36 - Discordance in Medication Adherence in Children with Simultaneous Persistent Asthma and Attention Deficit Hyperactivity Disorder

Poster Number: 36
Publication Number: 36.300

Lucy C. Holmes, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, United States; Samantha Eng, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, United States; Brian Wrotniak, John R. Oishei Children's Hospital, Buffalo, NY, United States

Background: Adherence to inhaled corticosteroids (ICS) in patients with persistent asthma improves clinical outcomes, and yet is typically poor. There are many diverse barriers to medication adherence and it is difficult to identify which barriers may be more influential and amenable to intervention. Yet, identifying the more dominant barriers is important so limited resources can be used most effectively. One method to identify more or less crucial barriers to ICS adherence in children with asthma is to compare ICS adherence to attention deficit disorder (ADHD) medication adherence in children who simultaneously have both diagnoses. If the adherence to these medications are significantly different in the same patient, then barriers that should affect both medications can be considered less impactful.

Objective: To compare adherence to ICS and ADHD medications in children ages 5 to 16 years with simultaneous persistent asthma and ADHD, persistent asthma alone, and ADHD alone.

Design/Methods: We reviewed pharmacy refill data from children ages 5 to 16 years, seen in an urban predominately Medicaid, pediatric clinic in 2017, and with billing codes for asthma or ADHD on the date of service (DOS). Children met inclusion criteria if they had persistent asthma or ADHD and were prescribed an ICS or ADHD medication, respectively, for 12 continuous months from the initial DOS. Children who did not fill at least one prescription were excluded. We calculated medication adherence to inhaled corticosteroids (ICS) and ADHD medications using Proportion Days Covered (PDC). We also compared PDC for ICS between patients with both diagnoses and asthma alone, matching by asthma severity and age. We compared PDC for ADHD medication between patients with both diagnoses and ADHD alone, matching by age.

Results: We identified 1491 children with asthma and/or ADHD. Forty-four children met inclusion criteria for simultaneous persistent asthma and ADHD. (Figure 1) In these children, PDC was 25% for ICS and 60% for ADHD medication. (p < 0.001) In children with persistent asthma alone PDC was 25% for ICS, while in children with ADHD alone PDC was 66% (p=0.795). (Table 1)Conclusion(s): Patients with simultaneous persistent asthma and ADHD are significantly less likely to fill their ICS than their ADHD medication. Children who have both diagnoses did not have improved medication adherence for the corresponding disease than those who had one diagnosis. This suggests that within a predominately Medicaid population, barriers such as cost, access to pharmacies, health literacy, education, and culture may be less influential barriers to ICS adherence.
Figure 1Consort Flow Diagram
Table 1Demographics, Asthma Severity Level, and Proportion Days Covered (PDC)