Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #106518

Scott A. Lorch, MD, MSCE¹, Kelly C. Wade, MD, PhD¹, Gabriel J. Escobar, MD², Susan Bakewell-Sachs, PhD, RN³, Barbara Medoff-Cooper, PhD, RN⁴, and Jeffrey H. Silber, MD, PhD¹. (1) Pediatrics, The Children's Hospital of Philadelphia, 3535 Market Street, Suite 1029, Philadelphia, PA 19104, 215-590-5635, lorch@email.chop.edu, (2) Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, (3) School of Nursing, The College of New Jersey, 2000 Pennington Rd, PO Box 7718, Ewing, NJ 08628-0718, (4) School of Nursing, University of Pennsylvania, 420 Guardian Drive, Philadelphia, PA 19104-6096

Research Objective: Antibiotics and asthma medications are commonly prescribed to children. Although premature infants may receive more of these medications than other children, the use and appropriateness of these prescriptions is unknown. The purpose of this study is to determine (1) the incidence of antibiotic and asthma medication use in a cohort of premature infants enrolled in a managed care system and (2) prognostic factors for appropriate use of these medications. Study Design: As part of the Infant Functional Study, all infants (N=896) born less than 32 weeks gestational age (GA) at 6 Northern California Kaiser Permanente hospitals between 1998 and 2001 were eligible as well as 543 randomly-selected infants of 33-34 weeks GA. Infants were excluded for congenital anomalies, home ventilation, or loss to follow-up. Data were collected on antibiotic, bronchodilator, and steroid prescriptions filled within one year of discharge from the hospital. Use of oral albuterol and oral steroids without inhaled steroids were collected as markers of inadequate treatment. Logit models determined prognostic factors for use of these medications after controlling for socioeconomic status (SES), neonatal complications, and site of outpatient care. Results: Among the 1437 infants, 0.69 antibiotic courses/pt/yr were filled; 463 infants (32%) received at least one antibiotic course. 275 infants (19.2%) received albuterol (210 received inhaled and 127 received oral formulations), while 116 (8.1%) received steroids (73 received inhaled and 83 received oral formulations). GA and neonatal complications were not associated with increased use of antibiotics; rather, black race (OR 1.57, 95% CI 1.06-2.31), hispanic ethnicity (OR 1.43, 95% CI 1.07-1.91) and male sex (OR 1.30, 95% CI 1.03-1.63) were associated with increased antibiotic use. When SES was controlled, black race lost significance (OR 1.38, 95% CI 0.92-2.07), but hispanic ethnicity and male sex remained associated with antibiotic use. Black race was a significant predictor of use of albuterol syrup (OR 3.91, 95% CI 2.19-6.96) and use of albuterol syrup without inhaled albuterol (OR 3.54, 95% CI 1.67-7.50) after controlling for SES and site of care. Neonatal complications such as bronchopulmonary dysplasia were associated with use of steroids, but no factor was associated with the use of oral steroids without inhaled steroids. Conclusions: Race and ethnicity were more predictive than neonatal complications for the use of medications and inappropriate care in this high-risk population. Despite adjustment for site of care and severity of illness, racial disparities in care persist in this managed care population.

Learning Objectives:

(
• Identify the incidence of antibiotic and asthma medication use in premature infants; (
• Descibe the differences in predictive factors for increased use of antibiotics and asthma medications; (
• Understand the role of race and ethnicity in the use and inappropriateness of these medications.

Keywords: Child Health, Quality of Care

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation