Corticosteroid prescription filling for children covered by medicaid following an emergency department visit or a hospitalization for asthma

Objective: To identify predictors of corticosteroid prescription filling fo llowing an emergency department (ED) visit or a hospitalization for asthma. Design: A retrospective cohort study. Patients: Tennessee children (defined as those aged 2-17 years in this stud y) covered by Medicaid were included in the cohort if they had an ED visit or a hospitalization for asthma between July 1, 1995, and December 31, 1997 . Main Outcome Measures: Prescriptions filled in the child's name for an oral corticosteroid within 7 days of the latest ED visit or hospitalization for asthma. Results: Of 6035 Tennessee children covered by Medicaid with an ED visit fo r asthma and of 2102 covered by Medicaid with a hospitalization for asthma during the study period, less than half (44.8% following an ED visit and 55 .5% following a hospitalization) had prescriptions filled for oral corticos teroids within 7 days. Factors independently predicting a child's not havin g an oral, corticosteroid prescription filled included older age, black rac e, and residence in rural regions of the state. Conversely, children with o ral corticosteroid prescriptions in the previous 6 months were more likely to have oral corticosteroid prescriptions filled following an ED visit for asthma, and children with more than 3 beta -agonist prescriptions in the pr evious 6 months were more likely to have oral corticosteroid prescriptions filled following a hospitalization for asthma. Conclusions: Overall, fewer than half of Tennessee children covered by Medi caid had an oral corticosteroid prescription filled following an ED visit o r a hospitalization for asthma. Age, race, and county of residence predicte d failure to have a prescription filled. Further study is needed to determi ne whether variations in corticosteroid prescription filling relate to phys ician practice, family behavior, or both.