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.