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Improvements in Asthma Pharmacotherapy and Self-Management

An Example of a Population-Based Disease Management Program

  • Original Research Article
  • Published:
Disease Management & Health Outcomes

Abstract

Background and objective

In day-to-day practice, asthma treatment and self-management often fall short of the objectives defined by clinical practice guidelines. The objective of this study was to determine whether a population-based asthma disease management program, using broad-based educational interventions, can have a favorable impact on physician and patient adherence to guidelines-based care.

Methods

A longitudinal, before-and-after design was used to evaluate program impacts on pharmacotherapy and health status. Patients with asthma (n = 35 450) were enrolled in the program from September 2000 through to June 2001. Patients were identified for the study based on a 12-month retrospective analysis of pharmacy claims. Patients were members of prescription benefit plans managed by Medco Health and were aged 5 years and older. Patients in the intervention group received asthma education materials during the 12-month period following enrollment. The materials emphasized guidelines-based principles of asthma pharmacotherapy, self-management, trigger avoidance and patient-physician partnership. Physicians received guidelines-based flow sheets to facilitate therapy tracking, and pharmacotherapy review. Asthma drug utilization was measured during the 12-month period prior to enrollment and the 12-month period following enrollment. Utilization data on controller and reliever medications were derived from a pharmacy claims database. Drug utilization changes for the intervention group were compared with those for matched controls. A health survey was conducted on a random sample of program participants at enrollment and at 12-month follow-up. The health survey included questions on asthma-related quality of life (QOL), medical utilization, productivity, and self-management skills.

Main outcome measures and results

The percentage of patients who started controller therapy during the study period was significantly higher for the intervention group than the control group (20.7% versus 18.1%, p < 0.001). The controller prescription fill rate increased significantly in the intervention group compared with controls (p < 0.0001); the increase was primarily driven by increased refill rates for patients already using controllers. Reliever prescription fill rates decreased for both the intervention group and controls. Program participants reported significant improvements in asthma-related QOL (p < 0.05) and self-management skills. Self-reported medical utilization decreased for office visits (p < 0.05) and emergency room visits (p < 0.01).

Conclusions

A population-based asthma disease management program can improve controller prescribing rates (new therapy starts), controller adherence rates (refill persistency), and self-management skills. These changes in physician and patient behavior help close the gaps between guidelines and practice in asthma therapy.

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Acknowledgements

This study evaluates the outcomes of a disease management program offered by Medco Health with financial support from Integrated Therapeutics Group (ITG), a subsidiary of Schering-Plough Corporation. The authors would like to thank the following individuals for their contributions during the development and evaluation of this program: Berhanu Alemayehu, Stacy Ferrari, Les Paul, and Melinda Thiel. The authors have no conflicts of interest directly relevant to the content of this study.

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Authors and Affiliations

  1. Medco Health Solutions, Inc., 100 Parsons Pond Drive F2-2, Franklin Lakes, New Jersey, NJ 07417, USA

    Richard A. Feifer (Senior Director of Medical Policy), Robert R. Verbrugge, Mona Khalid, Rebecca Levin, Gwendolyn B. O’Keefe & Ronald E. Aubert

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  1. Richard A. Feifer
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  2. Robert R. Verbrugge
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  3. Mona Khalid
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  4. Rebecca Levin
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  6. Ronald E. Aubert
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Correspondence to Richard A. Feifer.

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Feifer, R.A., Verbrugge, R.R., Khalid, M. et al. Improvements in Asthma Pharmacotherapy and Self-Management. Dis-Manage-Health-Outcomes 12, 93–102 (2004). https://doi.org/10.2165/00115677-200412020-00003

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  • DOI: https://doi.org/10.2165/00115677-200412020-00003

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