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| |  Prescribing Restrictions May Prevent Patients From Getting Best Asthma Medication: Presented at CHEST By Ed Susman MONTREAL, CANADA -- November 7, 2005 -- Restrictive prescribing processes -- often used in Canadian provinces to try to ensure proper yet cost-effective treatment - may be having the opposite effect, new research suggests. "In our study, the prescribing restrictions that appear to have the criteria aligned to guidelines may have the unintended outcome of making it more difficult for some physicians to apply asthma guidelines in their practice," reported Andrew McIvor, MD, head, division of respirology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada. In his poster presentation on November 2nd here at the American College of Chest Physicians Annual Meeting (CHEST), Dr. McIvor said he and colleagues interviewed 284 general practitioners about their likelihood of following prescription guidelines for patients with either public or private insurance. "The net impact of aligning asthma reimbursement to placements in guidelines with criteria that entail an administrative process for the physicians appears to be that physicians more frequently prescribe products that are more easily accessible and not necessarily in accordance with guidelines," Dr. McIvor said. "For example, doctors may increase the dose of inhaled corticosteroids instead of adding long-acting beta agonists as a combination treatment," he said. "This also suggests that patients who are candidates for certain therapies are not receiving them." According to an analysis performed by P/S/L Associates of Toronto, aided by support from GlaxoSmithKline, Inc., the study found that since 2003: - Use of Advair diminished considerably. "These results demonstrate that administrative decisions which are done with good intentions may have a negative impact on the quality of care of patients," Dr. McIvor said. "It is essential in the future to make sure that an evaluation process is in place to assess the impact in real life of these decisions before continuing and maintaining their implementation," he said. In answering the questionnaire, physicians ranked asthma symptoms, treatment guidelines and insurance coverage as the 3 most important factors impacting drug therapy choice, Dr. McIvor said. About 80% of the doctors surveyed said they ask their patients about drug coverage before making a prescribing decision. If the patients had public insurance, about 375 of doctors said they would increase the dose on inhaled corticosteroids for worsening symptoms. But if the patient had private insurance, doctors would increase the steroid dose 22% of the time. Canadian asthma guidelines recommend inhaled corticosteroids as the mainstay of maintenance therapy. If asthma is not adequately controlled by low doses of inhaled corticosteroids, additional therapy with a long-acting beta agonist should be considered as the first option. Intuitively, adherence to recommendations made within guidelines should translate into optimal outcomes for patients, Dr. McIvor said. The study findings indicate that "patients with private drug coverage are treated more closely to guidelines," he added.
[Presentation title: Do Restrictive Reimbursement Processes Inhibit Physicians From Adopting and Implementing Guidelines Into Their Practice: The Canadian Asthma Experience.]
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