Suboptimal Use of Inhaled Corticosteroids in Children with Persistent Asthma: Inadequate Prescription, Poor Drug Adherence, or Both?
Bibliographic record
Abstract
STUDY OBJECTIVE: To assess the use of inhaled corticosteroids in children with persistent asthma, including patients' adherence to these drugs and physicians' prescribing patterns, by using a novel drug adherence measure, the Proportion of Prescribed Days Covered (PPDC). DESIGN: Retrospective analysis. DATA SOURCE: Two administrative claims databases in Quebec, Canada. PATIENTS: Two thousand three hundred fifty-five children aged 5-15 years with persistent asthma who used more than 3 doses/week on average of a short-acting β-agonist during a 12-month period before beginning treatment with inhaled corticosteroids between 1997 and 2005. MEASUREMENTS AND MAIN RESULTS: The PPDC measure was defined as the total days' supply dispensed divided by the total days' supply prescribed. During the 12-month follow-up period, 20% of the children received only one prescription for inhaled corticosteroids with no prescribed renewals. The mean number of prescriptions (including prescribed renewals) was 5.0, corresponding to only 152 days' supply prescribed. Mean PPDC (drug adherence) was 62.4%. Only 25% of the patients had controlled asthma, based on the use of 3 or fewer doses/week of short-acting β(2)-agonists and absence of moderate-to-severe exacerbations. CONCLUSION: A large percentage of children with persistent asthma were prescribed intermittent rather than daily inhaled corticosteroids, and patient adherence to these drugs was suboptimal even though children had free access to their drugs. Many of these patients continued to experience poor asthma control. The PPDC adherence measure developed for this study allowed a better understanding of the gap between treatment goals and asthma control.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".