TRENDS IN PAEDIATRIC TRENDS IN PAEDIATRIC HOSPITAL ADMISSION - - PowerPoint PPT Presentation

TRENDS IN PAEDIATRIC TRENDS IN PAEDIATRIC HOSPITAL ADMISSION HOSPITAL ADMISSION AND PRESCRIBING FOR AND PRESCRIBING FOR ASTHMA IN IRELAND ASTHMA IN IRELAND OVER A TEN YEAR STUDY OVER A TEN YEAR STUDY PERIOD. PERIOD.

• Dr. Anne O’Farrell, Dr. Davida De La
• Dr. Anne O’Farrell, Dr. Davida De La

Harpe, Harpe,

• Dr. Kathleen Bennett, Dr. Howard
• Dr. Kathleen Bennett, Dr. Howard

Johnson Johnson

Background: Background:

 Ireland has the 4

Ireland has the 4th

th highest recorded rate of asthma

highest recorded rate of asthma in the world and its prevalence worldwide is rising. in the world and its prevalence worldwide is rising.1

1

 However, hospital admissions for asthma have

However, hospital admissions for asthma have decreased in many developed countries. decreased in many developed countries.

 It has been hypothesised that this downward trend

It has been hypothesised that this downward trend in hospitalisations may be due to better prescribing in hospitalisations may be due to better prescribing and better primary care. and better primary care.2

2

1 1.

.

Asher

Asher et al et al (2006) Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and (2006) Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multi-country cross-sectional surveys. eczema in childhood: ISAAC Phases One and Three repeat multi-country cross-sectional surveys. Lancet, Lancet, 368: 368: 733–434. 733–434. 2

2

Korhonen et al, (2002). Hospitalization trends for paediatric asthma in eastern Finland:a 10-yr survey. Korhonen et al, (2002). Hospitalization trends for paediatric asthma in eastern Finland:a 10-yr survey. Eur Respir J., Eur Respir J., 19: 19: 1035–1039 1035–1039

Background: Background:

 No published studies in Ireland on

No published studies in Ireland on examining trends in hospital examining trends in hospital admission in children with asthma admission in children with asthma and the possible association between and the possible association between prescribing patterns for asthma prescribing patterns for asthma medications. medications.

Aim of the study: Aim of the study:

 To investigate ten year hospital

To investigate ten year hospital admissions and prescribing trends for admissions and prescribing trends for children with asthma in Ireland. children with asthma in Ireland.

Method: Method:

 Data extracted from Health Atlas database

Data extracted from Health Atlas database

 Morbidity data

Morbidity data based on HIPE data. All hospital based on HIPE data. All hospital discharges for patients aged <15 years with principal discharges for patients aged <15 years with principal diagnosis of asthma (ICD-9 Codes 493) from 2000-2004 diagnosis of asthma (ICD-9 Codes 493) from 2000-2004 and (ICD-10 Codes J45-J46) from 2005-2009. and (ICD-10 Codes J45-J46) from 2005-2009.

 Prescribing data

Prescribing data based on Primary Care Re- based on Primary Care Re- imbursement System (PCRS). Asthma-related drugs imbursement System (PCRS). Asthma-related drugs were identified using ATC Codes R03 were identified using ATC Codes R03

Statistical analyses: Statistical analyses:

 Data analysed using JMP, SAS and

Data analysed using JMP, SAS and StatsDirect. StatsDirect.

 Rates were age- standardized to the EU

Rates were age- standardized to the EU standard population (direct method). standard population (direct method).

 Poisson regression was used and

Poisson regression was used and significance set at p<0.05. significance set at p<0.05.

 Further trend analysis was carried out in

Further trend analysis was carried out in StatsDirect. StatsDirect.

Results- No. discharges/patients <15 yrs Results- No. discharges/patients <15 yrs with principal diagnosis asthma: with principal diagnosis asthma:

Year Year

• No. of discharges
• No. of discharges
• No. of Patients
• No. of Patients

2000 2000 2,534 2,534 2,241 2,241 2001 2001 2,411 2,411 2,129 2,129 2002 2002 2,171 2,171 1,900 1,900 2003 2003 2,280 2,280 2,010 2,010 2004 2004 2,536 2,536 2,186 2,186 2005 2005 2,567 2,567 2,226 2,226 2006 2006 2,654 2,654 2,338 2,338 2007 2007 1,935 1,935 1,656 1,656 2008 2008 1,910 1,910 1,664 1,664 2009 2009 1,799 1,799 1,565 1,565 Total Total 22,797 22,797 19,915 19,915

*12% are repeat admissions

Results: Results:

Test for trend: p=0.03

Figure 1. Age standardised hospital discharge rate 1,000 population for those aged 0-14 year with a principal diagnosis of asthma.

1 2 3 4 2 2 1 2 2 2 3 2 4 2 5 2 6 2 7 2 8 2 9 Year of discharge Rate per 1,000 population 0-14 yrs Linear ( 0-14 yrs)

JEAN DO YOU KNOW OF ANY REASON WHY SIGNIFICAN REDUCTION IN HOSP. DISCHARGES IN 2007??

Results: Results:

Figure 2. Age standardised discharge rate per 1,000 population with principal diagnosis of diseases of the digestive system (ICD- 10 K00-K93 ) for 0-14 year olds.

2 4 6 8 10 12 14 2005 2006 2007 2008 2009 Year of Discharge Rate per 1000 population Diseases of the digestive system for 0-14 year olds Linear (Diseases of the digestive system for 0-14 year olds)

Test for trend: p>0.08 JEAN: THIS IS IN HERE TO SHOW THAT THE REDN. IN HOSP ADMS IN 2007 NOT SEEN IN OTHER DISEASES SO LIKELY TO BE REAL!

Results: Results:

Figure 3. Age-specific rates for those those with a principal diagnosis of asthma on hospital discharge.

1 2 3 4 5 6 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year of discharge

Rate per 1000 population

0-4 yrs 5-9 yrs 10-14 yrs

Significant linear trend for age-grpups 0-4 years and 10-14 years.

Results-Demographic profile: Results-Demographic profile:

 Male to Female Ratio 1.82:1

Male to Female Ratio 1.82:1

 Most common age group – 0-4 years

Most common age group – 0-4 years

 22,705 (99.5%) discharged home

22,705 (99.5%) discharged home

 8,531 (37.4%) discharges medical card holders

8,531 (37.4%) discharges medical card holders

 Median LOS 2 days (range 1-47)

Median LOS 2 days (range 1-47)

 Significant reduction in Median LOS from 2006

Significant reduction in Median LOS from 2006

• nwards (2 days vs. 1 day, p<0.001)
• nwards (2 days vs. 1 day, p<0.001)

 46,363 bed days used over ten year study period.

46,363 bed days used over ten year study period.

 155 (0.7%) discharges involved stay in ICU – 304

155 (0.7%) discharges involved stay in ICU – 304 ICU bed days ICU bed days.

.

Results-Prescribing data: Results-Prescribing data:

 In 2000, 50,447 children received

In 2000, 50,447 children received asthma medications which had asthma medications which had increased to 73,184 children by increased to 73,184 children by 2009. 2009.

 Males and the youngest age were

Males and the youngest age were most likely to receive asthma most likely to receive asthma medication. medication.

Results-Prescribing Results-Prescribing

Figure 3. Age-standardised rate for asthma perscribing in children (0-15 years) 2000-2009 50 100 150 200 250 300 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Age standardised rate per 1000 GMS eligible pop (95% CI)

*significant upward linear trend, p<0.001

NOTE FOR JEAN: This is all RO3 prescribing for children NOTE FOR JEAN: This is all RO3 prescribing for children – is this what you would like to see – is this evidence of – is this what you would like to see – is this evidence of good prescribing??? good prescribing???

Figure 4. Prescribing of asthma medications to children (0-15yrs) for years 2000-2009 by type of drug.

20 40 60 80 100 120 140 160 180

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Rate per 1000 GMS eligib

Selective b2 agonists-inhalant Adrenergics-inhalant Glucocorticoids-inhalant Anticholinergics-inhalant Antiallergics-inhalant Nonselective b2 agonists-systemic Selective b2 agonists -systemic Xanthines-systemic Leukotriene receptors-systemic

Strengths and Limitations: Strengths and Limitations:

 First study of its kind in Ireland to look at prescribing

First study of its kind in Ireland to look at prescribing patterns and hospital discharges. patterns and hospital discharges.

 Study covers a long time period – essential to

Study covers a long time period – essential to minimize random variation. minimize random variation.

 Although there was a change in ICD code during study

Although there was a change in ICD code during study period it has been suggested that ICD-9 and ICD-10 period it has been suggested that ICD-9 and ICD-10 codes for asthma are strongly correlated –so decrease codes for asthma are strongly correlated –so decrease not likely to be a coding issue. not likely to be a coding issue.

Strengths and Limitations: Strengths and Limitations:

 Morbidity data from HIPE based on those <15 years for ease

Morbidity data from HIPE based on those <15 years for ease

• f calculation of age standardised rates.
• f calculation of age standardised rates.

 Prescribing data from PCRS based on data obtained from the

Prescribing data from PCRS based on data obtained from the General Medical Services (GMS) scheme different age groups. General Medical Services (GMS) scheme different age groups.

 Eligibility for the PCRS scheme is means-tested for those

Eligibility for the PCRS scheme is means-tested for those under 70 yrs of age. under 70 yrs of age.

 Cannot be considered representative of the entire population

Cannot be considered representative of the entire population

• socially disadvantaged and elderly over-represented.
• socially disadvantaged and elderly over-represented.

 Captures approx. 28% of all prescribing in this age-group

Captures approx. 28% of all prescribing in this age-group

Strengths and Limitations: Strengths and Limitations:

 Data from PCRS on demographic details of patient,

Data from PCRS on demographic details of patient, information of drugs prescribed but information of drugs prescribed but no no diagnostic data. diagnostic data.

 No data on A& E attendances the reduction in hospital

No data on A& E attendances the reduction in hospital admissions may be due to better care in A&E. admissions may be due to better care in A&E.

 We are currently working with A&E consultants.

We are currently working with A&E consultants.

Summary: Summary:

 The number and age standardised rate for hospital

The number and age standardised rate for hospital discharges for asthma has decreased significantly over the discharges for asthma has decreased significantly over the 10 year study period- similar to findings in Finland. 10 year study period- similar to findings in Finland.

 There has also been a significant increase in the number and

There has also been a significant increase in the number and rate of prescribing of asthma drugs rate of prescribing of asthma drugs (JEAN WHICH DRUG IS (JEAN WHICH DRUG IS INDICATIVE OF GOOD PRESCRIBING?) INDICATIVE OF GOOD PRESCRIBING?)

 .

.

 This study suggests that

This study suggests that increased or can I say better??? increased or can I say better??? (IS THIS TRUE) (IS THIS TRUE) prescribing is associated with decreased risk prescribing is associated with decreased risk

• f hospitalisation for children with asthma.
• f hospitalisation for children with asthma.

 Further studies need to be carried out to determine if there

Further studies need to be carried out to determine if there has been a concomitant decrease in A&E admissions for has been a concomitant decrease in A&E admissions for paediatric asthma over the study time-period. paediatric asthma over the study time-period.

Acknowledgements: Acknowledgements:

 All co-authors in particular Dr.

All co-authors in particular Dr. Kathleen Bennett who provided us Kathleen Bennett who provided us with the PCRS data and Dr. Howard with the PCRS data and Dr. Howard Johnson for providing the Health Johnson for providing the Health Atlas Data. Atlas Data.