J Korean Med Sci.  2015 Aug;30(8):1048-1054. 10.3346/jkms.2015.30.8.1048.

The Effect of Asthma Clinical Guideline for Adults on Inhaled Corticosteroids PrescriptionTrend: A Quasi-Experimental Study

• Kim SH
• Cho BL
• Shin DW
• Hwang SS
• Lee H
• Ahn EM
• Yun JM
• Chung YH
• Nam YS

• KMID: 2164498
• DOI: http://doi.org/10.3346/jkms.2015.30.8.1048

Abstract

In order to increase inhaled corticosteroid (ICS) use and to reduce hospitalization, emergency department visits and ultimately the economic burden of asthma, "Korean Asthma Management Guideline for Adults 2007" was developed. To assess the guideline effects on physician's ICS prescription for asthma, we conducted segmented regression and multilevel logistic regression using National Health Insurance claims database of outpatient visits from 2003 to 2010. We set each quarter of a year as a time unit and compared ICS prescription between before and after guideline dissemination. A total of 624,309 quarterly visits for asthma was observed. The ICS prescription rate before and after guideline dissemination was 13.3% and 16.4% respectively (P < 0.001). In the segmented regression, there was no significant guideline effect on overall ICS prescription rate. In multilevel logistic regression analyses, the effect of guideline on overall ICS prescription was not significant (odds ratio, 1.03; 95% CI, 1.00-1.06). In subgroup analysis, ICS prescription increased in secondary care hospitals (odds ratio, 1.15; 95% CI, 1.02-1.30) and in general hospitals (odds ratio, 1.10; 95% CI, 1.04-1.16). However, in primary clinics, which covered 81.7% of asthma cases, there was no significant change (odds ratio, 0.98; 95% CI, 0.94-1.02). From the in-depth interview, we could identify that the reimbursement criteria of the Health Insurance Review and Assessment Service and patient's preference for oral drug were barriers for the ICS prescription. The domestic asthma clinical guideline have no significant effect on ICS prescription, especially in primary clinics.

Keyword

Asthma; Guideline; Corticosteroid

MeSH Terms

Administration, Inhalation
Adrenal Cortex Hormones/*administration & dosage
Allergy and Immunology/standards
Anti-Inflammatory Agents/administration & dosage
Asthma/*drug therapy/*epidemiology
Drug Prescriptions/*statistics & numerical data
Guideline Adherence/*utilization
Humans
*Practice Guidelines as Topic
Prevalence
Pulmonary Medicine/standards
Republic of Korea/epidemiology
Treatment Outcome
Adrenal Cortex Hormones
Anti-Inflammatory Agents

Figure

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  Fig. 1 Annual prevalence of asthma in Korea.

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  Fig. 2 Segmented regression of the inhaled corticosteroid prescription rate. The vertical redline indicates the point of the guideline dissemination.

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  Fig. 3 Sensitivity analysis using segmented regression of the inhaled corticosteroid prescription rate. The vertical redline indicates the point of the guideline dissemination.

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