Trends in use of inhaled corticosteroids for asthma management: 1994-1998

PURPOSE: To evaluate trends in prescribing of inhaled corticosteroids for asthma between 1994 and 1998 and patterns of prescribing in relation to selected physician characteristics. METHODS: Using a HMO database, a physician sample (N =335) was linked to patient encounter data and pharmacy claims (N =51,345) for asthma patients ages 5 to 45 years (N =6,944). Longitudinal and cross-sectional analytic methods were used to examine physician prescribing patterns across the study period. RESULTS: The percent of physicians prescribing an inhaled corticosteroid increased over time with consistently greater prescribing among specialists. Annual comparisons by specialty groups revealed that specialists (allergy and pulmonary) prescribed inhaled steroids to a larger proportion of their patients than generalists (family practice, internal medicine, pediatrics, pediatric emergency department); (range: 0.61-0.69 vs. 0.31-0.39, p<.01). The lowest proportions were found among pediatric emergency department physicians (range: 0.00-0.10) and pediatricians (range: 0.17-0.27). CONCLUSIONS: Significant linear trends in either physician group were not observed during this 5-year period. Differences across physician groups were evident.