Improving Outcomes for Children With Persistent Asthma

Two abstracts presented Saturday at The American Academy of Allergy, Asthma & Immunology 2019 Annual Meeting February 22-25 in San Francisco, California, discussed how formulary switching can affect outcomes for patients with severe persistent asthma, as well as how improving outcomes may be associated with increased quality measures.

The first abstract¹ outlined how changes to a patient’s inhaled corticosteroid (ICS) by an insurance company can lead to increased emergency department (ED) visits and hospitalizations when their asthma is severe. This is an issue because efforts to keep patients’ preferred ICS consistent can lead to a significant reduction in total healthcare costs.

To assess the effects on children with severe persistent asthma, the researchers conducted a 2-year retrospective chart review between 2016 to 2017 to measure changes in hospitalizations and ED visits. Asthma clinic records of hospitalizations and ED visits of 98 children with uncontrolled asthma (median age of 10 years) were reviewed in the study. Data collected included medication refill history, changes in insurance, and reasons for visits. P

Patients who had fewer than 2 refills within 3 months and had physician documentation revealing failure to take medication as suggested, despite having unhindered access to ICS, were considered “noncompliant.” Patients who experienced changes in preferred ICS were labeled as ‘‘medication refill issue.’’

A change in ICS was linked to a higher frequency of ED visits and hospitalizations. Researchers found that patients considered noncompliant had more ED, but not hospital, visits than patients who used medication as directed. However, medication refill issues were determined primarily responsible for an increased total of both ED visits (P <.001) and hospitalizations (P = .012).

Changing preferred ICS for asthma treatment has been a common practice among insurance companies, which creates lapses in medication use while patients, pharmacies, and physicians strived to adjust. Future research is needed to see if frequent ICS changes are linked to noncompliance.

The second abstract² detailed how attainment of asthma-specific Healthcare Effectiveness and Data Information Set quality measures could potentially improve clinical outcomes.

The study reviewed asthma exacerbation outcomes from patients with persistent asthma (PA), arranged by attainment of medication management (MM) and/or asthma medication ratio (AMR). It was observed that differences between patients who attained or hadn’t attained AMR were larger than those who attained or hadn’t attained MM.

A retrospective analysis of claims relating to ambulatory medical records of patients age 5 or older who displayed signs of PA and were continuously enrolled from May 2015 to April 2017. A total of 12,042 patients attained MM while 20,706 had not. Also, 24,388 patients attained AMR while 8360 had not. Patients attaining both MM and AMR were identified during a 1-year baseline period.

Asthma exacerbations were identified during a 1-year follow-up period. Patients who attained MM and/or AMR were less likely to experience exacerbations compared to those who hadn’t attained MM. Patients who achieved MM and AMR had fewer asthma-related hospitalizations compared with those who did not attain MM and AMR (5.1% and 4.9% vs 5.8% and 7.4%) and fewer ED visits (8.4% and 9.5% versus 13.6% and 18.1%).

References

1. Thomas CM, Krupp NL, Fiscus CD, et al. Preferred medication changes in high risk asthma patients leads to increased ED visits and hospitalizations. Presented at the American Academy of Allergy, Asthma & Immunology 2019 Annual Meeting; February 22-25; San Francisco, CA. Abstract 236.
2. Near A, Huang H, Ariely R, et al. Clinical outcomes in patients with persistent asthma (PA) by attainment of Healthcare Effectiveness and Data Information Set (HEDIS) measures: stratification by medication management (MM) and/or asthma medication ratio (AMR) attainment. Presented at the American Academy of Allergy, Asthma & Immunology 2019 Annual Meeting; February 22-25; San Francisco, CA. Abstract 158.