Specialty asthma care no benefit to adherence in underserved children

Results of a study of underserved children with asthma in the USA suggest that they may be losing out on the benefits of specialty care.

Researchers from the University of Maryland in Baltimore found that Medicaid-insured children being treated by an allergist filled a suboptimal number of prescriptions for controller medication, while overfilling prescriptions for rescue medication from other practitioners.

“Despite access to specialty asthma care that focused on prescribing and teaching appropriate medication use, few patients had appropriate asthma medication fill rates during the period of the study,” comment authors Mary Bollinger and colleagues.

Indeed, they found that nearly 30% of prescriptions from allergists went unfilled during the 18-month study.

Among the 53 children with persistent asthma aged 2 to 8 years, 50.9% of inhaled corticosteroid prescriptions (initial and refill) from their allergist went unfilled, as did 50.5% of inhaled corticosteroid/long-acting β-agonist prescriptions, and 35.5% of leukotriene modifier prescriptions.

By contrast, 81.5% of patients filled a prescription for oral corticosteroids during the study period, despite only 28.3% having this documented by their allergist, indicating that they were prescribed by other healthcare professionals.

The team comments that this “is not surprising because patients are more likely to see their primary care physician or urgent care site than their asthma specialist for acute exacerbations.”

Of greater concern, they say, is the high rate of short-acting β-agonist use, which was reported by almost every patient (94.3%), despite only 52.8% having this documented in their allergy records. Furthermore, the average of 5.1 fills per child equates to one dose of rescue medication every 1.07 days, indicating very poor control, the authors note.

Bollinger and colleagues say there are probably many reasons why adherence to controller medication in patients from low socioeconomic background is so poor, despite no requirement for copayment or authorization. Possible reasons include formulary limitations, access to pharmacies, and socioeconomic stressors that compete with obtaining medications.

Writing in the Annals of Allergy, Asthma & Immunology, the team says that additional strategies are needed to track adherence to asthma control medication in children, which could be implemented at pharmacies or by health insurance companies.

“Limiting short-acting β-agonist refills and requiring parents to contact their child’s health care practitioner for additional rescue medication refills may allow an opportunity to address adherence with preventive asthma medications and improve asthma control,” they conclude.

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