What Drives Prescribing of Asthma Medication to Children? A Multilevel Population-Based Study
| Autor: | Liset van Dijk, Madelon Bracke, Hubert G. M. Leufkens, Bert Brunekreef, Peter Spreeuwenberg, Hubertus G. M. Arets, Mira G. P. Zuidgeest, Henriette A. Smit |
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| Přispěvatelé: | University of Groningen |
| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty Pediatrics Asthma/child pharmacoepidemiology Adolescent Population CHILDHOOD Context (language use) FREQUENT DIAGNOSIS preschool Diagnosis Differential Drug Utilization Review multilevel Epidemiology medicine Humans Anti-Asthmatic Agents Practice Patterns Physicians' Medical prescription Child education Montelukast Original Research Netherlands Respiratory Sounds Asthma Analysis of Variance Family Characteristics education.field_of_study ANTIASTHMATIC DRUGS business.industry prescribing Age Factors Infant medicine.disease professional practice respiratory tract diseases Logistic Models Bronchiolitis Child Preschool Bronchitis Female BURDEN Family Practice business medicine.drug |
| Zdroj: | Annals of Family Medicine, 7(1), 32-40. ANNALS FAMILY MEDICINE |
| ISSN: | 1544-1717 1544-1709 |
| DOI: | 10.1370/afm.910 |
| Popis: | PURPOSE Diagnosing asthma in children with asthmatic symptoms remains a challenge, particularly in preschool children. This challenge creates an opportu- nity for variability in prescribing. The aim of our study was to investigate how and to what degree patient, family, and physician characteristics infl uence pre- scribing of asthma medication in children. METHODS We undertook a multilevel population-based study using the second Dutch national survey of general practice (DNSGP-2), 2001. Participants were 46,371 children aged 1 to 17 years belonging to 25,537 families registered with 109 general practitioners. Using a multilevel multivariate logistic regression analysis with 3 levels, our main outcome measure was the prescribing of asthma medication, defi ned as at least 1 prescription for β2-adrenergic agonists, inhaled corticosteroids, cromones, or montelukast during the 1-year study period. RESULTS We identifi ed characteristics signifi cantly associated with prescribing asthma medication on all 3 levels (child, family, and physician). The variance in prescribing among physicians was signifi cantly higher with children who were younger than 6 years than with children aged 6 years and older (95% CI, 3.5%- 25.2% vs 2.4%-13.4%). Several diagnoses other than asthma and asthmatic com- plaints were strongly associated with prescribing asthma medication, including bronchitis/bronchiolitis (OR = 9.04; 95% CI, 7.57-10.8) and cough (OR = 6.51; 95% CI, 5.68-7.47). CONCLUSIONS Our study shows a much higher variance in prescribing patterns among general practitioners for children younger than 6 years compared with older children, which could be a direct result of the diagnostic complexities found in young children with asthmatic symptoms. Thus diagnostic gaps may lead to more physician-driven prescribing irrespective of the clinical context. |
| Databáze: | OpenAIRE |
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