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NIH guidelines recommend treatment of moderate or severe childhood asthma with preventive anti-inflammatory medication (inhaled corticosteroids. cromolyn or nedocromil). The guidelines also emphasize providing patient education. The study objectives were a) to determine if the NIH guidelines for the treatment of childhood asthma were implemented by prescribing preventive medication. b) to determine if the NIH guidelines for the treatment of childhood asthma were implemented by providing patient education and c) to measure the influence of primary care physicians prescribing in accordance with the NIH guidelines on adverse clinical outcomes. Adverse clinical outcomes were measured by severe asthma exacerbations resulting in: hospital admissions. emergency department visits or a course of oral steroids from the primary care physicians. The data were collected from primary-care physicians in nine managed care plans in the northeastern USA. 311 children enrolled in Medicaid (aged 2-19 years) were identified as having a diagnosis and treatment for asthma during the period January through December 1994. Detailed clinical and pharmacy data were extracted from medical records by nurse reviewers forthe period January 1993 through March 1995. The NIH guidelines for the use of preventive anti-inflammatory medication were implemented on at least one occasion for 61. l % of the children with moderate or severe asthma in this Medicaid population during 1994. Patient education was provided to 41.8% of the children. Cox regression analyses showed prescribing preventive medication for moderate to severe asthmatics in accordance with the NIH guidelines was associated with a reduced risk of receiving a course of oral steroids. ( The findings of the present study suggest that many children with moderate or severe asthma were not prescribed preventive medication or provided education by primary care providers as recommended in the NIH guidelines. Inadequate implementation of the NIH guidelines for prescribing preventive medications was associated with adverse clinical outcomes. ( ACKNOWLEDGMENTS I would like to express my appreciation to my dissertation com mi nee for their support and guidance over the last few years. I would especially like to thank Susan Andrade and Cynthia Willey fortheir enthusiasm and commitment to the success of the project. I am grateful for the helpful comments in the early stages of the development of the proposal and the patient. critical support during the review and revision of the manuscripts. Their helpful comments and criticisms had a significant impact on the quality of the work and my motivation to persevere. I would like to thank Harry Sterling and Janice Griffin for their assistance with this project, especially with regards to data management. I also want to acknowledge the essential support from both Nina Kajiji and Christian Vye at the URJ Academic Computing Center, both of whom patiently helped me to learn how to prepare the SAS programs. I would especially like to thank Dr Cynthia Willey both for her support, highly valued advice and for providing me with this opportunity to begin a career as a researcher in a field that I have discovered I find both exciting and challenging to study.

PRESCRIBING PATTERNS AND CLINICAL OUTCOMES IN ASTHMATIC CHILDREN: A HISTORICAL COHORT STUDY