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ASTHMA

Evaluation of a Physician-Focused Educational Intervention on Medicaid Children with Asthma

Assistant Professor, Center for Minority Health Services Research, Department of Clinical and Administrative Pharmacy Sciences, School of Pharmacy, Howard University, Washington, DC

Diane L McNally, MS

Project Coordinator, Center on Drugs and Public Policy, Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, MD

Ilene H Zuckerman, PharmD

Associate Professor, Center on Drugs and Public Policy, Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore

Reprints: Euni Lee PharmD PhD, Center for Minority Health Services Research, Department of Clinical and Administrative Pharmacy Science, School of Pharmacy, Howard University, 2300 Fourth St., NW, Washington, DC 20059-0001, fax 202/806-4478, eunlee{at}howard.edu

BACKGROUND: The 1990 Omnibus Budget Reconciliation Act mandated drug utilization review in response to inappropriate drug use. In the Pennsylvania Medicaid program, pediatric asthma is associated with high healthcare utilization and cost.

OBJECTIVE: To determine the effects of a physician-focused educational intervention on asthma drug use and healthcare utilization.

METHODS: Pre- and postintervention comparison design was used in children 5–18 years of age who were enrolled in the Pennsylvania Medicaid fee-for-service program from July 1, 1998, to March 31, 1999 (preintervention), and July 1, 1999, to March 31, 2000 (postintervention). The intervention packet included patients' drug profiles, medical history, monograph with national asthma management guidelines, and patient education materials to physicians. Main outcome measures are changes in asthma drug utilization among high-users of short-acting ß₂-agonists (SAB).

RESULTS: The intervention focused on 2 asthma drug use criteria: (1) high-use of quick-relief medication and (2) use of salmeterol without the availability of a quick-relief medication. The intervention reduced quick-relief medication use by 26% among patients with higher use without significant changes in long-term control drugs. In addition, 82% of the recipients evaluated had a positive change in salmeterol utilization as either having an SAB inhaler added after the intervention or salmeterol discontinued after the intervention. There was no significant change in asthma-related emergency department visits or hospitalizations.

CONCLUSIONS: Although the physician responders agreed on the usefulness of the educational materials, the results suggest that the intervention had limited success in improving the pharmacologic management and no effect on the health outcomes. We believe that mailed educational materials to physicians can be effective to change prescribing behavior; however, a more multifaceted intervention may be necessary to improve health outcomes.

Key Words: asthma, children, drug utilization review, Medicaid

Published Online, April 30, 2004. www.theannals.com, DOI 10.1345/aph.1D515