The Controller-to-Total Asthma Medication Ratio Is Associated With Patient-Centered As Well As Utilization Outcomes

• Published in: Chest Vol. 130; no. 1; pp. 43 - 50
• Main Authors: Schatz, Michael, Zeiger, Robert S., Vollmer, William M., Mosen, David, Mendoza, Guillermo, Apter, Andrea J., Stibolt, Thomas B., Leong, Albin, Johnson, Michael S., Cook, E. Francis
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2006; American College of Chest Physicians; Elsevier B.V
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - adverse effects; Adrenal Cortex Hormones - therapeutic use; Adult; Anti-Asthmatic Agents - administration & dosage; Anti-Asthmatic Agents - adverse effects; Anti-Asthmatic Agents - therapeutic use; Asthma; Asthma - classification; Asthma - drug therapy; asthma population management; asthma quality of care; Asthmatics; Care and treatment; Corticosteroids; Dosage and administration; Drug therapy; Emergency medical care; Female; Health maintenance organizations; Health Maintenance Organizations - statistics & numerical data; HMOs; Hospitalization; Humans; inhaled corticosteroids; Male; Medical care; Medical Records Systems, Computerized; medication ratio; Methods; Middle Aged; Monitoring systems; Patient outcomes; Patient-Centered Care; Patients; Pharmacy; Quality control; Quality management; Quality of life; Questionnaires; Ratios; ROC Curve; Severity of Illness Index; Steroids; Surveys and Questionnaires; β-agonists; United States; United States > US; California; β-agonists; medication ratio; asthma population management; HEDIS; PPV; ROC; asthma; asthma quality of care; AOMS; AQLQ; ATAQ; inhaled corticosteroids
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.130.1.43

The ratio of controller medication to total asthma medications has been related to asthma utilization outcomes, but its relationship to patient-centered outcomes has not been explored. Surveys that included validated asthma quality-of-life, control, and symptom severity tools were completed by a random sample of 2,250 health maintenance organization members aged 18 to 56 years who had persistent asthma. Linked computerized pharmacy data provided dispensing information on β-agonist canisters and asthma controller medication. The ratio was calculated as the number of controller medications dispensed during the year of the survey divided by the total number medications (ie, inhaled β-agonist plus controller medications) dispensed. The relationships of the optimal ratio cutoff to patient-centered outcomes and to subsequent acute asthma exacerbations were determined. Mean asthma quality-of-life, asthma control, and symptom severity scale scores were significantly (p < 0.0001) more favorable in patients with ratios of ≥ 0.5. After adjusting for demographic characteristics, patients with ratios of ≥ 0.5 were significantly less likely to have adverse results regarding asthma quality of life (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.52 to 0.80), asthma control (OR, 0.62; 95% CI, 0.50 to 0.77), and symptom severity (OR, 0.53; 95% CI, 0.43 to 0.65), and were also less likely to experience subsequent asthma hospitalizations or emergency department visits (OR, 0.44; 95% CI, 0.26 to 0.74) than patients with lower ratios. A higher controller medication/total asthma medication ratio is associated with better patient-centered asthma outcomes as well as with reduced emergency hospital utilization. This adds further support to the use of the medication ratio as an asthma quality-of-care measure.