Increased health care use in patients with moderate-to-severe asthma due to frequent preferred medication changes.
Increased health care use in patients with moderate-to-severe asthma due to frequent preferred medication changes.
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由于频繁更换首选药物，中度至重度哮喘患者的医疗保健使用量增加。
DOI：
10.1016/j.anai.2022.05.016
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Kloepfer,KirstenM
中科院分区：
文献类型：
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作者：
Huddleston,ChristinaM;Slaven,JamesE;Weist,AndreaD;Krupp,NadiaL;Kloepfer,KirstenM
哮喘是最常见的慢性儿科呼吸道疾病，影响610万18岁以下儿童，其中60%的儿童被诊断为持续性哮喘。根据2项NHLBI指南，患有中度和重度哮喘的儿童（步骤3-6）应每天服用3次吸入性皮质类固醇（ICS）。2对哮喘住院的研究表明，过去12个月内的住院史是再次入院的预测因素。因此，确定5种方法来提供最佳的哮喘控制并消除护理障碍是很重要的。6潜在的障碍很多，包括无法获得护理和缺乏保险7。4，5难以控制哮喘的治疗指南侧重于再教育、8评估护理障碍和治疗依从性。依从性还受到多个因素的影响，包括教育，健康素养，交通和财务障碍。4在2016年和2017年10月，我们观察到印第安纳州的保险公司每2-3个月改变一次首选ICS±LABA 11。我们担心这会导致药物依从性的差距，因为12名医生，药房和患者正在努力遵守频繁的变化。因此，我们13调查了这些频繁的变化是否导致我们的高危哮喘人群中因哮喘急性发作而住院的增加。15 16 2016年1月至2017年12月期间，在我们的高危哮喘门诊中，98名儿童（中位年龄9.7岁，60%为男性，17 70%为非洲裔美国人）因18次哮喘急性发作至少住院一次，共住院203次。89/98（91%）的患者由州政府管理的19项医疗补助或由四个共同管理的医疗补助组织之一覆盖。根据NHLBI指南，20例患者均诊断为中度或重度哮喘，21例患者在高危哮喘诊所接受随访，并每日接受ICS±LABA处方。对于每名患者，在每23次用药前3个月，对22次药物补充史和保险范围进行审查
Asthma is the most common chronic pediatric respiratory disease, affecting 6.1 million US 1 children under the age of 18, 1 with 60% of these children diagnosed with persistent asthma. Per 2 NHLBI guidelines, children with moderate and severe asthma (steps 3-6) should be prescribed 3 daily inhaled corticosteroids (ICS). 2 Studies looking at asthma hospitalizations show that a history 4 of hospitalization within the past 12 months is a predictor for readmission. 3 Therefore, identifying 5 methods to provide the best asthma control possible and to eliminate barriers to care is important. 6 Potential barriers are numerous and include the inability to access care and a lack of insurance 7 coverage. 4, 5 Guidelines for treatment of difficult to control asthma have focused on re-education, 8 assessment of barriers to care, and treatment adherence. Adherence is also influenced by multiple 9 factors including education, health literacy, transportation, and financial barriers. 4 In 2016 and 10 2017, we observed that insurance companies in Indiana were changing their preferred ICS±LABA 11 every 2-3 months. We were concerned this was leading to gaps in medication adherence as 12 physicians, pharmacies and patients worked to comply with the frequent changes. Therefore we 13 investigated if these frequent changes resulted in an increase in hospitalizations for asthma 14 exacerbations within our high-risk asthma population. 15 16Between January 2016 through December 2017, 98 children (median age 9.7 years, 60% male, 17 70% African American) in our high-risk asthma clinic had at least one hospitalization for an 18 asthma exacerbation, for a total of 203 hospitalizations. 89/98 (91%) patients were covered by 19 Medicaid administered by the state or by one of four co-managed Medicaid-based organizations. 20 All patients had a diagnosis of moderate or severe asthma per NHLBI guidelines, 2 and were 21 followed in the high-risk asthma clinic and were prescribed daily ICS±LABA. For each patient, 22 medication refill history and insurance coverage were reviewed for 3 months prior to each 23