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What drives prescribing of asthma medication to preschool wheezing children? A primary care study
Author(s) -
Montella Silvia,
Baraldi Eugenio,
Bruzzese Dario,
Mirra Virginia,
Di Giorgio Angela,
Santamaria Francesca
Publication year - 2013
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.22761
Subject(s) - medicine , medical prescription , asthma , attendance , emergency department , inhaled corticosteroids , pediatrics , logistic regression , primary care , family medicine , psychiatry , economics , pharmacology , economic growth
There is limited information on which data primary care pediatricians (PCPs) use to decide whether to prescribe or not asthma maintenance treatment, and what drives prescribing a specific therapy. The study aim was to investigate how prescribing anti‐asthma maintenance treatment to preschool wheezing children is influenced by patient, family, environmental, and PCP characteristics. We conducted a cross‐sectional study at 32 PCPs sites in Campania, Italy. Medical, family, and environmental information of 376 preschool wheezy children, and characteristics of the enrolled PCPs were collected. Main outcome measures of multilevel multivariate logistic regression analyses were the prescribing of maintenance treatment, and the prescription of a combined therapy as opposed to monotherapy. Variables significantly associated with long‐term inhaled corticosteroids (ICS) and/or leukotriene modifiers prescription included frequent wheezing (OR = 7.19), emergency department (ED) visits (OR = 2.21), personal allergic diseases (OR = 8.49), day‐care/kindergarten attendance (OR = 2.67), a high PCP prescribing volume (OR = 2.74), and a low proportion of 0‐ to 5‐year‐old patients with wheezing diagnosis (OR = 1.16). Leukotriene modifiers plus ICS were much more likely prescribed than ICS or leukotriene modifiers alone to older children (OR = 1.06) and to patients experiencing frequent wheezing (OR = 3.00), ED visits (OR = 3.12), or tobacco smoke exposure during the first 2 years of life (OR = 2.04). Finally, PCP's characteristics significantly associated with ICS plus leukotriene modifiers prescription were group practice (OR = 4.16) and a high prescribing volume (OR = 1.45). Our findings suggest that child characteristics alone are not sufficient to explain how PCPs decide to prescribe maintenance treatment and which therapy to assign, but variables associated to PCPs are crucial as well. Pediatr Pulmonol. 2013; 48:1160–1170. © 2013 Wiley Periodicals, Inc.