An evaluation of outpatient pediatric asthma prescribing patterns in the United States

Abstract

Pediatric asthma is often under-diagnosed and under-treated, resulting in a lack of concentration, difficulty sleeping, and tiredness. The Global Initiative for Asthma (GINA) guidelines recommended that children should be prescribed maintenance inhalers along with rescue inhalers. Concurrent use of rescue and maintenance inhalers were considered appropriate use for this study. The aim of the study was to determine the prevalence of inappropriate prescribing patterns against various patient and prescriber demographic factors. A total of 2,264 patients meeting the inclusion criteria for ICD 10 codes, J45.20 - J45.52 and age less than 18 were extracted from the 2018 National Ambulatory Medical Care Survey (NAMCS), which captures ambulatory services offered in physicians’ offices directly engaged in patient care. This data is collected by the National Center of Health Statistics (NCHS), a division of the CDC. The data were analyzed using descriptive analysis, two-tailed t-tests, and ANOVA with an alpha significance level at 0.05. The majority of the pediatric patient population was in the age range of 17-18 years old. Overall, more patients were prescribed inappropriately (68.3%) as compared to appropriate prescribing (31.7%). Inappropriate prescribing was seen more for patients with Medicaid (24.8%) and self-payment (38.2%) as compared to other types of payment (p= 0.052). General practice/ family physicians (35.1%) and nurse practitioners (20.9%) prescribed more inappropriately as compared to other prescribers. (p= 0.001). Patients from the Southern region of the U.S. were prescribed more inappropriately compared to the other regions in the U.S. (p= 0.205). This study concluded that a significant number of pediatric asthma patients across all demographics were not appropriately prescribed inhalers, thus not adhering to GINA guidelines. Appropriate prescribing and adhering to guidelines would prevent morbidity, mortality and improve the patient's quality of life, thereby saving healthcare costs.