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September 2002

Effectiveness of an Asthma Management Program for Pediatric Members of a Large Health Maintenance Organization

Author Affiliations

From the Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver (Drs Lukacs, France, Barón, and Crane), and the Department of Preventive Medicine, Kaiser Permanente (Dr France), Colorado, Denver. Dr Lukacs is now with the National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md.

Arch Pediatr Adolesc Med. 2002;156(9):872-876. doi:10.1001/archpedi.156.9.872

Objective  To assess the impact of an asthma management program on the dispensing of inhaled corticosteroids, hospitalizations, and emergency department (ED) visits on children, adolescents, and young adults.

Design  We used medical record and pharmacy data for the 18 months after initiation of a pilot asthma management program. Two intervention offices were matched with 2 control offices on pediatric volume, number of pediatricians or family practitioners, and specialist availability.

Setting  Primary care offices at Kaiser Permanente Colorado, in Denver and Boulder.

Patients  We identified 298 patients, 18 years or younger, who were listed in an asthma registry between February 1 and July 31, 1997, as having moderate or severe asthma.

Intervention  The Kaiser Permanente Colorado Asthma Care Management Program is an outpatient-based program that provides comprehensive evaluation, education, and follow-up to patients identified from an asthma registry or referred by providers.

Main Outcome Measures  The proportion of patients who received more than 1 dispensing of inhaled corticosteroid during the observation period. Additional outcomes measured the proportion of patients with 1 or more hospitalizations or ED visits.

Results  A significantly greater proportion of patients from the intervention group received more than 1 dispensing of inhaled corticosteroid compared with controls (relative risk [RR], 1.41; 95% confidence interval [CI], 1.08-1.72). We found no significant difference in the proportion of patients who were hospitalized (RR, 1.37; 95% CI, 0.48-3.71) or visited the ED (RR, 0.86; 95% CI, 0.49-1.40).

Conclusions  The presence of an asthma management program may improve dispensing of inhaled corticosteroids to young patients with moderate or severe asthma, as recommended by national guidelines. This type of program may not have an effect on hospitalizations or ED visits.