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APHA Scientific Session and Event Listing

Asthma medications and health services utilization in a Medicaid managed care pediatric population

José Capriles, MD, MPH, MHSA1, Mario Rodríguez1, Ruth Ríos2, and Yelitza Sánchez2. (1) Puerto Rico Health Services Research Institute, University of Puerto Rico, Graduate School of Public Health, Box 365067 - Office B-448, San Juan, PR 00936-5067, 787-758-2525, ext. 7015, jcapriles@rcm.upr.edu, (2) School of Public Health, University of Puerto Rico, Medical Sciences Campus, PO BOX 365067, San Juan, PR 00936

Statement of the problem: Asthma is the most common pediatric chronic lung disease diagnosed in Puerto Rico. The National Heart, Lung, Blood Institute (NHLBI) created asthma guidelines to improve care and patient outcomes.

Objective: To identify health services utilization and asthma medications in Medicaid managed care (MMC) patients.

Procedure: This study explores health services utilization patterns and medications for patients less than 18 years old with asthma under MMC. Claims files from 51,188 patients for three years were analyzed. Healthcare utilization was defined in four continuous variables measuring the frequency of visits and/or use of a specific service in a year. An asthma medication index was used. The index is a value that ranges from 0 to 1.00, with a higher score indicating a better prescribing pattern. It is derived by dividing the total number of dispensed anti-inflammatory drug prescriptions by the sum of dispensed â2-agonist and anti-inflammatory drug prescriptions during a 12 month period.

Results: Over 94.7% of the patients presents index below .50, representing a less favorable prescribing pattern. This tendency was sustained when the use of emergency room, hospitalizations, office visits and multiple service use (P < .005) were considered. Patients with hospitalization and multiple service use present an index of .45 or less, while patients with emergency room and office visits present an index value over .51 (p < .000).

Conclusion: A high rate of poor prescribing pattern is uncovered among MMC patients. Noncompliance with guidelines is associated with increased resource utilization and costly outcomes.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

Keywords: Medicaid Managed Care, Treatment Patterns

Presenting author's disclosure statement:

Not Answered

Issues Related to Managed Care, Medicaid and Medications for the Uninsured

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA