Imagine the following scenario: you or your child are hospitalized, and upon discharge are given a prescription by your doctor to treat the underlying condition. And, hopefully, to prevent you or your child from having to be hospitalized again. Sound simple, right?
Unfortunately, patients and their families don’t always fill their prescriptions, even if not doing so means they could end up in the hospital again. New work published in The Journal of Pediatrics shows just over 50 percent of a large cohort of pediatric patients filled beta agonist and oral steroid prescriptions after being hospitalized for asthma, and fewer than 40 percent filled inhaled steroid prescriptions.
The study was led by PolicyLab's Chén Kenyon, MD, MSHP and Director of Research for CHOP’s Pediatric Advanced Care Team, Chris Feudtner, MD, PhD, MPH. The study fits into one of PolicyLab’s broad areas of investigation, improving health care delivery.
One of the most common diseases of childhood, asthma is one of the leading reasons children seek medical attention. According to 2013 CDC data, 8.3 percent of U.S. children under the age of 18 have asthma, and in 2011 there were 1.8 million emergency department visits for asthma-related causes.
The NIH’s National Asthma Education and Prevention Program guidelines recommend patients who have been hospitalized for asthma be given several medications, “including continuation of inhaled short-acting beta agonists and oral steroids, along with continuation or consideration of initiation of a preventative controller medication such as an inhaled corticosteroid,” the study’s authors note.
However, adherence to these guidelines has not been evaluated broadly, and prescribing and fill rates vary. So with this study the investigators sought to determine the percentage of patients who actually filled prescriptions following hospitalization, and what effect filling prescriptions had on readmission rates.
Using Medicaid data, Drs. Kenyon and Feudtner identified a total of 31,658 children aged 2 to 18 years across the U.S. who were admitted for asthma between January 1, 2006 and September 3, 2007. The researchers found roughly 55 percent of children filled beta agonist or oral steroid prescriptions within three days of discharge, while 37 percent filled prescriptions for inhaled steroids. After including inhaler fills that occurred in the month prior to hospitalization, rates for beta agonist fills increased to 67 and 45 percent for inhaled steroids.
With fill rates in hand, the researchers then turned to readmission rates. They found patients who filled beta agonist and inhaled steroid prescriptions had lower readmission rates within 14 days of discharge. Oral steroids were also associated with a slight drop in readmission rates.
“Those who filled prescriptions for short-acting beta agonists and inhaled steroids experienced early readmission less frequently than children who did not, and those who filled inhaled corticosteroids experienced 15- to 90-day readmission less frequently than those who did not,” the authors note.
“These results may not surprise many, but few practices have been shown to reduce hospital readmissions,” said Dr. Kenyon. “Though this is a retrospective study that cannot confirm causality, these findings offer a compelling connection between something relatively straightforward that we can do at the time of discharge (make sure patients have their medications in hand) and better outcomes.”
In the era of accountable care, all healthcare stakeholders stand to benefit from such a practice,” he added.