Timing of emergency department visits for childhood asthma after initial inhaled corticosteroid use.
Timing of emergency department visits for childhood asthma after initial inhaled corticosteroid use.
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初次使用吸入皮质类固醇后儿童哮喘急诊就诊的时间。
DOI：
10.1089/pop.2013.0126
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发表时间：
2015
影响因子：
2.5
通讯作者：
Tyler-Hill,Yasmin
中科院分区：
文献类型：
--
作者：
Rust,George;Zhang,Shun;Holloway,Kelvin;Tyler-Hill,Yasmin
吸入性糖皮质激素作为长期控制哮喘的慢性护理计划的一部分，可以预防急性加重和急诊，但患者依从性低和提供者处方不足（临床惯性）可能会限制这些益处。国家医疗补助计划是低收入儿童保险的主要来源，支付药物和预防保健费用，并承担儿童常见慢性病（如哮喘）的不良后果。本研究测量了2007年美国南部14个州43，156名被诊断为哮喘的医疗补助登记儿童在首次吸入皮质类固醇处方（ICS-Rx）后90天内急诊（艾德）就诊的发生率和时间。1/5例哮喘儿童（19.6%）在初始ICS-Rx后的前90天内至少接受了1次艾德访视;其中10%的访视发生在前48小时内，25%发生在第一周内。继续使用ICS-Rx与艾德访视风险降低相关。艾德就诊率无种族差异。对于医疗补助入组儿童，初始ICS-Rx是哮喘相关艾德访视短期风险的警告标志，而持续使用ICS-Rx至少90天具有保护作用。可能需要在初始ICS-Rx后的前2天内进行初级保健随访，以防止不良结局。医疗补助计划可以使用索赔数据来监测指南一致性治疗的依从性，并用于标记艾德就诊风险较高窗口的哨兵事件。人口健康管理2015;18：54-60。
Inhaled corticosteroids can prevent acute exacerbations and emergency visits when used as part of a chronic care plan for long-term control of asthma, but low patient adherence and inadequate provider prescribing (clinical inertia) can limit these benefits. State Medicaid programs are a major source of insurance coverage for low-income children, paying for medications and preventive care, as well as bearing the cost of adverse outcomes for common chronic conditions in childhood, such as asthma. This study measured the incidence and timing of emergency department (ED) visits in the first 90 days after an initial inhaled corticosteroid prescription (ICS-Rx) among 43,156 Medicaid-enrolled children with a diagnosis of asthma in 14 southern states in 2007. One in 5 children (19.6%) with asthma had at least 1 ED visit in the first 90 days after initial ICS-Rx; 10% of these visits occurred within the first 48 hours, and 25% occurred within the first week. Continued ICS-Rx use was associated with lower risk of an ED visit. There were no racial differences in the ED visit rates. Initial ICS-Rx for Medicaid-enrolled children is a warning flag for short-term risk of asthma-related ED visits, whereas continued ICS-Rx use is protective for at least 90 days. Primary care follow-up may be needed within the first 2 days after initial ICS-Rx to prevent adverse outcomes. Medicaid programs could use claims data for surveillance of adherence to guideline-concordant therapy and for sentinel events marking windows of a higher risk for ED visits.Population Health Management2015;18:54–60.