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Corticosteroid Prescription Filling for Children Covered by Medicaid Following an Emergency Department Visit or a Hospitalization for Asthma
William O. Cooper, MD, MPH;
Gerald B. Hickson, MD
Arch Pediatr Adolesc Med. 2001;155:1111-1115.
Objective To identify predictors of corticosteroid prescription filling following
an emergency department (ED) visit or a hospitalization for asthma.
Design A retrospective cohort study.
Patients Tennessee children (defined as those aged 2-17 years in this study)
covered by Medicaid were included in the cohort if they had an ED visit or
a hospitalization for asthma between July 1, 1995, and December 31, 1997.
Main Outcome Measures Prescriptions filled in the child's name for an oral corticosteroid
within 7 days of the latest ED visit or hospitalization for asthma.
Results Of 6035 Tennessee children covered by Medicaid with an ED visit for
asthma and of 2102 covered by Medicaid with a hospitalization for asthma during
the study period, less than half (44.8% following an ED visit and 55.5% following
a hospitalization) had prescriptions filled for oral corticosteroids within
7 days. Factors independently predicting a child's not having an oral corticosteroid
prescription filled included older age, black race, and residence in rural
regions of the state. Conversely, children with oral corticosteroid prescriptions
in the previous 6 months were more likely to have oral corticosteroid prescriptions
filled following an ED visit for asthma, and children with more than 3 ß-agonist
prescriptions in the previous 6 months were more likely to have oral corticosteroid
prescriptions filled following a hospitalization for asthma.
Conclusions Overall, fewer than half of Tennessee children covered by Medicaid had
an oral corticosteroid prescription filled following an ED visit or a hospitalization
for asthma. Age, race, and county of residence predicted failure to have a
prescription filled. Further study is needed to determine whether variations
in corticosteroid prescription filling relate to physician practice, family
behavior, or both.
From the Division of General Pediatrics,
Vanderbilt Children's Hospital, Vanderbilt University Medical Center,
Nashville, Tenn.
Corresponding author and reprints: William O. Cooper, MD, MPH, Division
of General Pediatrics, Vanderbilt Children's Hospital, Suite 5028, Medical
Center East, Nashville, TN 37232-8555 (e-mail: william.cooper{at}mcmail.vanderbilt.edu).
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