Disparities in asthma medication dispensing patterns: The case of pediatric asthma in puerto rico

Doryliz Vila, Cynthia S Rand, Michael D. Cabana, Amarilis Quiones, Mirla Otero, Christina Gamache, Rafael Ramírez, Pedro Garca, Glorisa Canino

Research output: Contribution to journalArticle

Abstract

Background. Disparities exist in asthma medication dispensing between children with public insurance and those with private insurance under a Managed Care Medicaid system in Puerto Rico. Objectives. Island-wide medical claims data were used to examine the extent to which differences between the private and public health care sectors affect medication dispensing and health care utilization among asthmatic children. Methods. Children 318 years old with at least one service claim [outpatient, hospitalization, or emergency department (ED) visit] for asthma or reactive airway disease from 2005 to 2006 were selected. Chi-square analyses compared medication dispensing and health care utilization between the public and private sectors. Negative binomial regression identified factors associated with the mean dispensing rate of prescriptions for anti-inflammatory controller medication (CM). Results. Private insurance families (n =28,088) were dispensed significantly more CM (48.3 vs. 12.0) and quick relief medication (47.4 vs. 44.6) than public insurance families (n =13,220). The dispensing of inhaled corticosteroids (24.4 vs. 6.7) and leukotriene modifiers and cromolyn (31.4 vs. 5.7) was dramatically higher in the private sector. In contrast, emergency room use was significantly higher among public insurance children (51.7 vs. 13.8). Multivariate analysis showed that age, number of β-agonists, and type of insurance was associated with CM dispensing; private insurance showed the greatest effect. Conclusion. Asthmatic Puerto Rican children enrolled in public insurance were significantly less likely to be dispensed CM than children with private insurance; suggesting that under-treatment of public insured children may substantially contribute to increased asthma morbidity in this population as evidenced by significantly higher rates of ED visits. Capsule summary. A disparity exists in asthma medication dispensing between children with public insurance compared with those with private insurance under a Managed Care Medicaid system in Puerto Rico. If asthma disparities in medication dispensing are to be reduced, then a better understanding of the complex ways in which multiple variables related to the health care system policies, socioeconomic factors, family and provider interactions, as well as the relative weight that each one contributes to the observed inequalities is needed.

Original languageEnglish (US)
Pages (from-to)1136-1141
Number of pages6
JournalJournal of Asthma
Volume47
Issue number10
DOIs
StatePublished - Dec 2010

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Puerto Rico
Insurance
Asthma
Pediatrics
Patient Acceptance of Health Care
Hospital Emergency Service
Private Sector
Medicaid
Managed Care Programs
Cromolyn Sodium
Health Care Sector
Leukotrienes
Public Sector
Ambulatory Care
Hispanic Americans
Islands
Capsules
Prescriptions
Adrenal Cortex Hormones
Hospitalization

Keywords

  • asthma
  • children
  • disparities in medication dispensing
  • health care system
  • Puerto Rico

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Immunology and Allergy
  • Pediatrics, Perinatology, and Child Health

Cite this

Disparities in asthma medication dispensing patterns : The case of pediatric asthma in puerto rico. / Vila, Doryliz; Rand, Cynthia S; Cabana, Michael D.; Quiones, Amarilis; Otero, Mirla; Gamache, Christina; Ramírez, Rafael; Garca, Pedro; Canino, Glorisa.

In: Journal of Asthma, Vol. 47, No. 10, 12.2010, p. 1136-1141.

Research output: Contribution to journalArticle

Vila, D, Rand, CS, Cabana, MD, Quiones, A, Otero, M, Gamache, C, Ramírez, R, Garca, P & Canino, G 2010, 'Disparities in asthma medication dispensing patterns: The case of pediatric asthma in puerto rico', Journal of Asthma, vol. 47, no. 10, pp. 1136-1141. https://doi.org/10.3109/02770903.2010.517338
Vila, Doryliz ; Rand, Cynthia S ; Cabana, Michael D. ; Quiones, Amarilis ; Otero, Mirla ; Gamache, Christina ; Ramírez, Rafael ; Garca, Pedro ; Canino, Glorisa. / Disparities in asthma medication dispensing patterns : The case of pediatric asthma in puerto rico. In: Journal of Asthma. 2010 ; Vol. 47, No. 10. pp. 1136-1141.
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abstract = "Background. Disparities exist in asthma medication dispensing between children with public insurance and those with private insurance under a Managed Care Medicaid system in Puerto Rico. Objectives. Island-wide medical claims data were used to examine the extent to which differences between the private and public health care sectors affect medication dispensing and health care utilization among asthmatic children. Methods. Children 318 years old with at least one service claim [outpatient, hospitalization, or emergency department (ED) visit] for asthma or reactive airway disease from 2005 to 2006 were selected. Chi-square analyses compared medication dispensing and health care utilization between the public and private sectors. Negative binomial regression identified factors associated with the mean dispensing rate of prescriptions for anti-inflammatory controller medication (CM). Results. Private insurance families (n =28,088) were dispensed significantly more CM (48.3 vs. 12.0) and quick relief medication (47.4 vs. 44.6) than public insurance families (n =13,220). The dispensing of inhaled corticosteroids (24.4 vs. 6.7) and leukotriene modifiers and cromolyn (31.4 vs. 5.7) was dramatically higher in the private sector. In contrast, emergency room use was significantly higher among public insurance children (51.7 vs. 13.8). Multivariate analysis showed that age, number of β-agonists, and type of insurance was associated with CM dispensing; private insurance showed the greatest effect. Conclusion. Asthmatic Puerto Rican children enrolled in public insurance were significantly less likely to be dispensed CM than children with private insurance; suggesting that under-treatment of public insured children may substantially contribute to increased asthma morbidity in this population as evidenced by significantly higher rates of ED visits. Capsule summary. A disparity exists in asthma medication dispensing between children with public insurance compared with those with private insurance under a Managed Care Medicaid system in Puerto Rico. If asthma disparities in medication dispensing are to be reduced, then a better understanding of the complex ways in which multiple variables related to the health care system policies, socioeconomic factors, family and provider interactions, as well as the relative weight that each one contributes to the observed inequalities is needed.",
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AU - Otero, Mirla

AU - Gamache, Christina

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AU - Garca, Pedro

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N2 - Background. Disparities exist in asthma medication dispensing between children with public insurance and those with private insurance under a Managed Care Medicaid system in Puerto Rico. Objectives. Island-wide medical claims data were used to examine the extent to which differences between the private and public health care sectors affect medication dispensing and health care utilization among asthmatic children. Methods. Children 318 years old with at least one service claim [outpatient, hospitalization, or emergency department (ED) visit] for asthma or reactive airway disease from 2005 to 2006 were selected. Chi-square analyses compared medication dispensing and health care utilization between the public and private sectors. Negative binomial regression identified factors associated with the mean dispensing rate of prescriptions for anti-inflammatory controller medication (CM). Results. Private insurance families (n =28,088) were dispensed significantly more CM (48.3 vs. 12.0) and quick relief medication (47.4 vs. 44.6) than public insurance families (n =13,220). The dispensing of inhaled corticosteroids (24.4 vs. 6.7) and leukotriene modifiers and cromolyn (31.4 vs. 5.7) was dramatically higher in the private sector. In contrast, emergency room use was significantly higher among public insurance children (51.7 vs. 13.8). Multivariate analysis showed that age, number of β-agonists, and type of insurance was associated with CM dispensing; private insurance showed the greatest effect. Conclusion. Asthmatic Puerto Rican children enrolled in public insurance were significantly less likely to be dispensed CM than children with private insurance; suggesting that under-treatment of public insured children may substantially contribute to increased asthma morbidity in this population as evidenced by significantly higher rates of ED visits. Capsule summary. A disparity exists in asthma medication dispensing between children with public insurance compared with those with private insurance under a Managed Care Medicaid system in Puerto Rico. If asthma disparities in medication dispensing are to be reduced, then a better understanding of the complex ways in which multiple variables related to the health care system policies, socioeconomic factors, family and provider interactions, as well as the relative weight that each one contributes to the observed inequalities is needed.

AB - Background. Disparities exist in asthma medication dispensing between children with public insurance and those with private insurance under a Managed Care Medicaid system in Puerto Rico. Objectives. Island-wide medical claims data were used to examine the extent to which differences between the private and public health care sectors affect medication dispensing and health care utilization among asthmatic children. Methods. Children 318 years old with at least one service claim [outpatient, hospitalization, or emergency department (ED) visit] for asthma or reactive airway disease from 2005 to 2006 were selected. Chi-square analyses compared medication dispensing and health care utilization between the public and private sectors. Negative binomial regression identified factors associated with the mean dispensing rate of prescriptions for anti-inflammatory controller medication (CM). Results. Private insurance families (n =28,088) were dispensed significantly more CM (48.3 vs. 12.0) and quick relief medication (47.4 vs. 44.6) than public insurance families (n =13,220). The dispensing of inhaled corticosteroids (24.4 vs. 6.7) and leukotriene modifiers and cromolyn (31.4 vs. 5.7) was dramatically higher in the private sector. In contrast, emergency room use was significantly higher among public insurance children (51.7 vs. 13.8). Multivariate analysis showed that age, number of β-agonists, and type of insurance was associated with CM dispensing; private insurance showed the greatest effect. Conclusion. Asthmatic Puerto Rican children enrolled in public insurance were significantly less likely to be dispensed CM than children with private insurance; suggesting that under-treatment of public insured children may substantially contribute to increased asthma morbidity in this population as evidenced by significantly higher rates of ED visits. Capsule summary. A disparity exists in asthma medication dispensing between children with public insurance compared with those with private insurance under a Managed Care Medicaid system in Puerto Rico. If asthma disparities in medication dispensing are to be reduced, then a better understanding of the complex ways in which multiple variables related to the health care system policies, socioeconomic factors, family and provider interactions, as well as the relative weight that each one contributes to the observed inequalities is needed.

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