Journal of Asthma and Allergy (Jan 2024)

A Retrospective Claims Database Study to Clarify Treatment Reality of Asthma Patients Before and After Referral to a Specialist

  • Hozawa S,
  • Ono K,
  • Makita N,
  • Uchimura H,
  • Arita Y,
  • Hirai T,
  • Tashiro N

Journal volume & issue
Vol. Volume 17
pp. 9 – 19

Abstract

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Soichiro Hozawa,1 Keita Ono,2 Naoyuki Makita,3 Hitomi Uchimura,3 Yoshifumi Arita,3 Takehiro Hirai,2 Naoki Tashiro3 1Hiroshima Allergy and Respiratory Clinic, Hiroshima, Japan; 2AstraZeneca K.K., Tokyo, Japan; 3AstraZeneca K.K., Osaka, JapanCorrespondence: Soichiro Hozawa, Hiroshima Allergy and Respiratory Clinic, 6F, 1-9-28 Hikari-machi, Higashi-ku, Hiroshima, 732-0052, Japan, Tel +81-82-568-1167, Fax +81-82-568-1239, Email [email protected]: Japanese guidelines recommend that patients with uncontrolled asthma be referred by non-specialists to specialists (allergists and/or pulmonologists). This study investigated the reality of clinical practice in asthma patients referred to specialists in Japan.Patients and Methods: This was a retrospective, observational cohort study of asthma patients in a health insurance claim database (Cross Fact) referred from facilities with non-specialists to those with specialists from January 2016 to December 2018. The referred asthma patients were defined as patients with ≥ 4 inhaled corticosteroid (ICS)-containing prescriptions during a 1-year baseline period, with an asthma diagnosis, and who had visited a facility with specialists. Asthma exacerbation, maintenance treatment, laboratory tests, and medical procedures before and after referral were analyzed.Results: Data for 2135 patients were extracted, of which 420 with referral codes were analyzed. The proportion of patients with asthma exacerbations was 50.2% (95% confidence interval [CI]: 45.4– 55.1%) before referral and 37.4% (95% CI: 32.7– 42.2%) after, a significant decrease (P< 0.001; McNemar test). The proportions of patients prescribed ICS alone, long-acting beta-agonists (LABA), and ICS/LABA were lower after referral than before, but the proportions of patients prescribed long-acting muscarinic antagonists (LAMA), ICS/LABA/LAMA, and biologics increased after referral. More asthma-related laboratory tests were performed after referral, and spirometry incidence increased from 16.4% before referral to 51.4% after referral.Conclusion: This study shows a decrease in asthma exacerbations, change in asthma treatments, and increase in laboratory tests after referral to a specialist, suggesting that referrals to specialists lead to better management of asthma.Keywords: asthma, database, referral, specialist, symptom exacerbation

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