PURPOSE OF THE STUDY.
This study assessed the relationship between prescription fills for asthma medications after pediatric asthma hospital discharge and subsequent hospital readmission.
Patients between the ages of 2 and 18 years with claims for inpatient hospitalizations for asthma from January 1, 2006, to September 30, 2007, were included. Patients were excluded if aged <2 years, if they died during their index hospitalization, or were discharged to other care facilities.
Retrospective cohort study of Medicaid claims data taken from 12 states from 2005 to 2007. The primary outcome of interest was time to readmission for a diagnosis of asthma within 90 days of index hospital discharge. Pharmacy claims for short-acting β agonists (SABA), oral corticosteroids (OCS), inhaled corticosteroids (ICS), or a combination inhaled steroid and long-acting β agonist (ICS/LABA) between 1 day before and 3 days after hospital discharge were used as predictors.
Between January 1, 2006, to September 30, 2007, 31 658 children were admitted to an inpatient unit for asthma. Between the day before discharge and the 3 subsequent days, 17 363 children (55%) filled a prescription for a SABA, 18 135 (57%) for an OCS, and 11 708 (37%) for an ICS. Within 90 days of discharge, 1986 children (6.3%) were readmitted for asthma. Median time to admission was 40 days. Within 14 days of discharge, 419 children (1.3%) were readmitted, and 1567 children (5.0%) were readmitted between 15 and 90 days. Children with a SABA (hazard ratio [HR] 0.67, 95% confidence interval [CI] 0.51–0.87) or ICS fill (HR 0.59, 95% CI 0.42–0.85) had a lower hazard of readmission with 14 days compared with those who did not. Over the 15- to 90-day interval, only ICS fill was associated with a reduction in readmission hazard (HR 0.87, 95% CI 0.77–0.98). Patients who filled all 3 recommended medications after discharge had the lowest hazard of readmission within 14 days (HR 0.31, 95% CI 0.16–0.60).
Those who filled prescriptions for SABA and ICS experienced early readmission less frequently than children who did not and was associated with a decreased hazard of early readmission. Those who filled ICS experienced 15- to 90-day readmission less frequently than those who did not. This study demonstrates the effects of recommended medication classes on short-term readmission and shows an association of SABA (and borderline association of OCS fill) with lower early readmission hazard.
The findings in this study are consistent with previous studies regarding fill rates of OCS, SABA, and ICS. Having adequate access to rescue medications at home may improve inflammatory response and symptom control if patients return to an environment with triggers or before flare resolution. Efforts to improve rates of medication fill post–hospital discharge for asthma may significantly lower the readmission rate.
- Copyright © 2015 by the American Academy of Pediatrics