The study of prescribing patterns and cost of asthma via Nation Health Insurance Research Database and risk factors of asthma exacerbation

• Main Authors: Hai-Lun, 孫海倫
• Other Authors: Ming-Chih Chou
• Format: Others
• Language: en_US
• Online Access: http://ndltd.ncl.edu.tw/handle/06880498430703190383

博士 === 中山醫學大學 === 醫學研究所 === 94 === Guidelines from the Global Initiative for Asthma (GINA) mention several medications for the treatment of asthma. These medications include oral and inhaled beta-2 agonists, oral and inhaled corticosteroids, xanthines, leukotriene receptor antagonists, and their combinations. In addition to asthma, these drugs are commonly prescribed to treat other respiratory diseases, such as acute bronchitis, chronic cough, lower respiratory infection, or even bronchopneumonia. We analyzed differences in prescribing patterns between pediatric patients with and those without asthma, as coded in the claim records from the National Health Insurance Research Database. In addition, we analyzed the prescribing patterns of anti-asthma drugs by pediatricians, family physicians and other practitioners in asthmatic patients. Furthermore, we also analyzed between-group differences in the prescribing patterns of anti-asthma drugs, focusing on inhaled therapy as administered by pediatricians, family physicians and other practitioners. In many countries, the burden of asthma is sufficient to warrant its recognition as a high-priority disorder in governmental health strategies. Cost is another major economic impact on asthma. So health-care utilization and costs, including those related to office, outpatient hospital, emergency department, and inpatient hospital visits were compared between pediatric patients with and those without asthma. To improve the control of asthma and reduce medication needs, patients should avoid exposure to risk factors (allergens and irritants that make asthma worse). Air pollution is one of the common risk factor of asthma. The last purpose of this study was to evaluate the relationship between air pollution and asthma exacerbation in children and adults. For prescribing patterns in asthma and non-asthma patients group, oral beta-2 agonists were the most frequently monotherapy in both groups of patients (52.6-77.6% vs 62.8-84.8%). Oral beta-2 agonists combined with xanthines or oral corticosteroids combined with an oral beta-2 agonist were the most frequent combination therapies in both groups. Inhaled corticosteroids were used in 3.1-11.0% of patients with asthma; the rate varied by patient age. In conclusion, prescribing patterns were similar in pediatric patients with and those without asthma. For prescribing patterns by general pediatricians, family physicians and physicians in different disciplines groups, data for a total of 225,537 anti-asthma prescriptions were collected from the National Health Insurance Research Database for the period from January 1, 2002 to March 31, 2002. Oral beta 2-agonist was the most commonly prescribed drug used as monotherapy, with prescription rates of 70.4%, 46.9% and 58.0% by pediatricians, family physicians and other physicians respectively. A xanthine derivative was the next most commonly prescribed monotherapy. Oral corticosteroids combined with oral beta 2-agonist followed by oral beta 2-agonist combined with a xanthine derivative were the two most commonly prescribed dual agent combined therapies by all three categories of physicians. The prescription rate for inhaled corticosteroid monotherapy was 7.8% by pediatricians, 5.6% by family physicians and 8.0% by other care providers. The prescription rate for inhaled adrenergic was the highest in family physicians (14.9%), followed by the other care providers (7.2%) and was lowest in pediatricians (3.1%). In summary, pediatricians and family physicians appeared to share similar opinions about the medical management of children with asthma, in that both most commonly prescribed oral beta 2-agonists and xanthine derivatives, either alone or in combined therapy. Family physicians were least like to prescribe inhaled corticosteroid and most likely to prescribe inhaled adrenergic agent. Focusing on inhaled therapy as administered by pediatricians, family physicians and other physicians, the study consisted of all prescriptions for outpatients under 16 years of age from 1 January 2002 to 31 March 2002. Medications were grouped into two categories: inhaled bronchodilators, and inhaled corticosteroids. Inhaled bronchodilators were prescribed by 16.2% of pediatricians, 12.6% of family physicians and 22.7% of other physicians, with rates for inhaled corticosteroids of 13.9%, 6% and 12.9%, respectively. The prescribing frequency for inhaled therapy was lowest for patients under 2 years of age for all provider subgroups. In pediatrician and other physician subgroups, the more anti-asthma medications were prescribed, the more frequently inhaled medications were prescribed. Such trend was not observed in family physician subgroup. In conclusion, our cross-sectional retrospective descriptive study of asthma care provided by Taiwanese medical professionals showed that the family physicians prescribed inhaled bronchodilators and corticosteroids less frequently than pediatricians and other physicians. The lowest prescription rate for inhaled medication was for the subgroup of patients under 2 years of age, irrespective of professional category. Family physicians tended to prescribe inhaled therapy without combining other anti-asthma medications regardless of age subgroup. For health utilization and cost, we evaluated 33,461 patients aged 3–17 years who were enrolled in the National Health Insurance Research database from January 1 to December 31, 2002. The period prevalence of treated asthma was 6.0%. Pediatric patients with asthma used substantially more services than did those without asthma in all categories. Hospital outpatient visits and overall health-care expenditures for patients with asthma were 2.2-fold higher than those of patients without asthma. Asthma care represented 20% of all health-care services that patients with asthma received, while the remaining 80% were for nonasthma care. Almost three-fourths of all asthma-related costs were attributable to office and hospital outpatient visits; one-fourth was attributable to urgent care and hospitalizations. These findings may serve as baseline data for future evaluations of changes in health care utilization and expenditures among pediatric patients with asthma. The last purpose of this study was to evaluate the relationship between air pollution and asthma exacerbation in children and adults. Pearson’s analysis was used to establish correlations between air pollutants –SO2, NO2, ozone, CO, and PM10 –and emergency department visits for asthma in 2004. Among children, there were significant positive correlations between NO2 (r = 0.72), CO (r = 0.65) and PM10 (r = 0.63) and emergency department visits for asthma. Among adults, only weakly positive, non-significant correlations between all air pollution measures and emergency department visits for asthma were found. This study suggests that air pollution plays a role in acute exacerbation of asthma in children, but not in adults.