301815
Childhood Asthma Control and Community Pharmacies: Moving to Population Health
![142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual](images/banner.jpg)
Childhood asthma morbidity varies tremendously across regions. Pharmacies are well-positioned for an increased role in population health management. We hypothesized that the asthma medication ratio (AMR), a nationally-recognized patient-level quality metric, could be calculated at the pharmacy-level (Ph-AMR) and would be associated with community morbidity.
Methods
We examined asthma medication fills for children (0-18 years) between 1/31/2010-1/30/2012 at 29 retail pharmacies in a single chain within Greater Cincinnati. Medications were categorized “controller” (inhaled corticosteroids, leukotriene receptor antagonists) or “rescue” (inhaled beta-agonists). Ph-AMR was calculated by dividing controller by controller+rescue fills, similar to the patient-level AMR where ratios <0.5 are associated with increased morbidity. Community asthma morbidity was defined as utilization (emergency department visitation or hospitalization) rates in the census tracts where the pharmacies were located. Associations between Ph-AMR and community morbidity were assessed using linear regression.
Results
There were 41,307 asthma medications filled; the average Ph-AMR was 0.52 (range 0.38-0.66). Pharmacies’ census tracts had average annual rates of 30.2 utilizations per 1,000 children (range 2.3-65.8). Low Ph-AMR (<0.5) pharmacies were in census tracts with utilization rates significantly greater than high Ph-AMR (≥0.5) pharmacies (46.9 vs. 15.2 per 1,000; p=0.0008). Ph-AMR accounted for 52% of utilization rate variation (p<0.0001). For every 0.1 increase in Ph-AMR, the utilization rate decreased by 12.8 per 1,000 (p=0.004), after adjustment for census tract poverty and transportation access.
Conclusions
The Ph-AMR was strongly and independently associated with local childhood asthma morbidity. Pharmacies may be a population health leverage point for assessing and improving asthma control within a community.
Learning Areas:
Advocacy for health and health educationChronic disease management and prevention
Clinical medicine applied in public health
Epidemiology
Provision of health care to the public
Public health or related research
Learning Objectives:
Evaluate whether a nationally-recognized patient-level asthma quality metric could be calculated at the pharmacy-level
Assess whether a pharmacy-level asthma quality metric is associated with community-level childhood asthma morbidity
Keyword(s): Child Health Promotion, Health Disparities/Inequities
Qualified on the content I am responsible for because: My expertise includes the use of census and community-level data to explore ways to predict asthma outcomes and identify asthma “hot spots” in Cincinnati. I also have expertise in community-academic partnerships, such as a collaborative project with public health officials aimed at the reduction of asthma-related housing risks.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.