OBJECTIVES: To examine the patient and provider factors associated with prescribing of asthma medications in pediatric office visits.

METHODS: This cross-sectional study utilized data from 2012-2014 National Ambulatory Medical Care Survey (NAMCS) and included patients aged 6-17 years, with asthma as a primary diagnosis (ICD9-CM 493.xx). The study examined prescribing of asthma medication classes such as short acting beta agonists (SABAs), inhaled corticosteroids (ICS), oral corticosteroids (OCS), and leukotriene modifiers (LTM). Descriptive weighted analysis evaluated asthma medication prescriptions. Multivariable logistic regression analyses examined factors associated with asthma prescribing practices.

RESULTS: An estimated 2.6 million pediatric office visits were made annually for asthma as a primary diagnosis. The majority of asthma visits involved males (58.8%), children aged 6-11 years (58.8%), and whites (77.8%). Asthma control was documented in 38.2% of the visits and asthma medications were prescribed in 82.4% of the visits. Visits without documentation of asthma control were associated with higher odds of ICS (OR=2.1) and OCS (OR=3.6) prescriptions. Visits in South (OR=2.9), those involving established patients (OR=3.7), visits with pediatricians (OR=2.9), and with documentation of uncontrolled asthma (OR=6.2) were associated with higher odds of OCS prescriptions. Only Midwest region (OR=3.1) was associated with higher odds of SABA prescriptions. Medicaid (OR=0.4), general practitioner (OR=0.3) and pediatric specialist (OR=0.2) were associated with lower odds of LTM prescriptions.

CONCLUSIONS: Documentation of asthma control was lacking in more than 60% of office visits and was associated with increased use of OCS. Furthermore, controlling for documentation of control status, we found higher odds of OCS and ICS prescriptions based on geographic region and provider specialty. These findings suggest that evaluation and documentation of asthma control is an important first step to improve the quality of pediatric asthma care.