Ratio of controller to total asthma medications: determinants of the measure

Michael S Broder, Benjamin Gutierrez, Eunice Chang, David Meddis, Michael Schatz
American Journal of Managed Care 2010, 16 (3): 170-8

OBJECTIVE: To investigate differences in demographics, physician specialty, and medication use between patients who achieve high versus low ratios of controller to total asthma medications.

STUDY DESIGN: Cohort analysis.

METHODS: We used a Health Insurance Portability and Accountability Act-compliant claims database to identify patients aged 5 to 56 years with persistent asthma during a premeasurement year and a measurement year. Based on values in the measurement year, the ratio of controller to total asthma medications ratio was defined using the following formula: (Units of Controllers) / (Units of Controllers + Relievers). Descriptive analysis and multivariate logistic regression models were used to examine patients with high and low ratios.

RESULTS: The final study group comprised 38,538 patients with persistent asthma; 28,496 (73.9%) had high ratios. Specialty of usual-care physician differed (P <.001), with more high-ratio patients than low-ratio patients having an allergist or pulmonologist. Patients who received combination inhaled corticosteroid-long-acting beta-agonist therapy (odds ratio [OR], 2.4) or leukotriene receptor antagonist therapy (OR, 3.5) were more likely to be in the high-ratio group compared with those dispensed a single inhaled corticosteroid. High-group and low-group assignment could be calculated by partial-year data: assignment based on 1 quarter of data was concordant with assignment based on full-year ratio in 91% of cases (Pearson product moment correlation coefficient, 0.864; kappa statistic, 0.761), and assignment based on 2 quarters of data was concordant with full-year results in 94% of cases (Pearson product moment correlation coefficient, 0.928; kappa statistic, 0.843).

CONCLUSIONS: A high ratio of controller to total asthma medications is associated with greater controller adherence and with more controller fills. The ratio can be calculated using 1 or 2 quarters of pharmacy claims data, at a time when intervention may reduce asthma-related exacerbations. Interventions that may improve the ratio include changing from single inhaled corticosteroid therapy and from asthma specialist care.

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