PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of hsresearchLink to Publisher's site
 
Health Serv Res. 2001 June; 36(2): 357–371.
PMCID: PMC1089228

Asthma prevalence, cost, and adherence with expert guidelines on the utilization of health care services and costs in a state Medicaid population.

Abstract

OBJECTIVE: To provide a descriptive analysis of asthma prevalence and costs in a Medicaid population and gauge the degree of adherence with expert guidelines for asthma medication management from the National Asthma Education and Prevention Program. DATA SOURCES: Kentucky Medicaid administrative data for 1996. STUDY DESIGN: A cross-sectional retrospective analysis was used to determine adherence with asthma medication guidelines and utilization of asthma-related health care services and costs. Multivariate logistic regression was used to determine the relationship between nonadherence with the guidelines and utilization of health care services. PRINCIPAL FINDINGS: Of the 530,000 Medicaid recipients, 24,365 (4.6 percent) were identified as having asthma. Average annual asthma-related costs ($616) accounted for less than 20 percent of total health care costs ($3,645). Nonadherence to the guidelines was prevalent. Less than 40 percent of the patients received a prescription for a rescue medication, and fewer than 10 percent of the patients who received daily inhaled short-acting beta-2 agonists were regular users of inhaled steroids. Nonadherence to the guidelines was associated with an increased risk of an asthma-related hospitalization (odds ratio = 1.5, p < .05). CONCLUSIONS: Guideline nonadherence was widespread and associated with an increase in exacerbations of asthma that resulted in hospitalizations. Asthma prevalence and utilization of health care services in a Medicaid population were similar to previous estimates reported nationally and in health maintenance organizations.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.4M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Armstrong EP, Manuchehri F. Ambulatory care databases for managed care organizations. Am J Health Syst Pharm. 1997 Sep 1;54(17):1973–2005. [PubMed]
  • Balkrishnan R, Norwood GJ, Anderson A. Outcomes and cost benefits associated with the introduction of inhaled corticosteroid therapy in a medicaid population of asthmatic patients. Clin Ther. 1998 May-Jun;20(3):567–580. [PubMed]
  • Blumenschein K, Johannesson M. Relationship between quality of life instruments, health state utilities, and willingness to pay in patients with asthma. Ann Allergy Asthma Immunol. 1998 Feb;80(2):189–194. [PubMed]
  • Bosco LA, Gerstman BB, Tomita DK. Variations in the use of medication for the treatment of childhood asthma in the Michigan Medicaid population, 1980 to 1986. Chest. 1993 Dec;104(6):1727–1732. [PubMed]
  • Donahue JG, Weiss ST, Livingston JM, Goetsch MA, Greineder DK, Platt R. Inhaled steroids and the risk of hospitalization for asthma. JAMA. 1997 Mar 19;277(11):887–891. [PubMed]
  • Gerstman BB, Bosco LA, Tomita DK. Trends in the prevalence of asthma hospitalization in the 5- to 14-year-old Michigan Medicaid population, 1980 to 1986. J Allergy Clin Immunol. 1993 Apr;91(4):838–843. [PubMed]
  • Gottlieb DJ, Beiser AS, O'Connor GT. Poverty, race, and medication use are correlates of asthma hospitalization rates. A small area analysis in Boston. Chest. 1995 Jul;108(1):28–35. [PubMed]
  • Joseph CL, Havstad SL, Ownby DR, Johnson CC, Tilley BC. Racial differences in emergency department use persist despite allergist visits and prescriptions filled for antiinflammatory medications. J Allergy Clin Immunol. 1998 Apr;101(4 Pt 1):484–490. [PubMed]
  • Laumann JM, Bjornson DC. Treatment of Medicaid patients with asthma: comparison with treatment guidelines using disease-based drug utilization review methodology. Ann Pharmacother. 1998 Dec;32(12):1290–1294. [PubMed]
  • Lewis NJ, Patwell JT, Briesacher BA. The role of insurance claims databases in drug therapy outcomes research. Pharmacoeconomics. 1993 Nov;4(5):323–330. [PubMed]
  • Motheral BR, Fairman KA. The use of claims databases for outcomes research: rationale, challenges, and strategies. Clin Ther. 1997 Mar-Apr;19(2):346–366. [PubMed]
  • Nestor A, Calhoun AC, Dickson M, Kalik CA. Cross-sectional analysis of the relationship between national guideline recommended asthma drug therapy and emergency/hospital use within a managed care population. Ann Allergy Asthma Immunol. 1998 Oct;81(4):327–330. [PubMed]
  • Ray WA, Griffin MR. Use of Medicaid data for pharmacoepidemiology. Am J Epidemiol. 1989 Apr;129(4):837–849. [PubMed]
  • Sears MR, Taylor DR, Print CG, Lake DC, Li QQ, Flannery EM, Yates DM, Lucas MK, Herbison GP. Regular inhaled beta-agonist treatment in bronchial asthma. Lancet. 1990 Dec 8;336(8728):1391–1396. [PubMed]
  • Smith DH, Malone DC, Lawson KA, Okamoto LJ, Battista C, Saunders WB. A national estimate of the economic costs of asthma. Am J Respir Crit Care Med. 1997 Sep;156(3 Pt 1):787–793. [PubMed]
  • Stempel DA, Durcannin-Robbins JF, Hedblom EC, Woolf R, Sturm LL, Stempl AB. Drug utilization evaluation identifies costs associated with high use of beta-adrenergic agonists. Ann Allergy Asthma Immunol. 1996 Feb;76(2):153–158. [PubMed]
  • Stempel DA, Hedblom EC, Durcanin-Robbins JF, Sturm LL. Use of a pharmacy and medical claims database to document cost centers for 1993 annual asthma expenditures. Arch Fam Med. 1996 Jan;5(1):36–40. [PubMed]
  • Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States. N Engl J Med. 1992 Mar 26;326(13):862–866. [PubMed]
  • Wingert TD, Kralewski JE, Lindquist TJ, Knutson DJ. Constructing episodes of care from encounter and claims data: some methodological issues. Inquiry. 1995;32(4):430–443. [PubMed]
  • Wissow LS, Gittelsohn AM, Szklo M, Starfield B, Mussman M. Poverty, race, and hospitalization for childhood asthma. Am J Public Health. 1988 Jul;78(7):777–782. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust