Pharmacy data ‘could reduce asthma treatment inequality’

Research has found that the ratio of dispensed asthma controller to rescue medication at community pharmacies is associated with the need for emergency asthma treatment in paediatric patients.

Patients at pharmacies with a low ratio of controller to rescue medication used emergency care four times more often than patients at pharmacies with higher ratios.

Reporting in Pediatrics, the researchers say their findings suggest that community pharmacists could be ideally placed to improve the evidence-based management of asthma.

“As front-line members of the health care delivery system, pharmacies and pharmacists offer the advantage of both consistent patient interaction and the ability to track prescription data over time”, writes the team, led by Andrew Beck (Cincinnati Children’s Hospital Medical Center, Ohio, USA).

The researchers collated medication data from 27 pharmacies in a single county in Ohio that dispensed 18,842 controller medications and 16,625 rescue medications during the 3-year study period.

They calculated the Pharmacy-level Asthma Medication Ratio (Ph-AMR) by dividing the total number of dispensed controller medications by the sum of dispensed controller and rescue medications for each pharmacy.

They then correlated these data with those for emergency visits and hospitalisations for asthma in children aged 2 to 17 years at the local hospital.

The researchers found a linear association between Ph-AMR and emergency incidents. The 10 pharmacies with a Ph-AMR below 0.5 had an incident rate of 26.1 events per 1000 child–years compared with a rate of 9.9 events in pharmacies with higher Ph-AMR. In the lowest Ph-AMR quintile (0.38–0.48) the event rate was 28.4 per 1000 child–years, while in the highest quintile (0.59–0.66) it was only 7.1.

Beck and colleagues say that they were motivated to develop the Ph-AMR after noting “deep disparities” in their community. Indeed, they found that the percentage of children living below the poverty line ranged from 2.3% to 42.2% and the rate of poverty was almost double in low Ph-AMR pharmacies than high Ph-AMR pharmacies.

The ratio is a community-based version of a measure devised by the USA’s National Committee for Quality Assurance that is usually calculated annually for individuals. The researchers say that using it at a population level could help inform the allocation of resources to pharmacies in areas in greatest need of improvement.

“Pharmacies could then more aggressively provide medication delivery or counselling services, flag patients who refill a disproportionate number of rescue medications compared with controllers, or more regularly communicate with physicians regarding those patients who do not seem to be responding to current therapy,” they suggest.

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