Preventive Therapy for Asthmatic Children Under Florida Medicaid: Changes During the 1990s
Preventive Therapy for Asthmatic Children Under Florida Medicaid: Changes During the 1990s
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佛罗里达州医疗补助计划下哮喘儿童的预防性治疗：20 世纪 90 年代的变化
作者：
C. David
背景：为了应对我国日益增长的哮喘患病率和严重程度，美国国立卫生研究院于1991年发表了一份专家共识报告《哮喘诊断和处理指南》。该报告的一个重要方面包括，建议中度哮喘儿童可以受益于每日使用抗炎药物，如吸入皮质类固醇和色甘露。目的：本文的目的是研究佛罗里达州医疗补助覆盖的儿童在两个两年期间(第一次是在指南发布后不久，第二次是在7年后)每日抗炎药物处方的变化；并估计接受其中一种治疗的儿童对治疗的依从性。设计：两个两年期间的每一个研究小组只包括2至18岁的儿童，他们有哮喘医疗补助的医疗或机构索赔，并在此期间持续覆盖。从门诊索赔档案中，为每个儿童收集了一份记录，其中包含在每个间隔期间每类哮喘药物的处方数量。对于每个每天收到任何预防性药物处方的儿童，这些处方的数量和第一次处方之后的时间被用来计算药物的可用性。结果：儿童至少获得一种预防药物处方的比例从1990-1992年的26.9%上升到1997-1998年的52.6%。在早期，非裔美国儿童接受预防性治疗的可能性较小，但到1997年，这种差异缩小了。假设一次补充提供一个月的药物供应，在最初的处方之后，获得足够治疗一半以上时间的药物的儿童比例从6.1%上升到11.2%。对于使用β激动剂最多的儿童(在两年内开了11张或更多处方)，这一比例从25.3%上升到35.8%；在那些有5个或更多疗程的全身类固醇的儿童中，这一比例从36.6%上升到40.2%。在第二个间隔期间，口服孟鲁司特的依从性并不比吸入每日药物好。结论：在NIH指南发布后的7年里，佛罗里达医疗补助覆盖的哮喘儿童接受每日抗炎药物处方的比例几乎翻了一番。然而，在这两个间隔期间，即使在哮喘最严重的患者中，对曾经开过的治疗的依从性仍然很低。在这些药物实现其潜力之前，将需要有效的战略来提高依从性。
Background: In response to the increasing prevalence and severity of asthma in this country, the National Institutes of Health in 1991 published an expert consensus report Guidelines for the Diagnosis and Management of Asthma. An important aspect of the report included the recommendation that children with moderate asthma may benefit from daily treatment with anti‐inflammatory drugs such as inhaled corticosteroids and cromolyn. Objectives: The objective of this article is to examine changes in prescribing of daily anti‐inflammatory drugs for children covered by Florida Medicaid during two 2‐year periods, the first just after publication of the Guidelines and the second 7 years later; and to estimate adherence to treatment by children who received one of them. Design: The study groups for each of the two 2‐year periods included only children 2 to 18 years old who had medical or institutional claims to Medicaid for asthma and who were continuously covered during the period. From outpatient claims files, a record was assembled for each child containing the number of prescriptions in each category of asthma drugs during each interval. For each child who had received a prescription for any daily preventative drug, the number of such prescriptions and the time after the first were used to calculate availability of medication. Results: The proportion of children receiving at least one prescription for a preventive drug rose from 26.9 per cent of children in 1990–1992 to 52.6 per cent in 1997–1998. African‐American children were less likely to receive a preventive in the earlier period, but the difference narrowed by 1997. Assuming that one refill provided a month's supply of drug, the percentage of children who had enough drug dispensed to treat for more than half of the time following the initial prescription rose from 6.1 to 11.2 per cent. For children with the highest use of β‐agonist (11 or more prescriptions over 2 years), the percentage rose from 25.3 to 35.8; in those with 5 or more courses of a systemic steroid, the proportion rose from 36.6 to 40.2. During the second interval, adherence to use of oral montelukast was no better than to inhaled daily medications. Conclusion: In the 7 years after the publication of the NIH Guidelines, asthmatic children covered by Florida Medicaid had an approximate doubling in the proportion who received a prescription for a daily anti‐inflammatory drug. However, during both intervals the adherence to treatment once prescribed remained low even among those with the severest asthma. Effective strategies to improve adherence will be needed before these drugs can realize their potential.
影响因子：
14.2
作者：
Adams, RJ;Fuhlbrigge, A;Martinez, F
通讯作者：
Martinez, F
致电患者的药房，通过测量处方补充率来评估哮喘药物的依从性。
DOI：
10.1016/s0022-3476(00)90019-2
发表时间：
2000
期刊：
The Journal of pediatrics
影响因子：
--
作者：
Sherman,J;Hutson,A;Baumstein,S;Hendeles,L
通讯作者：
Hendeles,L