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PULMONARY

Effect of Practitioner Education on Adherence to Asthma Treatment Guidelines

Assistant Clinical Professor, Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, CT

Prabashni Reddy, PharmD

Lead Pharmacoeconomist, Abt Associates Clinical Trials, Cambridge, MA

N Michelle Laster-Bradley, PhD MS BS Pharm

Health Outcomes Scientist, ACS State Healthcare, Atlanta, GA; Affiliate Assistant Professor, Pharmacy Care Systems, School of Pharmacy, Auburn University, Auburn, AL

Sheila Dorval, BSPharm

Health Program Supervisor, Department of Social Services, Hartford, CT

Bharathi Munagala, MS

Lead Programmer, Health Information Designs, Auburn, AL

C Michael White, PharmD

Assistant Professor, Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs; Director, Clinical Pharmacology Research, Hartford Hospital, Hartford

Reprints: Prabashni Reddy PharmD, Abt Associates Clinical Trials, 55 Wheeler St., Cambridge, MA 02138-1168, FAX 617/868-2221, E-mail prabashni_reddy{at}abtassoc.com

OBJECTIVE: To determine whether a letter-based intervention program submitted to prescribers and pharmacists would improve drug therapy in users of high-dose ß₂-agonists (HDBs).

STUDY DESIGN: Retrospective drug utilization review.

PATIENTS AND METHODS: The intervention group consisted of 135 asthmatic patients (identified through ICD-9-CM codes) in the Connecticut Medicaid Program who submitted >1 claim per month for short-acting ß₂-agonists (over a 6-mo period). Patient-specific intervention packets were mailed to the patients' prescribers and pharmacists, and their use of long-term control agents and healthcare utilization was evaluated over 6 months. These variables were compared with a comparison group (n = 510) of asthmatics drawn from the same Medicaid program who were not considered to be high-dose users of short-acting ß₂-agonists at baseline.

RESULTS: Prior to the intervention, the intervention group used fewer long-term asthma control agents as compared with the comparison group (58% vs. 96%; p < 0.001); there was no significant difference after the intervention program (65% vs. 71%; p = 0.169). The acquisition of spacers was greater in the intervention group than in the control group after the intervention (7% vs. 2%; p = 0.007). At the end of the 6-month intervention period, 46% of patients in the intervention group were no longer HDB users (p < 0.001). The higher frequency of prescriber office visits in the intervention group than the comparison group before the intervention (0.46 ± 0.82 vs. 0.25 ± 0.66; p < 0.001) was not evident after the intervention program (0.24 ± 0.63 vs. 0.18 ± 0.60; p = 0.283).

CONCLUSIONS: This intervention program had modest impact on improving the use of long-term control agents and reducing prescriber office visits.

Key Words: asthma, ß₂-agonist use, drug utilization review, treatment guidelines

Published Online, June 10, 2003. www.theannals.com, DOI 10.1345/aph.1C506