May 13, 2015
Pharmacies Untapped Resource for Controlling
Pediatric Asthma

Cincinnati—Pharmacies can play a critical role in making sure that children keep their asthma under control, according to a new study using geographic data on where prescriptions for “controller” or “rescue” medications were more likely to be filled.

The study, published online recently by the journal Pediatrics, finds that fewer asthma controller medications compared to asthma rescue medications were dispensed in neighborhoods with high rates of asthma-related emergency-room use and hospitalization.

Background information in the study, led by researchers from the Cincinnati Children’s Hospital Medical Center, notes that earlier investigations have shown that underuse of medications that can prevent asthma attacks and control asthma symptoms may contribute to disparities in asthma rates.

Controller medications are underused for a variety of reasons, according to the authors, including under-prescribing by healthcare providers, under-availability of the medications at pharmacies, and poor adherence to medications by patients.

“As on-the-ground members of the healthcare team, community-based pharmacies and pharmacists are well-positioned for an increased role in population health management,” said lead author Andrew Beck, MD, a pediatrician at Cincinnati Children’s. “Tracking medication fills could highlight ways in which pharmacies could deliver proactive, as opposed to reactive, asthma care.”

For the study, researchers looked at two sets of data that provided information on Hamilton County in southwest Ohio: One looked at children aged 2 to 17 years who either visited the emergency department or were hospitalized for asthma exacerbations at Cincinnati Children’s between January 31, 2010, and January 30, 2012, while the other, provided by 27 retail Kroger pharmacies in 27 distinct census tracts or neighborhoods, included all 35,467 asthma medications filled for children in the 2-to-17 age group during the same time period.

Classifying medications as either controller or rescue, the researchers calculated for each pharmacy a dispensing ratio called the Pharmacy-level Asthma Medication Ratio (Ph-AMR).

They determined that pharmacies located in high-utilization census tracts, i.e., those with more asthma attacks, dispensed more rescue medications than controller medications throughout the year, while pharmacies in low-utilization, or healthy, census tracts did the opposite.

With a median Ph-AMR of 0.53, tracts with Ph-AMR less than 0.5 had significantly higher utilization rates than those with Ph-AMR equal to or greater than 0.5 to 26.1 visits per 1,000 child-years compared to 9.9, respectively.

“For every 0.1 increase in Ph-AMR, utilization rates decreased by 9.5, after adjustment for underlying poverty and access,” the authors write. “Seasonal variation in fills was evident, but pharmacies in high-utilizing tracts filled more rescue than controller medications at nearly every point during the study period.”

Beck suggested that pharmacies “might aggressively provide medication delivery or counseling services, they could flag patients who refill a disproportionate number of rescue medications compared to controllers, or they could more regularly communicate with physicians regarding those patients who do not seem to be responding to current therapy. Our findings also support more active data-sharing between such integral members of the healthcare team.”
U.S. Pharmacist Social Connect