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©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Part X: An Overview of Asthma, Medicaid, and Asthma Management Issues Christopher H. Purdy, PhD student, Biostatistics, New York State University at Buffalo
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Parts of this Presentation 1. Literature Review 2. Results of the Asthma Education Analysis 3. Resources for Further Study
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Literature Review Apter’s 1997 article in the Annals of Allergy Asthma and Immunology concludes that insurance was the most significant predictor of asthma care and morbidity from asthma related conditions. Balkrishnan’s 1998 paper concluded that the introduction of inhaled corticosteroid therapy for Medicaid patients was associated with an improvement in care and a decrease in cost.
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Berg’s 2004 paper concluded that low-income families of Latino origin were more likely not to have the resources for good asthma management and hence were associated with more acute episodes and emergency department visits. Blixen’s 1999 article argues that health insurance alone may not be sufficient to ensure proper asthma management. It may be necessary to educate persons so that they utilize available services appropriately and so they manage their own case properly.
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Cabana’s 2005 article argues that there exists a relative lack of standardized reliable information to guide physicians for the most appropriate standards for pediatric asthma care. Chabra’s 1998 article addresses the inequities in regard to African American and Latino young children in regard to asthma care and concomitant hospitalizations, and argues for social welfare programs to address these disparities of care.
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Cooper’s 2001 article addressed the surprising reality that the majority of Tennessee children who had an acute asthmatic episode failed to fill an oral corticosteroid following an emergency department visit. This paper also concluded that there existed a statistically significant relationship between demographics and the probability of this negative outcome, and the paper argued for more extensive research to better elucidate this problem and possible solutions.
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation David’s 2004 article cites a positive reaction to the publication of NIH guidelines, that children in Florida had a marked increase in the rate of filling a prescription for a daily asthma controller medication, however the article also cites long term problems with adherence. Davidson’s 1994 article suggests that certain demographics are strongly associated with the likelihood of using emergency room services as opposed to primary care physician. This paper also suggests that patients with Medicaid were four times more likely to use the emergency room services than those with insurance or who were self-pay.
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Emerman’s 1994 paper found that increased case management and education services lead to better pediatric asthma control and less use of emergency room services. Evans’ 1999 paper found that the optimal site for inner city asthmatic patient management was in fact an inner city hospital. By aggregating all of the patients in one location, this resulted in better care, and also allowed the integration of emergency services with the services of management and education.
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation In conclusion there exists a wealth of research in regard to asthma management and control for both patients and providers. The NIH guidelines are certainly a benchmark for all providers, patients, and their families as the best place to start. But there exist a wealth of research and websites that are readily available to address certain specific concerns of both medical and financial interest.
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Analysis of NHAMCS Data Data used for the analysis was from the NCHS’s website The actual Data sets were the 2003 NHAMCS and 2003 NAMCS Data The N for this study was 100,033. The model used for the study was logistic regression. The significance level is 0.05.
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Logistic Regression Parameters Variable Parameter Est. P Value Age0.0310.0001 White-0.0420.8017 Black0.2080.2249 Hispanic0.0780.1027 Asian0.2360.2090 Medicaid0.1770.0025 Private Insuranc 0.1240.0357 Gender0.0230.5201
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Discussion of Logistic Regression Results The logistic regression revealed the relationship between asthma education and various demographic variables and insurance variables. As indicated by tables one and two some of the variables had a statistically significant relationship with asthma education and some did not. The variables age, Medicaid insurance, and Private Insurance had a statistically significant relationship with asthma education.
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Discussion Continued The variables white, black, Hispanic, Asian, and gender did not have a significant relationship with asthma education. An increase in age is associated with an increase in the probability of receiving asthma education. If an individual has either Medicaid or Private Insurance, this is associated with an increase in the probability of receiving asthma education.
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Discussion Continued Medicaid insurance and private insurance, are both associated with an increase in the probability of receiving asthma education, which may be indicative of providers may be more likely to order asthma education for individuals who do not have to private pay. Those in the white demographic group were slightly less likely to receive asthma education, and in terms of the gender variable, males were slightly more likely to receive asthma education than females.
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Discussion of Analysis Concluded No obvious explanation for the relationship with the white racial group and asthma education exists, and a similar comment can be made for the relationship between gender and asthma education. Restated, there does not exist an obvious explanation for why males would be more likely to receive asthma education than females would.
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Additional Resources for Further Study The NIH guidelines are the first and most authoritative set of guidelines for providers and those concerned with care and management of asthmatic illness The guidelines can be found at the following address : www.nhlbi.nih.gov/guidelines/asthma/asth gdln.pdf
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Website Resources There are many excellent websites that contain a wealth of information regarding the various facets of asthma, asthma management, and all related issues (i.e. economic issues, medication issues, research). Following is a partial list of excellent asthma related websites :
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Website Resources www.aaaai.org www.aaaai.org This website is the official website of the American Academy of Allergy Asthma and Immunology and contains a variety of services including academic articles, established pediatric guidelines, and services for asthma patients.
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Website Review Continued www.aafa.org www.aafa.org This is the website of the Asthma and Allergy association Foundation of America. More than 50 million Americans have allergies and 20 million have asthma. The Asthma and Allergy Foundation of America (AAFA) is here to help with free information.
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Continued www.lungusa.org www.lungusa.org This is a website associated with the American Lung Association. This page has subdirectories on the topics of Asthma Research and Studies, Asthma Control Test, and Asthma Publications. Therefore this site is useful for our purposes as the work that I am doing for CDHS will involve science and data and similar topics as the ones presented on this page. Some of the topics on the Asthma Research page are asthma trends, stats announcement, NHLBI, ALA survey, commission’s report, and a nurse survey.
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Website Review Continued www.niehs.nih.gov www.niehs.nih.gov This website is designed to encourage and report research on asthma drugs and management. The projects are designed to develop strategies for prevention and intervention, to assess the exposure to indoor allergens, and to study the genetics and pathogenesis of asthma. They also provide information on various allergens and prevetitive strategies for surviving the seasons with asthma and allergies.
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Journal Sources Journal of Asthma European Respiratory Journal Journal of Healthcare Quality Ambulatory Pediatric Journal Annals of Allergy American Journal of Managed Care Annals of Allergy, Asthma, and Immunology
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation More Journals Pediatrics Journal of the American Geriatric Society Annals of Pharmacotherapy Journal of the American Medical Association Archives of Family Medicine Medical Care Clinical Therapeutics
©2005 CDHS College Relations Group Buffalo State College/SUNY at Buffalo Research Foundation Conclusion Thank you for your time. Obviously asthma management is an ongoing reality for patients, providers, and insurers. There exist a wealth of resources for anyone interested, the above listing is just a beginning. Address Questions to the author via the Family Medicine Research Institute, ECMC Campus, Grider Street, Buffalo, NY.
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