Prescription fill patterns in underserved children with asthma receiving subspecialty care.

BACKGROUND: Children with asthma receiving specialty care have been found to have improved asthma outcomes. However, these outcomes can be adversely affected by poor adherence with controller medications. OBJECTIVE: To analyze pharmacy fill patterns as a measure of primary adherence in a group of underserved minority children receiving allergy subspecialty care. METHODS: As part of a larger 18-month nebulizer use study in underserved children (ages 2-8 years) with persistent asthma, 53 children were recruited from an urban allergy practice. Pharmacy records were compared with prescribing records for all asthma medications. RESULTS: Allergist controller prescriptions were written in 30-day quantities with refills and short-acting ß-agonists (SABAs) with no refills. Only 49.1% of inhaled corticosteroid (ICS), 49.5% of combination ICS and long-acting ß-agonist, and 64.5% of leukotriene modifier (LTM) initial and refill prescriptions were ever filled during the 18-month period. A mean of 5.1 refills (range, 0-14) for SABAs were obtained during 18 months, although only 1.28 SABA prescriptions were prescribed by the allergist. Mean times between first asthma prescription and actual filling were 30 days (range, 0-177 days) for ICSs, 26.6 days (range, 0-156 days) for LTMs, and 16.8 days (range, 0-139 days) for SABAs. CONCLUSION: Underserved children with asthma receiving allergy subspecialty care suboptimally filled controller prescriptions, yet filled abundant rescue medications from other prescribers. Limiting albuterol prescriptions to one canister without additional refills may provide an opportunity to monitor fill rates of both rescue and controller medications and provide education to patients about appropriate use of medications to improve adherence.

Concordance of Medicaid and pharmacy record data in inner-city children with asthma.

BACKGROUND: Management of asthma involves adherence to medication regimens. Assessing adherence is difficult for health care providers and researchers. Self-reported medication use is subjective, so objective methods of data collection for medication use are frequently used in asthma research. The aim of this project is to examine the concordance between asthma medication pharmacy data culled from Medicaid claims data ("Medicaid pharmacy data") and patient pharmacy record data obtained from individual pharmacies ("pharmacy record data"). METHODS: Medicaid pharmacy data and pharmacy record data were obtained from inner-city children enrolled in a prospective study of children with persistent asthma. A subject level comparison of pharmacy records and Medicaid pharmacy data pharmacy records was done to determine concordance between the 2 data collection methods. RESULTS: Of 513 children recruited for inclusion, 221 were consented and randomized. Medicaid claims data were collected on 72.8% (n=161) of the 221 enrolled subjects. Pharmacy record data were available on 96.8% (n=214) of the 221 subjects. Data presented represent the 159 subjects who had both Medicaid claims data and pharmacy records data available throughout the study period. There was complete agreement between Medicaid pharmacy data and pharmacy record for 26% (n=42) of subjects. A total of 1858 asthma medication claims were captured by the Medicaid pharmacy data. Medicaid pharmacy data missed 149 claims that were capture by the pharmacy record data. Medicaid pharmacy data failed to capture a single claim on 4.4% (n=7) of subjects. The pharmacy record data captured a total of 1627 asthma medication claims and missed 371 claims that were captured by the Medicaid pharmacy data. Pharmacy record data failed to capture a single claim in 1.9% (n=3) of subjects. CONCLUSIONS: There was overlap between the pharmacy data captured by the Medicaid pharmacy dataset and pharmacy record dataset, but the overall concordance between the two data collection methods was low. Pharmacy records collected directly from the pharmacy included data on more subjects and pharmacy data culled from Medicaid claims captured more total number of claims. In spite of the differences in the methods used to collect data, pharmacy fill records are a rich source of data with both clinical and research applications. Clinicians and researchers must weigh the benefits and limitations of each method used to collect pharmacy data.