health Insurance claims database of outpatient visits from 2003 to 2010. We set each quarter of a year as a time unit and compared ICS prescription between before and after guideline dissemination. A total of 624,309 quarterly visits for asthma was observed. The ICS prescription rate before and after guideline dissemination was 13.3% and 16.4% respectively (P < 0.001). In the segmented regression, there was no significant guideline effect on overall ICS prescription rate. In multilevel logistic regression analyses, the effect of guideline on overall ICS prescription was not significant (odds ratio, 1.03; 95% CI, 1.00-1.06). In subgroup analysis, ICS prescription increased in secondary care hospitals (odds ratio, 1.15; 95% CI, 1.02-1.30) and in general hospitals (odds ratio, 1.10; 95% CI, 1.04-1.16). However, in primary clinics, which covered 81.7% of asthma cases, there was no significant change (odds ratio, 0.98; 95% CI, 0.94-1.02). From the in-depth interview, we could identify that the reimbursement criteria of the Health Insurance Review and Assessment Service and patient's preference for oral drug were barriers for the ICS prescription. The domestic asthma clinical guideline have no significant effect on ICS prescription, especially in primary clinics.
authors.affiliation: Department of Family Medicine, Seoul National University Hospital, Seoul, Korea. ; College of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Sang Hyuck
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Family Medicine, Seoul National University Hospital, Seoul, Korea. ; Advanced Institutes of Convergence Technology, Seoul National University, Suwon, Korea. ; Institute on Aging, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Be Long
authors.initials: BL
authors.lastname: Cho
authors.affiliation: Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Shin
authors.affiliation: Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea.
authors.forename: Seung-Sik
authors.initials: SS
authors.lastname: Hwang
authors.affiliation: Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hyejin
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Eun Mi
authors.initials: EM
authors.lastname: Ahn
authors.affiliation: Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jae Moon
authors.initials: JM
authors.lastname: Yun
authors.affiliation: Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Yun Hee
authors.initials: YH
authors.lastname: Chung
authors.affiliation: Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: You Seon
authors.initials: YS
authors.lastname: Nam
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000486:Allergy and Immunology / Q000592:standards; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D017410:Practice Guidelines as Topic; D015995:Prevalence; D015272:Pulmonary Medicine / Q000592:standards; D056910:Republic of Korea / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents
keywords: Asthma; Corticosteroid; Guideline