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Insurance Barriers in the Management of Uncontrolled Asthma in an Inner-City Population
AB50 Abstracts
SATURDAY
155
Texting Medication Reminders for Better Asthma Control in Children and Teens: An Update Humaa M. Bhatti, DO1, Wafa Alame, RN1, Joseph Adams2, Jenny M. Montejo, MD1, Milind V. Pansare, MD, FAAAAI1, Pavadee Poowuttikul, MD3, Elizabeth A. Secord, MD, FAAAAI3; 1Children’s Hospital of Michigan, Detroit, MI, 2Wayne State University, Detroit, MI, 3 Children’s Hospital of Michigan Department of Allergy Immunology, Detroit, MI. RATIONALE: Non-adherence to medication regimens continues to be a persistent problem among patients with asthma. Technology makes communication with our patients between visits easier and more meaningful for all parties. We examine the effects on asthma control of sending medication reminders and allowing patients to communicate with staff via text messaging, one year after implementation. METHODS: A cohort of 29 participants (up to age 18 years) was enrolled over one year. Text reminders were sent twice daily to the parents and/or teenage patients with understanding that patients should receive medication at receipt of reminders. Retrospective chart review was completed to examine frequency of steroid bursts, ER visits, and hospitalizations for asthma occurring in the year prior to starting the study and number occurring in the year since starting. RESULTS: 29 participants completed 1 year to date. In the 12 months prior to the study, 21/29 patients had two or more steroid bursts, 28/29 patients had at least one urgent visit, and 20/29 had been admitted. One year after starting the study, 15/29 had two or more steroid bursts, 17/29 had at least one urgent visit, and 11/29 had been admitted. Comparing what we had predicted at 6 months vs the actual numbers at one year, this represents continued improvement in each of these measures, despite the results not being as positive as we originally projected after 6 months. CONCLUSIONS: Our results suggest that communicating with our patients via text reminders is effecting positive change on control of their asthma, one year after initiating the study.
156
Effect of Educational Intervention on Adherence Estimatorä Scores and Asthma Control in Pediatric Patients Suzanne Burke-McGovern, MD1, Hilal Sekizkardes, MD1, Edan Sarid, MD2, Rauno Joks, MD3; 1SUNY-Downstate Medical Center, Brooklyn, 2SUNY Downstate, NY, 3Center for Allergy and Asthma Research, SUNY Downstate, Brooklyn, NY. RATIONALE: Non-adherence to asthma medications is a major factor contributing to the morbidity and mortality associated with asthma in the pediatric population. We investigated whether a single asthma education session improved medication adherence and asthma control. METHODS: A cross-sectional study was conducted with outpatient pediatric patients with persistent asthma. Children and their parents (n536) were asked to complete 2 surveys on 2 occasions separated by 2 months. These surveys consisted of the Adherence Estimatorä (AE) (Merck), a 3 question survey assessing perceived views of medication concern, commitment and cost; and the Asthma Control Test (cACT/ACT). Patients and parents were educated verbally within 1 hour of initial survey. Follow-up surveys were completed by n520 (55% of initial group). Data was analyzed with the Wilcoxon Signed Rank test. RESULTS: Pre-education the median total AE score was 4.9 and mean ACT score was 19.2 indicating a medium risk for adherence problems and well controlled asthma. Mean scores for concern, commitment and cost were 2.4, 2.4 and 0.4 respectively, indicating moderate to low risk for adherence problems. After education the mean total AE score was 3.3 (p5 0.315) and mean ACT score was 20.9 (p50.038) indicating an overall reduced risk of medication non-adherence and significant improvement in asthma control. Mean scores for concern, commitment and cost were 1.5 (P5 0.49), 1.7 (p50.59) and 0.1 (p50.25), respectively, indicating low risk for non-adherence in all categories. CONCLUSIONS: Educating pediatric patients about their medications significantly improved asthma control, but not AE adherence scores.
J ALLERGY CLIN IMMUNOL FEBRUARY 2015
157
Insurance Barriers in the Management of Uncontrolled Asthma in an Inner-City Population Naveen Nannapaneni, M.D.1, Roula H. Daher, M.D.1, Elizabeth A. Secord, MD, FAAAAI2,3; 1Wayne State University/ Detroit Medical Center, 2 Children’s Hospital of Michigan Department of Allergy Immunology, Detroit, MI, 3Wayne State University School of Medicine, Detroit, MI. RATIONALE: Admissions for acute asthma exacerbations are ubiquitous in inpatient medicine. Identifying causes of these exacerbations allows for targeted preventative measures to reduce hospitalizations. One suspected factor is access to appropriate pharmacotherapy, which can be limited by under-insurance and lack of insurance. This study serves as an exploratory descriptive analysis of the importance insurance barriers play in uncontrolled asthmatics. METHODS: 134 patients aged 1-80 with a known history of asthma who admitted for acute exacerbations to the general medicine or observation units of Detroit Receiving Hospital, Harper University Hospital, and Children’s Hospital of Michigan were surveyed after providing informed consent. Questions about their asthma history, management regimens, frequency of hospitalizations, and type of insurance were included. Data for minors was provided by their parents. Insurance barriers were defined as patients having either no insurance, prohibitive co-pays for medications, or a refusal by their insurance to authorize medications prescribed by their physician. RESULTS: 41.8% of all patients reported having at least one insurance barrier related to their asthma care. 12.7% were uninsured, 9.7% reported prohibitive co-pays which ranged from $6-$260, and 19.4% reported insurance refusal to authorize a medication prescribed by their physician. CONCLUSIONS: Insurance barriers are found in both inner-city adults and children with uncontrolled asthma and contributes to their hospitalizations by limiting their access to appropriate pharmacotherapies. Further in-depth investigations into these barriers are warranted based on this exploratory analysis, including whether recent changes in national healthcare policy reduce the quantity of insurance barriers for this population.
158
Are We Doing Enough to Protect Asthmatic Patients from Pneumococcal Disease? Martin A. Smith, MD1, Alexei Gonzalez-Estrada, MD2, Roxana I. Siles, MD1; 1Cleveland Clinic Foundation, Cleveland, OH, 2Respiratory Institute, Cleveland Clinic. RATIONALE: The Centers of Disease Control recommends pneumococcal vaccination among adult asthmatics between the ages of 19-64. Asthmatics are at increased risk from pulmonary and invasive pneumococcal disease1. We aim to assess adherence to guidelines in a large tertiary care setting. METHODS: We performed an IRB-approved retrospective chart review of randomly selected records from September 2010 - April 2014 using ICD-9 code 493.xx. Demographic, clinical and immunization data were collected and analyzed. RESULTS: We reviewed 129 cases of asthma confirmed by spirometry and/or provocation studies. The mean age was 45 years [range 19-64 years]; 62% were female and 83% were Caucasian. Fifty eight (46%) were never smokers and 18 (14%) were active smokers. Forty seven (36%) were managed by Pulmonologists; 21 (16%) by Allergists and 61 (47%) by a primary care provider (PCP) or other providers. Fifty three (41%) had moderate or severe persistent asthma. Thirty six (28%) had at least one course of prescribed oral steroids and 2 (1.6%) were hospitalized for asthma in the 6 months prior to data collection. We found that only 23 (17.8%) out of 129 subjects had received pneumococcal vaccination. Four (3.8%) subjects were offered vaccination, but declined. Of the 23 vaccinated patients, 14 (61%) were primarily managed by a specialist, and 9 (39%) were managed by their PCP (p50.39). CONCLUSIONS: Despite the inherent limitations of this retrospective study, primary prevention with pneumococcal vaccination remains low among asthmatics. Specialists were more likely to use the vaccine, albeit the rates remained low.
SATURDAY
155
Texting Medication Reminders for Better Asthma Control in Children and Teens: An Update Humaa M. Bhatti, DO1, Wafa Alame, RN1, Joseph Adams2, Jenny M. Montejo, MD1, Milind V. Pansare, MD, FAAAAI1, Pavadee Poowuttikul, MD3, Elizabeth A. Secord, MD, FAAAAI3; 1Children’s Hospital of Michigan, Detroit, MI, 2Wayne State University, Detroit, MI, 3 Children’s Hospital of Michigan Department of Allergy Immunology, Detroit, MI. RATIONALE: Non-adherence to medication regimens continues to be a persistent problem among patients with asthma. Technology makes communication with our patients between visits easier and more meaningful for all parties. We examine the effects on asthma control of sending medication reminders and allowing patients to communicate with staff via text messaging, one year after implementation. METHODS: A cohort of 29 participants (up to age 18 years) was enrolled over one year. Text reminders were sent twice daily to the parents and/or teenage patients with understanding that patients should receive medication at receipt of reminders. Retrospective chart review was completed to examine frequency of steroid bursts, ER visits, and hospitalizations for asthma occurring in the year prior to starting the study and number occurring in the year since starting. RESULTS: 29 participants completed 1 year to date. In the 12 months prior to the study, 21/29 patients had two or more steroid bursts, 28/29 patients had at least one urgent visit, and 20/29 had been admitted. One year after starting the study, 15/29 had two or more steroid bursts, 17/29 had at least one urgent visit, and 11/29 had been admitted. Comparing what we had predicted at 6 months vs the actual numbers at one year, this represents continued improvement in each of these measures, despite the results not being as positive as we originally projected after 6 months. CONCLUSIONS: Our results suggest that communicating with our patients via text reminders is effecting positive change on control of their asthma, one year after initiating the study.
156
Effect of Educational Intervention on Adherence Estimatorä Scores and Asthma Control in Pediatric Patients Suzanne Burke-McGovern, MD1, Hilal Sekizkardes, MD1, Edan Sarid, MD2, Rauno Joks, MD3; 1SUNY-Downstate Medical Center, Brooklyn, 2SUNY Downstate, NY, 3Center for Allergy and Asthma Research, SUNY Downstate, Brooklyn, NY. RATIONALE: Non-adherence to asthma medications is a major factor contributing to the morbidity and mortality associated with asthma in the pediatric population. We investigated whether a single asthma education session improved medication adherence and asthma control. METHODS: A cross-sectional study was conducted with outpatient pediatric patients with persistent asthma. Children and their parents (n536) were asked to complete 2 surveys on 2 occasions separated by 2 months. These surveys consisted of the Adherence Estimatorä (AE) (Merck), a 3 question survey assessing perceived views of medication concern, commitment and cost; and the Asthma Control Test (cACT/ACT). Patients and parents were educated verbally within 1 hour of initial survey. Follow-up surveys were completed by n520 (55% of initial group). Data was analyzed with the Wilcoxon Signed Rank test. RESULTS: Pre-education the median total AE score was 4.9 and mean ACT score was 19.2 indicating a medium risk for adherence problems and well controlled asthma. Mean scores for concern, commitment and cost were 2.4, 2.4 and 0.4 respectively, indicating moderate to low risk for adherence problems. After education the mean total AE score was 3.3 (p5 0.315) and mean ACT score was 20.9 (p50.038) indicating an overall reduced risk of medication non-adherence and significant improvement in asthma control. Mean scores for concern, commitment and cost were 1.5 (P5 0.49), 1.7 (p50.59) and 0.1 (p50.25), respectively, indicating low risk for non-adherence in all categories. CONCLUSIONS: Educating pediatric patients about their medications significantly improved asthma control, but not AE adherence scores.
J ALLERGY CLIN IMMUNOL FEBRUARY 2015
157
Insurance Barriers in the Management of Uncontrolled Asthma in an Inner-City Population Naveen Nannapaneni, M.D.1, Roula H. Daher, M.D.1, Elizabeth A. Secord, MD, FAAAAI2,3; 1Wayne State University/ Detroit Medical Center, 2 Children’s Hospital of Michigan Department of Allergy Immunology, Detroit, MI, 3Wayne State University School of Medicine, Detroit, MI. RATIONALE: Admissions for acute asthma exacerbations are ubiquitous in inpatient medicine. Identifying causes of these exacerbations allows for targeted preventative measures to reduce hospitalizations. One suspected factor is access to appropriate pharmacotherapy, which can be limited by under-insurance and lack of insurance. This study serves as an exploratory descriptive analysis of the importance insurance barriers play in uncontrolled asthmatics. METHODS: 134 patients aged 1-80 with a known history of asthma who admitted for acute exacerbations to the general medicine or observation units of Detroit Receiving Hospital, Harper University Hospital, and Children’s Hospital of Michigan were surveyed after providing informed consent. Questions about their asthma history, management regimens, frequency of hospitalizations, and type of insurance were included. Data for minors was provided by their parents. Insurance barriers were defined as patients having either no insurance, prohibitive co-pays for medications, or a refusal by their insurance to authorize medications prescribed by their physician. RESULTS: 41.8% of all patients reported having at least one insurance barrier related to their asthma care. 12.7% were uninsured, 9.7% reported prohibitive co-pays which ranged from $6-$260, and 19.4% reported insurance refusal to authorize a medication prescribed by their physician. CONCLUSIONS: Insurance barriers are found in both inner-city adults and children with uncontrolled asthma and contributes to their hospitalizations by limiting their access to appropriate pharmacotherapies. Further in-depth investigations into these barriers are warranted based on this exploratory analysis, including whether recent changes in national healthcare policy reduce the quantity of insurance barriers for this population.
158
Are We Doing Enough to Protect Asthmatic Patients from Pneumococcal Disease? Martin A. Smith, MD1, Alexei Gonzalez-Estrada, MD2, Roxana I. Siles, MD1; 1Cleveland Clinic Foundation, Cleveland, OH, 2Respiratory Institute, Cleveland Clinic. RATIONALE: The Centers of Disease Control recommends pneumococcal vaccination among adult asthmatics between the ages of 19-64. Asthmatics are at increased risk from pulmonary and invasive pneumococcal disease1. We aim to assess adherence to guidelines in a large tertiary care setting. METHODS: We performed an IRB-approved retrospective chart review of randomly selected records from September 2010 - April 2014 using ICD-9 code 493.xx. Demographic, clinical and immunization data were collected and analyzed. RESULTS: We reviewed 129 cases of asthma confirmed by spirometry and/or provocation studies. The mean age was 45 years [range 19-64 years]; 62% were female and 83% were Caucasian. Fifty eight (46%) were never smokers and 18 (14%) were active smokers. Forty seven (36%) were managed by Pulmonologists; 21 (16%) by Allergists and 61 (47%) by a primary care provider (PCP) or other providers. Fifty three (41%) had moderate or severe persistent asthma. Thirty six (28%) had at least one course of prescribed oral steroids and 2 (1.6%) were hospitalized for asthma in the 6 months prior to data collection. We found that only 23 (17.8%) out of 129 subjects had received pneumococcal vaccination. Four (3.8%) subjects were offered vaccination, but declined. Of the 23 vaccinated patients, 14 (61%) were primarily managed by a specialist, and 9 (39%) were managed by their PCP (p50.39). CONCLUSIONS: Despite the inherent limitations of this retrospective study, primary prevention with pneumococcal vaccination remains low among asthmatics. Specialists were more likely to use the vaccine, albeit the rates remained low.