Pediatric Hospital Medicine Fellow Childrens Hospital of Philadelphia Philadelphia, Pennsylvania, United States
Background: The 2020 NHLBI Focused Updates to the Asthma Management Guidelines include a strong recommendation for step-up to Single Maintenance and Reliever Therapy (SMART) for children ages 5+ with poorly-controlled asthma on low dose daily inhaled corticosteroids (ICS). For pediatric patients admitted for asthma, prior work has demonstrated that filling discharge prescriptions for short-acting beta agonists (SABA) and ICS was associated with diminished risk of early readmission. Objective: Analyze prescription fill and refill frequencies comparing eligible patients prescribed SMART vs. eligible patients remaining on alternative therapy using medication fulfillment data from hospital and community retail pharmacies. Design/Methods: A retrospective chart review was conducted for a QI project to promote SMART initiation for children 5+ admitted for asthma at a large children’s hospital. Eligibility for SMART was defined per the 2020 NHLBI recommendations. Inclusion criteria were ages 5-18, 2 or more asthma hospitalizations/ED visits in last 12 months, admitted on step 2 or 3 of NHLBI management, and admitted to PICU/general pediatrics/pulmonary teams from January 2021 to June 2023. Discharge prescription fills and refills were captured using data sourced from an in-hospital retail pharmacy as well as community pharmacies via Surescripts interface. Fills for initial SMART inhalers and refills within 5, 30, 60, and 90 days of discharge were tabulated, as were fills and refills for non-SMART ICS and SABA inhalers and oral steroid courses. Patients were dichotomized into those prescribed SMART vs. those not prescribed SMART. Fills were compared between groups based on frequency as well as pharmacy type (in-hospital vs. community), timing (at discharge vs. >5 days post-discharge), and use of concomitant therapy (montelukast, tiatropium, etc.). Data will be analyzed using R and with biostatistician input, and will be complete by March 2024. We will prepare a submission to our institutional IRB and expect this work to be deemed exempt from further review.
