Disparities in asthma medication dispensing patterns: The case of pediatric asthma in Puerto Rico

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 3–18 years old with at least one service claim (outpatient, hospitalization, or ED visit) for asthma or reactive airway disease from 2005–06 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 controller anti-inflammatory 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, ER use was significantly higher among public insurance children (51.7% vs. 13.8%). Multivariate analysis showed that age, number of beta-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 undertreatment of public insured children may substantially contribute to increased asthma morbidity in this population as evidenced by significantly higher rates of ED visits.