title: Analysis of prescription pattern and guideline adherence in the management of asthma among medical institutions and physician specialties in Taiwan between 2000 and 2010.
abstract: OBJECTIVE
  The aim of this study was to evaluate prescription patterns of antiasthmatic medications in ambulatory care, guideline adherence by physician specialties and medical institutions, and the rate of hospitalization and emergency department visits due to asthma exacerbation.
  
  
  METHODS
  The ambulatory visits between 2000 and 2010 from the Taiwan Longitudinal Health Insurance Database 2000 were analyzed for prescription trends. Seven classes of antiasthmatic medications were identified for prescription trend analysis. Prescription patterns of different medical institutions and physician specialties were further evaluated.
  
  
  RESULTS
  We studied 4495 patients with newly diagnosed asthma in 2000. Estimates indicated an increased use in fixed-dose combination of inhaled corticosteroids and long-acting β2-agonists (3.6% in 2002 to 28.8% in 2010) with decreased use of inhaled corticosteroids (14.5% in 2001 to 7.3% in 2010). Xanthine was still the most frequently used medication for asthmatic patients (60.2% in 2001 and 45.2% in 2010). Another marked increase was the use of leukotriene receptor antagonists (2.6% in 2001 to 6.0% in 2010). In the studied population, the rate of hospital admission or emergency department visit moderately decreased from 1.42% to 0.59% during 10 years. Physicians in medical centers and regional hospitals, as well as asthma specialists, dominated the increased use of fixed-dose combinations of inhaled corticosteroids and long-acting β2-agonists and leukotriene receptor antagonists.
  
  
  CONCLUSIONS
  Physicians in academic medical centers and asthma specialists achieved better adherence to the core recommendations of the international guidelines for asthma management. The reasons for guideline nonadherence among physicians in district hospitals and primary care clinics deserve health care professionals' attention and require further investigation.
authors: Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Chia-Lin
authors: CL
authors: Chou
authors: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Diahn-Warng
authors: DW
authors: Perng
authors: Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan.
authors: Ting-Lun
authors: TL
authors: Lin
authors: Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan.
authors: Anya Maan-Yuh
authors: AM
authors: Lin
authors: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Tzeng-Ji
authors: TJ
authors: Chen
authors: Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Ming-Shan
authors: MS
authors: Wu
authors: Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan; Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan; School of Pharmacy, Taipei Medical University, Taipei, Taiwan. Electronic address: ycchou@vghtpe.gov.tw.
authors: Yueh-Ching
authors: YC
authors: Chou
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use; D000328:Adult; D000553:Ambulatory Care; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D019468:Disease Management; D018450:Disease Progression; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination / Q000639:trends; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D013624:Taiwan; D019820:Xanthine / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D018927:Anti-Asthmatic Agents; D019820:Xanthine
keywords: asthma; fixed-dose combination inhaler; leukotriene receptor antagonist; long-acting β(2)-agonist; prescription patterns