Published Online: April 18, 2014
To improve asthma outcomes, population-based asthma care management uses electronic surveillance of medical records and pharmacy databases to (1) identify patients with persistent asthma, (2) establish and follow markers of uncontrolled asthma, (3) determine medication dispensing intensity, and (4) report asthma quality markers to the national quality assurance committees. Specifically, excessive short-acting beta-agonist (SABA) use is an administrative asthma impairment marker that identifies patients with uncontrolled asthma; however, efforts to improve care of such patients have been challenging and inadequately studied in Managed Care Organizations (MCOs).
In a study recently published in The Journal of Allergy and Clinical Immunology: In Practice, Zeiger and colleagues conducted a randomized, controlled clinical trial using pharmacy informational technology (computerized pharmacy records) to determine whether real-time outreach to excessive SABA users reduces SABA canister-dispensing.
Using these records, after real-time determination of a 7th SABA canister-dispensing in the prior 12 months (equivalent to about 4 puffs/day/year), 12-56 year-olds with physician-coded asthma and inhaled corticosteroid dispensing were block-randomized—by prior asthma specialist care and National Asthma Education and Prevention Program medication step-care level—into intervention (N=1001) and control groups (N=998). Intervention included real-time letter notification to the patient and an electronic message sent to their physician with management suggestions, including facilitated allergy referral for patients without prior asthma specialist care. The control group received this organization’s standard asthma care management without research contact. Frequency of the 7th SABA canister-dispensing in the follow-up year was the primary outcome.
Compared to controls, intervention patients reached 7 SABA canister-dispensings less frequently (50.7% versus 57.1%; risk ratio, 0.89; 95% CI, 0.82-0.97; P=0.007) and later (hazard ratio, 0.80; 95% CI, 0.71-0.91; P<0.001). SABA canister-dispensings were less in intervention (7.5+4.9) than controls (8.6+5.3) (rate ratio, 0.87; 95% CI, 0.82-0.93; P<0.001). Visits to allergists were also more frequent in intervention (30.9%) than control patients (16.8%), (P<0.001). These outreach intervention benefits occurred in patients without and not those patients with asthma specialist care in the prior 3 years before study onset, (P<0.001) (P=0.04 for interaction by prior specialist care).
Zeiger and colleagues showed that a novel administrative-based asthma outreach program improves markers of asthma impairment in patients without prior specialist care, and that this program is adaptable to MCOs with electronic medical records or to Independent Practice Associations, Integrated Medical Groups, Accountable Care Organizations, and other similar medical organizations that have access to computerized pharmacy data.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.