Asthma pharmacotherapy and utilization by children in 3 managed care organizations

Background: Asthma is the most common chronic disease among children and th e most frequent cause of hospitalization, Appropriate pharmacotherapy is a cornerstone of published national guidelines for the care of children with asthma. Objective: The goal was to compare the baseline pharmacotherapy and health care utilization from 1996 to 1997 in children with asthma at managed care organizations (MCOs). Methods: A common protocol was used to extract the study sample from 3 MCOs with automated claims and pharmacy databases. Children mere selected if th ey were 3 to 15 gears old as of June 1997 with 1 or more encounters (outpat ient, emergency department visit, hospitalization) with an asthma diagnosis in the previous year Results: Of the 13,352 children studied, less than 40% were given controlle rs during the 12-month interval, with ranges of 15% to 77% by level of bron chodilator use, 31% to 44% by age, and 38% to 42% by MCO. Among children gi ven 6 or more bronchodilators, controller dispensing ranged from 73% to 89% , among the 3 MCOs. Variability was most evident for inhaled corticosteroid s, for which dispensing ranged from 51% to 70%. Rates of asthma hospitaliza tion and emergency department visits also differed among the MCOs, ranging from 21 to 37 per 1000 person-gears and 37 to 142 per 1000 person-years, re spectively, Conclusion: Five years after dissemination of national guidelines for care, the pattern of asthma therapy does not reflect guideline recommendations. Variation among health care organizations with respect to asthma therapy an d utilization of health services exists. In addition, controller medication s may not be used by all children who could benefit from them.