CHARACTERIZATION OF ASTHMA MANAGEMENT IN THE FALLON COMMUNITY-HEALTH PLAN FROM 1988 TO 1991

In order to characterise asthma management in a managed care setting, we identified 10 301 patients who were diagnosed with asthma between 1 January 1988 and 31 December 1991 at a group model health maintenance organisation in central Massachusetts, US. We obtained for these pati ents automated utilisation files containing data on medications, hospi talisations, emergency room visits, office visits, and estimated costs of these services. The medication dispensed to the greatest proportio n of patients was beta(2) agonists either by inhalation (56%) or orall y (21%). Theophylline was dispensed to 23% of the patients. Maintenanc e therapy with inhaled anti-inflammatory medication was uncommon, as i nhaled corticosteroids (17%) and sodium cromoglycate (cromolyn sodium) [8%] were dispensed to fewer patients than other asthma medications. Among patients who had been hospitalised in the previous year, 36% wer e presently receiving inhaled corticosteroids, and among patients who used at least one beta(2) agonist metered-dose inhaler per month, 49% were presently receiving inhaled corticosteroids. Economic analyses sh owed that only 8% of the patients had either a hospital admission or a n emergency room visit, but hospital costs among these patients accoun ted for 25% of the total costs of asthma care. In addition, the top 10 % most expensive patients accounted for 42% of the total cost of asthm a care. We conclude that a substantial proportion of patients at incre ased risk of a severe attack, by virtue of having a recent hospitalisa tion, do not receive maintenance anti-inflammatory therapy, and that h ospitalisations among a relatively small proportion of asthma patients contribute significantly to the cost of asthma care.