Effectiveness of Asthma Preventer Dispensing for Preventing Childhood Asthma Readmissions: A Multisite Cohort Linkage Study

To determine the rate of asthma controller medication prescriptions at the time of hospital discharge following admission for asthma and its impact on hospital readmissions. The study also measured the impact of community prescriptions for asthma controller medications on readmissions.Pediatric patients (age 3–18) discharged with the diagnosis of wheezing or asthma were enrolled from multiple tertiary, mixed metropolitan, and regional hospitals in Australia. Patients with congenital heart disease, chronic lung disease, or neuromuscular conditions were excluded.An observational cohort study of children enrolled between September 2017 and August 2018 evaluated whether they were given an asthma controller medication at discharge from the hospital, refilled a previously prescribed controller within 3 days of discharge, or filled controller medication within the subsequent 12 months. Controller medications included inhaled corticosteroid, inhaled corticosteroid-long acting beta agonist, and leukotriene receptor antagonists. The primary outcome measured the effectiveness of asthma controller dispensing for preventing childhood asthma readmissions within 12 months.Of the 767 study participants (mean age 6.2 years, 62.8% male), 34.3% of the patients were readmitted to the hospital with asthma within 12 months. At the initial admission, 16% of patients were on controller medications. At discharge, 10.5% more patients were prescribed a controller, and 16% continued the controller they had already been prescribed. Less than half (45%) of those picked up their newly prescribed or previously prescribed controllers within 3 days of discharge. There was no protective effect from dispensing a controller medication at discharge on asthma hospital readmissions within 12 months (odds ratio 1.17, 95% confidence interval [CI] 0.69 to 1.97, P = .57). However, of the 566 children not prescribed asthma controller medications at discharge, 269 (47.5%) had 1 or more prescriptions dispensed in follow-up appointments from a subsequent provider within 12 months. The median cumulative days the controller was available at home (protected period) was under 98 days (60–167). Participants in the protected period had reduced risk of an asthma hospital readmission (hazard ratio 0.61, 95% CI 0.36 to 1.02, P = .06), including preschool children (hazard ratio 0.48, 95% CI 0.25, 0.93, P = .03).Almost three-fourths of patients discharged from the hospital with a diagnosis of asthma or wheezing were not prescribed asthma controller therapy. For those who did receive a prescription, less than 50% filled the medication. Asthma controller adherence and regular follow-ups in the community are essential if asthma readmission rates are to be reduced.It is concerning that most patients were not sent home with specific plans for asthma controller therapy across multiple hospital settings. This study further corroborates trends of poor medication fill rates for asthma controller medicines. Even when prescribed a controller medicine, readmission rates were not impacted. This study’s only factor leading to positive outcomes is when the community provider manages the prescription with subsequent asthma follow-ups. This may be because of patients having more trust in longitudinal physicians rather than the brief time they spent with the inpatient team. Consistent usage of asthma medicines is paramount to improving disease burden and preventing future exacerbations, including death. Although theoretically strong discharge education and asthma management seem important, outpatient providers who can promote adherence to asthma guidelines, additional teaching, controller medication prescriptions, and monitoring are more important.