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Annals of Family Medicine 7:32-40 (2009)
© 2009 Annals of Family Medicine, Inc.
doi: 10.1370/afm.910
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What Drives Prescribing of Asthma Medication to Children? A Multilevel Population-Based Study

Mira G. P. Zuidgeest, PharmD, PhD1,3, Liset van Dijk, PhD2, Peter Spreeuwenberg, MA2, Henriëtte A. Smit, MD, PhD3, Bert Brunekreef, PhD4,5, Hubertus G. M. Arets, MD, PhD6, Madelon Bracke, PhD1 and Hubert G. M. Leufkens, PharmD, PhD1

1 Division of Pharmacoepidemiology & Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands
2 NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
3 Centre of Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
4 Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
5 Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
6 Department of Paediatric Pulmonology, Wilhelmina Children’s Hospital, University Medical Centre, Utrecht, The Netherlands

CORRESPONDING AUTHOR: Bert Leufkens, PhD, Division of Pharmacoepidemiology & Pharmacotherapy, Utrecht University, PO Box 80082, 3508 TB, Utrecht, The Netherlands, h.g.m.leufkens{at}uu.nl

PURPOSE Diagnosing asthma in children with asthmatic symptoms remains a challenge, particularly in preschool children. This challenge creates an opportunity for variability in prescribing. The aim of our study was to investigate how and to what degree patient, family, and physician characteristics influence prescribing of asthma medication in children.

METHODS We undertook a multilevel population-based study using the second Dutch national survey of general practice (DNSGP-2), 2001. Participants were 46,371 children aged 1 to 17 years belonging to 25,537 families registered with 109 general practitioners. Using a multilevel multivariate logistic regression analysis with 3 levels, our main outcome measure was the prescribing of asthma medication, defined as at least 1 prescription for β2-adrenergic agonists, inhaled corticosteroids, cromones, or montelukast during the 1-year study period.

RESULTS We identified characteristics significantly associated with prescribing asthma medication on all 3 levels (child, family, and physician). The variance in prescribing among physicians was significantly higher with children who were younger than 6 years than with children aged 6 years and older (95% CI, 3.5%–25.2% vs 2.4%–13.4%). Several diagnoses other than asthma and asthmatic complaints were strongly associated with prescribing asthma medication, including bronchitis/bronchiolitis (OR = 9.04; 95% CI, 7.57–10.8) and cough (OR = 6.51; 95% CI, 5.68–7.47).

CONCLUSIONS Our study shows a much higher variance in prescribing patterns among general practitioners for children younger than 6 years compared with older children, which could be a direct result of the diagnostic complexities found in young children with asthmatic symptoms. Thus diagnostic gaps may lead to more physician-driven prescribing irrespective of the clinical context.

Key Words: Asthma/child • asthma/child, preschool • family practice • professional practice • multilevel • pharmacoepidemiology • prescribing




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