ICS often does not follow asthma hospitalization

Fewer than half of commercially insured children who have been hospitalized for asthma receive an inhaled corticosteroid (ICS), even though many of them make outpatient visits within 30 days of hospital discharge. An analysis of data for 5471 children aged from 2 to 17 years who were hospitalized for asthma found that 41% received an ICS within 30 days of discharge; by 60 days that figure rose to 46%. Yet three-quarters of patients had an outpatient visit within 30 days after discharge, and by 60 days that figure rose to 81%.

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Nonetheless, attending an outpatient appointment within 30 days of hospital discharge was associated with higher rates of ICS use as was using an ICS in the 35 days before hospital admission. The analysis also showed that younger children (aged 2 to 6 years) were more likely to receive an ICS after hospitalization and to attend an outpatient visit than older children. Overall, children who had an outpatient appointment within 30 days after hospital discharge were 40% more likely than those who did not have such a visit to receive an ICS (Andrews AL, et al. Acad Pediatr. 2017;17[2]:212-217).

Thoughts for Dr Burke

This is an analysis of commercial insurance payments for filled prescriptions. As such, it is not clear if discharging doctors didn’t write prescriptions for ICS or if families failed to fill scripts they were given. If parents didn’t fill prescriptions, was it because of lack of organization, interest, understanding, transportation, or money for a copay? The study’s perspective would also miss ICSs given by hospitals to families at discharge, a medication-in-hand approach that may be the one most likely to keep the child from returning to the hospital.