Friday, May 8, 2015

The Pharmacy as a Measure of the Health of Asthmatics in the Community: A New Metric Worth Considering

By: Lewis First, MD, MS; Editor-in-Chief    

          We are always looking for ways to improve the health of populations and the population of asthmatics in a given community can certainly vary in their utilization of health care resources (ranging from routine visits to exacerbations requiring usage of emergency or inpatient resources).  Wouldn’t it be helpful to have a measure that might indicate if the patients with asthma in your community are at risk for getting worse so you might intervene sooner than later to make sure they are complying with their asthma action plans?   Beck et al. (doi: 10.1542/peds.2014-3796) share with us this week in an early-released study how medication data from a chain of pharmacies in one county can determine a higher or lower utilization rate of emergency visits and inpatient admissions.  The authors define the “Pharmacy-level Asthma Medication Ratio (Ph-AMR) as the number of controller fills divided by the number of controller and rescue fills.  The higher the ratio, the more the controller is being utilized relative to rescue medications.  The outcome measure associated with the use of the ratio was the number of emergency visits and admissions divided by the number of asthmatic children in that county served by the 27 pharmacies it contained.   The authors did their best to control for confounders like poverty status and access to care. 
As to results, every 0.1 increase in the ratio resulted in a proportional decrease in emergency visits and hospitalizations.  This is a unique way to think about monitoring the health of the population and may prompt you to share the results with your neighborhood pharmacist to see if they can provide a similar metric on a periodic basis to you so that increased utilization might be curtailed with targeted interventions for those areas of your community served by pharmacies with lower Ph-AMR ratios.  To help you make sense of the importance of thinking about the health of populations and not just individual patients with asthma, check out the commentary written by Dr. Louis Vernacchio (doi: 10.1542/peds.2015-0809) who provides an interesting perspective on the implications of this study.  You’ll breathe easier thinking about ways to improve the monitoring of asthmatics in your community if you read this study and consider forming stronger interprofessional ties with the pharmacies you most rely upon to help insure the health of the population you serve.

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