Population health for children with asthma: time to let some fresh air in.

Abstract

I must confess that as a primary care pediatrician, treating asthma often feels stale: same old medications, same old conversations about the importance of daily controllers, same old preventable emergency department visits and hospitalizations. But in this issue of Pediatrics , Beck et al1 present a novel ecologic analysis that sheds new light on the topic, linking the asthma medication ratio (AMR; the ratio of asthma controller prescriptions filled to all asthma prescriptions filled) measured at the level of individual community pharmacies with pediatric asthma exacerbations within the census tract in which the pharmacy is located. The magnitude of the association was substantial, with a decrease of nearly 10 asthma exacerbations per 1000 children per year for each 0.1 increase in the pharmacy-level AMR. This central finding suggests that a low community-level AMR highlights a “hot spot” in which untoward asthma events are likely to occur at an increased rate relative to other areas with better community AMRs, even after adjustment for known confounders. Although ecologic … Address correspondence to Louis Vernacchio, MD, MSc, Pediatric Physicians’ Organization at Children’s, 77 Pond Ave, Suite 205C, Brookline, MA 02445. E-mail: louis.vernacchio{at}childrens.harvard.edu