Table 4.
Medication acquisition and healthcare encounters among all participants
| 12 mo before Randomization, % |
12 mo after Randomization, % |
||||||||
|---|---|---|---|---|---|---|---|---|---|
| All Participants (n = 330) | Enhanced Usual Care (n = 165) | Intervention (n = 165) | P Value | All Participants (n = 330) | Enhanced Usual Care (n = 165) | Intervention (n = 165) | P Value | P Value* | |
| Controller user | |||||||||
| Yes | 91.5 | 90.9 | 92.1 | 0.69 | 82.1 | 83.0 | 81.2 | 0.67 | 0.53 |
| No | 8.5 | 9.1 | 7.9 | 17.9 | 17.0 | 18.8 | |||
| Type of controllers† | |||||||||
| ICS alone | 40.3 | 41.8 | 38.8 | 30.0 | 29.7 | 30.3 | |||
| ICS + LABA only | 33.0 | 30.3 | 35.8 | 35.5 | 34.6 | 36.4 | |||
| LTRA alone | 2.1 | 2.4 | 1.8 | 3.0 | 4.2 | 1.8 | |||
| ICS + LTRA | 3.5 | 3.7 | 3.6 | 0.84 | 2.4 | 3.0 | 1.8 | 0.86 | 0.78 |
| ICS + LABA+LTRA | 11.2 | 12.1 | 10.3 | 10.0 | 10.3 | 9.7 | |||
| Methylxanthines/>15 d of systemic corticosteroids | 1.2 | 0.6 | 1.8 | 1.2 | 1.2 | 1.2 | |||
| None | 8.5 | 9.1 | 7.9 | 17.9 | 17.0 | 18.8 | |||
| Beclomethasone canister equivalents, mean (SD)‡ | 15.1 (13.0) | 15.7 (13.9) | 14.5 (12.2) | 0.42 | 13.6 (13.2) | 14.1 (14.0) | 13.1 (12.3) | 0.51 | 0.86 |
| SABA user | 93.3 | 92.1 | 94.6 | 0.38 | 84.6 | 81.8 | 87.3 | 0.17 | 0.92 |
| Albuterol canister equivalents, mean (SD)§ | 5.0 (4.4) | 5.2 (5.1) | 4.8 (3.6) | 0.39 | 4.6 (4.6) | 4.6 (5.2) | 4.5 (4.0) | 0.89 | 0.34 |
| No. of asthma exacerbations requiring systemic corticosteroids|| | |||||||||
| 0 | 67.9 | 66.1 | 69.7 | 75.2 | 77.6 | 72.7 | |||
| 1 | 18.2 | 17.6 | 18.8 | 0.59 | 15.5 | 15.2 | 15.8 | 0.59 | 0.16 |
| 2 | 7.3 | 9.1 | 5.5 | 6.1 | 4.9 | 7.3 | |||
| 3+ | 6.7 | 7.3 | 6.1 | 3.3 | 2.4 | 4.2 | |||
| Total d of systemic corticosteroid supply for asthma exacerbations, mean (SD)|| | 13.5 (9.7) | 13.6 (7.8) | 13.4 (11.6) | 0.60 | 13.1 (9.9) | 12.4 (9.7) | 13.6 (10.2) | 0.87 | 0.74 |
| Healthcare encounters | |||||||||
| Asthma-related¶ | |||||||||
| None | 19.1 | 18.8 | 19.4 | 30.6 | 34.6 | 26.7 | |||
| Hospitalization | 3.0 | 3.0 | 3.0 | 0.89 | 4.2 | 3.6 | 4.9 | 0.40 | 0.26 |
| ED visit | 18.8 | 17.6 | 20.0 | 18.5 | 15.8 | 21.2 | |||
| Outpatient visit | 78.2 | 80.0 | 76.4 | 67.6 | 64.2 | 70.9 | |||
| Respiratory-related** | |||||||||
| None | 16.1 | 15.8 | 16.4 | 25.2 | 27.9 | 22.4 | |||
| Hospitalization | 3.0 | 3.0 | 3.0 | 0.99 | 4.6 | 4.2 | 4.9 | 0.59 | 0.28 |
| ED visit | 20.9 | 20.6 | 21.2 | 18.8 | 16.4 | 21.2 | |||
| Outpatient visit | 81.5 | 83.0 | 80.0 | 73.0 | 70.9 | 75.2 | |||
| Total†† | |||||||||
| None | 2.4 | 1.2 | 3.6 | 3.9 | 4.9 | 3.0 | |||
| Hospitalization | 3.0 | 3.0 | 3.0 | 0.56 | 5.2 | 4.9 | 5.5 | 0.83 | 0.68 |
| ED visit | 29.1 | 29.7 | 28.5 | 25.5 | 24.9 | 26.1 | |||
| Outpatient visit | 97.3 | 98.2 | 96.4 | 96.1 | 95.2 | 97.0 | |||
Definition of abbreviations: ED = emergency department; ICD-9-CM = International Classification of Diseases, 9th revision, Clinical Modification; ICS = inhaled corticosteroid; LABA = long-acting, inhaled β2-agonists; LTRA = leukotriene modifiers; SABAs = short-acting β-agonists.
Extracted healthcare use data from electronic health records included all visits by service type (ED, hospital inpatient, or outpatient department and specialty) to Kaiser Permanente and its contracted facilities, and pharmacy dispensing records. Data are expressed as % unless otherwise indicated.
Mixed model-based P values for between-treatment differences in change from 12 months before to 12 months after randomization.
Percentages of participants with any or no asthma controller medications dispensed in each 12-month period.
The estimated total number of canisters of beclomethasone to which the asthma controller medications dispensed for a patient in each 12-month period was equivalent in terms of the antiinflammatory effectiveness. Each dispensing of a controller medication (excluding theophylline and systemic corticosteroids used for >15 d), in any form or quantity, was assigned a weight representing its equivalent in fractional or multiple canisters of beclomethasone 80 mg (30). The weighted values were summed for each patient to obtain a cumulative measure of controller medication dose dispensed during the 12 months before and after randomization separately.
The estimated total number of canisters of albuterol to which the amount of all SABAs dispensed in each 12-month period was equivalent in terms of the bronchodilator effectiveness. Each SABA medication, in any type or delivery mode, was assigned a weight representing its equivalent in canister of albuterol (30). The weighted values were summed for each patient to obtain a cumulative measure of dose dispensed during the 12 months before and after randomization separately.
Defined as systemic corticosteroids (by tablet, suspension, or injection) dispensed for 3 to 15 days of use.
Asthma-related healthcare encounters were visits with ICD-9-CM code 493 as a primary or secondary diagnosis.
Respiratory-related healthcare encounters were visits with any of the following ICD-9-CM codes as a primary or secondary diagnosis: 422, 427–428, 460–466, 470–474, 480–487, and 490–519.
Total healthcare encounters included all visits regardless of diagnosis.