Asthma continues to be one of the most prevalent chronic lung diseases and growing health concerns in the state of Texas. Asthma, a potentially deadly illness, affects the lungs and causes the airways to become inflamed and swollen, and surrounding muscles to tighten. Symptoms include episodes of coughing, chest tightness, wheezing and shortness of breath.
According to the Texas Behavioral Risk Factor Surveillance System in 2005, an estimated 1.5 million (6.8 percent) adult Texans and 458 thousand (7.3 percent) children 0-17 years of age currently report having asthma. Also, an estimated 2.5 million (11.1 percent) adult Texans and 728 thousand (11.6 percent) children report having had asthma during their lifetime.
In addition, asthma has had a significant economic impact on the state of Texas. According to the Texas Health Care Information Collection in 2004, hospital discharges listing asthma as the principle diagnosis and other diagnoses account for about $353 million in total charges.
The Texas Asthma Plan serves as a planning tool to initiate asthma activities in the state of Texas. The 2007-2010 Edition contains issue items with updated goals and action steps specific to regional areas throughout Texas.
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Impact of a prior authorization policy for montelukast on clinical outcomes for asthma and allergic rhinitis among children and adolescents in a state Medicaid program.
J Manag Care Spec Pharm. 2014 Jun;20(6):612-21
Authors: Keast SL, Thompson D, Farmer K, Smith M, Nesser N, Harrison D
BACKGROUND: Public policymakers often struggle with increased membership and limited budgets. Restrictions, commonly in the form of prior authorizations, are often placed on more costly pharmaceuticals, especially when lower cost or more effective products are available. Restrictions placed on products for difficult-to-manage disease states must be reviewed in order to ensure that unintended clinical consequences do not occur.
OBJECTIVE: To assess the impact of a prior authorization policy for montelukast on clinical outcomes for asthma and allergic rhinitis among children and adolescent members of Oklahoma Medicaid (MOK) from 2007 through 2010.
METHODS: Monthly individual-level utilization data were collected from MOK paid pharmacy and medical claims from January 1, 2007, through December 31, 2010, for members with asthma and/or allergic rhinitis. Members who were continuously eligible for the entire 48-month review period were included. The effect of a prior authorization policy for montelukast on emergency room (ER) utilization, disease-related physician office visits (DRV), and antibiotic prescription utilization (ABX) was analyzed using segmented logistic regression.
RESULTS: For all 3 outcomes, decreases in mean number of claims per member per month were detected when comparing the pre-implementation and post-implementation prior authorization periods for all 3 disease states of asthma, allergic rhinitis, or both. Odds of having an ER event at the point of prior authorization implementation were 0.71 (P less than 0.001) and were 1.29 (P less than 0.001) and 1.26 (P less than 0.001) for DRV and ABX, respectively. Overall trend in odds was 1.02 (P less than 0.001), 0.93 (P less than 0.001), and 0.95 (P less than 0.001) for ER, DRV, and ABX, but during the post-implementation period, the odds were 0.92 (P less than 0.001) for ER and 1.03 (P less than 0.001) for both DRV and ABX. The final result was an increasing trend prior to implementation for ER, a decrease at implementation, and a continued decrease in odds of an event in the post-implementation period. However, for DRV and ABX, there was an overall decrease in trend regardless of period, with a small increase in odds at the point of implementation.
CONCLUSIONS: While there was a point increase at implementation for DRV and ABX, the overall trend remained negative, indicating that no unexpected adverse clinical outcomes occurred. Additionally, no signal was found in ER use after implementation to indicate that unintended consequences occurred, particularly for those patients with asthma.
PMID: 24856599 [PubMed - indexed for MEDLINE]
Comparison of US emergency department acute asthma care quality: 1997-2001 and 2011-2012.
J Allergy Clin Immunol. 2015 Jan;135(1):73-80
Authors: Hasegawa K, Sullivan AF, Tsugawa Y, Turner SJ, Massaro S, Clark S, Tsai CL, Camargo CA, MARC-36 Investigators
BACKGROUND: It remains unclear whether the quality of acute asthma care in US emergency departments (EDs) has improved over time.
OBJECTIVES: We investigated changes in concordance of ED asthma care with 2007 National Institutes of Health guidelines, identified ED characteristics predictive of concordance, and tested whether higher concordance was associated with lower risk of hospitalization.
METHODS: We performed chart reviews in ED patients aged 18 to 54 years with asthma exacerbations in 48 EDs during 2 time periods: 1997-2001 (2 prior studies) and 2011-2012 (new study). Concordance with guideline recommendations was evaluated by using item-by-item quality measures and composite concordance scores at the patient and ED levels; these scores ranged from 0 to 100.
RESULTS: The analytic cohort comprised 4039 patients (2119 from 1997-2001 vs 1920 from 2011-2012). Over these 16 years, emergency asthma care became more concordant with level A recommendations at both the patient and ED levels (both P < .001). By contrast, concordance with non-level A recommendations (peak expiratory flow measurement and timeliness) decreased at both the patient (median score, 75 [interquartile range, 50-100] to 50 [interquartile range, 33-75], P < .001) and ED (mean score, 67 [SD, 7] to 50 [SD, 16], P < .001) levels. Multivariable analysis demonstrated ED concordance was lower in Southern and Western EDs compared with Midwestern EDs. After adjusting for severity, guideline-concordant care was associated with lower risk of hospitalization (odds ratio, 0.37; 95% CI, 0.26-0.53).
CONCLUSIONS: Between 1997 and 2012, we observed changes in the quality of emergency asthma care that differed by level of guideline recommendation and substantial interhospital and geographic variations. Greater concordance with guideline-recommended management might reduce unnecessary hospitalizations.
PMID: 25263233 [PubMed - indexed for MEDLINE]
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