Corticosteroid prescription filling for children covered by medicaid following an emergency department visit or a hospitalization for asthma

Objective: To identify predictors of corticosteroid prescription filling following an emergency department (ED) visit or a hospitalization for asthma. Design: A retrospective cohort study. Patients: Tennessee children (defined as those aged 2-17 years in this study) covered by Medicaid were included in the cohort if they had an ED visit or a hospitalization for asthma between July 1, 1995, and December 31, 1997. Main Outcome Measures: Prescriptions filled in the child's name for an oral corticosteroid within 7 days of the latest ED visit or hospitalization for asthma. Results: Of 6035 Tennessee children covered by Medicaid with an ED visit for asthma and of 2102 covered by Medicaid with a hospitalization for asthma during the study period, less than half (44.8% following an ED visit and 55.5% following a hospitalization) had prescriptions filled for oral corticosteroids within 7 days. Factors independently predicting a child's not having an oral, corticosteroid prescription filled included older age, black race, and residence in rural regions of the state. Conversely, children with oral corticosteroid prescriptions in the previous 6 months were more likely to have oral corticosteroid prescriptions filled following an ED visit for asthma, and children with more than 3 beta -agonist prescriptions in the previous 6 months were more likely to have oral corticosteroid prescriptions filled following a hospitalization for asthma. Conclusions: Overall, fewer than half of Tennessee children covered by Medicaid had an oral corticosteroid prescription filled following an ED visit or a hospitalization for asthma. Age, race, and county of residence predicted failure to have a prescription filled. Further study is needed to determine whether variations in corticosteroid prescription filling relate to physician practice, family behavior, or both.