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Financial Barriers May Increase Emergency Room Visits for Children with Asthma

A new Canadian study, led by an AllerGen Networks of Centres of Excellence investigator, reveals that financial barriers — in the form of sharing asthma medication costs between insurers and families — are contributing to poor asthma control in children.

This is the first study to examine the effects of medication cost-sharing as a percentage of household income, on health outcomes in children with asthma. Findings are published in the January 2011 issue of Annals of Allergy, Asthma & Immunology.

Recognizing the low rate of asthma control in Canadian children, the research team led by Dr. Wendy Ungar, senior scientist in Child Health Evaluative Sciences at The Hospital for Sick Children (SickKids) and an AllerGen NCE investigator, set out to examine the factors contributing to severe asthma attacks that result in emergency department visits or hospitalizations in children.

The cohort study looked at data from 490 Toronto-area children, aged 1 to 18 years of age, with asthma. The research team was particularly interested in the relationship of certain demographic factors, including socio-economic status, health status, health resource use, symptoms, and drug coverage, to asthma control.

A highly significant finding in the sub-group of drug plan holders was that for every 1 percent increase in family income spent out-of-pocket on a child’s asthma medications, there was a 14 percent increase in the number of severe asthma attacks resulting in an emergency room visit or hospital admission.

“It was concerning to see that as parents faced higher out-of-pocket costs for their child’s asthma medications, severe asthma attacks increased,” says Ungar. “Understanding the health impact of financial barriers, in the form of deductibles and co-payments, is critical evidence in the formulation of effective drug policy as drug plans increasingly seek ways to contain costs while preserving patient health.”

The research team found the following factors were significantly associated with more frequent asthma attacks requiring urgent care: younger age; previous emergency visits; nebulizer use; pet ownership; and having asthma education, but no management or action plan. Having an asthma action plan was found to significantly reduce the number of severe asthma attacks. Moreover, children from families with high income adequacy, a measure that combines household income with family size, had 28 percent fewer severe asthma attacks than children with low income adequacy.

In addition to the above findings, the researchers looked at a subgroup within the data sample, all of whom had drug insurance, and found that girls had 26 percent fewer exacerbations than boys. Children in this subgroup with food, drug, or insect allergies also had 52 percent more severe asthma attacks than did children without allergies. Meanwhile, children of families with annual insurance deductibles greater than $90 had 95 percent fewer exacerbations.

The study was conducted in collaboration with the Institute for Clinical Evaluative Sciences and was supported by AllerGen NCE Inc. (the Allergy, Genes and Environment Network), a member of the Networks of Centres of Excellence program; the Canadian Institutes of Health Research (CIHR); and SickKids Foundation.

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