Adherence to asthma treatment guidelines among children in the maryland medicaid program

Abstract

Background: Asthma is the most common chronic illness in children. However, adherence to asthma treatment guidelines in children is poor. The factors associated with this nonadherence are not well understood. Objectives: The purpose of this study was to assess adherence to national asthma treatment guidelines in pediatric Medicaid enrollees in Maryland. Factors associated with nonadherence and with short-term persistence in nonadherence were studied. Methods: Adherence was assessed by applying 7 criteria to Maryland Medicaid claims data for children with asthma between the ages of 5 and 18 years. These criteria were based on the National Heart, Lung, and Blood Institute's National Asthma Education and Prevention Program (NAEPP). To examine patterns of nonadherence to guidelines, each patient's asthma medication use was compared over 2 consecutive 6-month periods. Results: The most frequently failed treatment criterion was lack of use of anti-inflammatory inhalers in persistent asthma (20.2%). Compared with younger children (5–8 years) older children (9–18 years) were at higher risk of failing several of the criteria, including overuse of beta 2-agonist inhalers, inappropriate use of salmeterol, and lack of use of inhaled anti-inflammatory drugs. Prevalence of nonadherence was significantly different during the 2 periods (31.2% vs 18.9%; P <0.001), with adherence in 1 period having poor agreement with adherence in the second (κ = 0.26). Conclusions: Based on this study of Maryland Medicaid claims data, approximately one third of children with asthma are not being treated in accordance with current treatment guidelines. Older children are at higher risk than younger children for nonadherence to NAEPP guidelines. Adherence to asthma treatment guidelines varies over time, suggesting that patients' regimens should be monitored frequently.