A Retrospective Claims Database Study to Clarify Treatment Reality of Asthma Patients Before and After Referral to a Specialist

IF 3.7 3区医学 Q2 ALLERGY

Journal of Asthma and Allergy Pub Date : 2024-01-18 DOI:10.2147/jaa.s437944

Soichiro Hozawa, Keita Ono, Naoyuki Makita, Hitomi Uchimura, Yoshifumi Arita, Takehiro Hirai, Naoki Tashiro

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引用次数: 0

Abstract

Purpose: Japanese guidelines recommend that patients with uncontrolled asthma be referred by non-specialists to specialists (allergists and/or pulmonologists). This study investigated the reality of clinical practice in asthma patients referred to specialists in Japan.
Patients and Methods: This was a retrospective, observational cohort study of asthma patients in a health insurance claim database (Cross Fact) referred from facilities with non-specialists to those with specialists from January 2016 to December 2018. The referred asthma patients were defined as patients with ≥ 4 inhaled corticosteroid (ICS)-containing prescriptions during a 1-year baseline period, with an asthma diagnosis, and who had visited a facility with specialists. Asthma exacerbation, maintenance treatment, laboratory tests, and medical procedures before and after referral were analyzed.
Results: Data for 2135 patients were extracted, of which 420 with referral codes were analyzed. The proportion of patients with asthma exacerbations was 50.2% (95% confidence interval [CI]: 45.4– 55.1%) before referral and 37.4% (95% CI: 32.7– 42.2%) after, a significant decrease (P< 0.001; McNemar test). The proportions of patients prescribed ICS alone, long-acting beta-agonists (LABA), and ICS/LABA were lower after referral than before, but the proportions of patients prescribed long-acting muscarinic antagonists (LAMA), ICS/LABA/LAMA, and biologics increased after referral. More asthma-related laboratory tests were performed after referral, and spirometry incidence increased from 16.4% before referral to 51.4% after referral.
Conclusion: This study shows a decrease in asthma exacerbations, change in asthma treatments, and increase in laboratory tests after referral to a specialist, suggesting that referrals to specialists lead to better management of asthma.

Keywords: asthma, database, referral, specialist, symptom exacerbation

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一项旨在澄清哮喘患者在转诊至专科医生前后治疗现状的回顾性索赔数据库研究

目的：日本指南建议，哮喘未得到控制的患者应由非专科医生转诊至专科医生（过敏症专科医生和/或肺科专科医生）。本研究调查了日本哮喘患者转诊至专科医生的临床实践情况：这是一项回顾性、观察性队列研究，研究对象是健康保险理赔数据库（Cross Fact）中的哮喘患者，研究时间为 2016 年 1 月至 2018 年 12 月，研究对象从拥有非专科医生的医疗机构转诊至拥有专科医生的医疗机构。转诊的哮喘患者被定义为在1年基线期内开具≥4张含吸入性皮质类固醇（ICS）处方、确诊为哮喘且曾在有专科医生的机构就诊的患者。对转诊前后的哮喘恶化、维持治疗、实验室检查和医疗程序进行了分析：提取了 2135 名患者的数据，对其中 420 名有转诊代码的患者进行了分析。转诊前，哮喘加重患者的比例为 50.2%（95% 置信区间 [CI]：45.4- 55.1%），转诊后为 37.4%（95% 置信区间：32.7- 42.2%），比例显著下降（P< 0.001; McNemar 检验）。转诊后，单用 ICS、长效β-受体激动剂（LABA）和 ICS/LABA 的患者比例低于转诊前，但转诊后，长效毒蕈碱拮抗剂（LAMA）、ICS/LABA/LAMA 和生物制剂的患者比例有所增加。转诊后进行了更多的哮喘相关实验室检查，肺活量测定的发生率从转诊前的 16.4% 增加到转诊后的 51.4%：这项研究表明，转诊至专科医生后，哮喘加重的情况减少了，哮喘治疗方法改变了，实验室检查增加了，这表明转诊至专科医生能更好地管理哮喘。

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来源期刊

Journal of Asthma and Allergy Medicine-Immunology and Allergy

CiteScore

5.30

自引率

6.20%

发文量

185

审稿时长

16 weeks

期刊介绍： An international, peer-reviewed journal publishing original research, reports, editorials and commentaries on the following topics: Asthma; Pulmonary physiology; Asthma related clinical health; Clinical immunology and the immunological basis of disease; Pharmacological interventions and new therapies. Although the main focus of the journal will be to publish research and clinical results in humans, preclinical, animal and in vitro studies will be published where they shed light on disease processes and potential new therapies.