Prescribed therapy for asthma: therapeutic ratios and outcomes

BMC Family Practice

Research Article

Irene Eriksson¹  Pascal Caillet²  Idlir Licaj³  Manon Belhassen³  Laurent Laforest³  Eric Van Ganse⁴  Gilles Devouassoux⁵  Gérard Chatte⁶ 

[1] Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden;Epidemiology and Public Health Department, Amiens University Hospital Center, Amiens, France;Pharmacoepidemiology Lyon, UMR 5558 CNRS - Claude Bernard University, Lyon, France;Pharmacoepidemiology Lyon, UMR 5558 CNRS - Claude Bernard University, Lyon, France;Respiratory Medicine, Croix Rousse University Hospital, Lyon, France;Respiratory Medicine, Croix Rousse University Hospital, Lyon, France;Respiratory physician, Caluire, France;

关键词: Electronic health records;    Primary care;    Asthma;    Inhaled corticosteroids;    Prescribing;    Exacerbations;   

DOI  :  10.1186/s12875-015-0265-2

 received in 2014-11-10, accepted in 2015-03-30,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundInhaled corticosteroids (ICS) are the cornerstone of asthma therapy. The ICS-to-total-asthma-medication ratios, calculated from claims data, indicate potentially risky disease management in asthma. Our aim was to assess the utility of ICS-to-total-asthma-medication ratios from primary care electronic medical records (EMRs) in detecting patients at risk of asthma exacerbation, as approached by prescription of oral corticosteroids and/or antibiotics.MethodsRetrospective cohort studies were identified, using the Health Improvement Network general practice database (THIN, United Kingdom) and the Cegedim Longitudinal Patient Data (France). We selected asthma patients aged 16–40 years, with ≥ 4 prescriptions for asthma medications in 2007 and ≥ 1 prescription in 2008. For each country, three groups were defined according to ratio value in 2008: 0% (non-ICS users), <50% (low-ICS-ratio group) and ≥50% (high-ICS-ratio group). Outcomes were marker of asthma exacerbations: systemic corticosteroids and antibiotics. They were compared between groups in each country.ResultsAmong 38,637 British and 4,587 French patients, higher numbers of prescriptions per patient of systemic corticosteroids, antibiotics and total asthma medications were observed in the low-ICS-ratio groups compared to other groups (p < 0.0001 for each outcome in both countries). Likewise, low-ICS-ratio patients had more medical contacts (p < 0.0001 in both countries), suggesting poorly controlled asthma. ICS-treated patients had lower risks of receiving systemic corticosteroids in 2008 in the high-ICS-ratio group, compared to the low-ICS-ratio group: RR = 0.54, 95%CI = [0.50-0.57] and RR = 0.78, 95%CI = [0.67-0.91] in the UK and France, respectively.ConclusionsPatients with high ICS-to-total-asthma-medication ratios presented fewer asthma-related outcomes. The low ICS-to-total-asthma-medication ratio calculated with EMRs data reflects insufficient prescribing of ICS relative to all asthma medications, which may lead to deteriorated asthma control.

【 授权许可】

Unknown   
© Laforest et al.; licensee BioMed Central. 2016. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.