Asthma prescription patterns for children: can GPs do better?

Figures & data

Table I. Types of asthma medication prescribed in 2993 children with asthma (aged 0–17 years) in 6686 contacts resulting in a prescription for asthma (%).

Age groupSex	0–5 years			6–17 years
	Boys	Girls	Total	Boys	Girls	Total	All Total
Total number of contacts	1850	1086	2936	2023	1727	3750	6686
Type of asthma medication
Bronchodilators	47.6%	46.0%	47.0%	55.4%	59.4%	57.2%	52.8%
Corticosteroids	57.0%	53.8%	55.8%	49.6%	46.0%	48.0%	51.4%
Antibiotics	4.9%	5.0%	4.9%	3.0%	2.1%	2.6%	3.6%
Anticholinergics	2.9%	3.1%	3.0%	1.1%	1.3%	1.2%	2.0%
Leukotriene antagonists	0.2%	0.3%	0.2%	1.0%	1.1%	1.0%	0.7%
Mucolytics	0.4%	0.5%	0.4%	1.0%	0.5%	0.7%	0.6%
Cromones	0.3%	0.3%	0.3%	0.2%	1.2%	0.6%	0.5%

Sum of proportions > 100%, because during a consultation more than one prescription could be issued.

Table II. Type of asthma prescription for children with asthma aged 0–5 years (n = 1398) and 6–17 years (n = 1595) during a one-year registration period.

AgeSex	0–5 years			6–17 years
	Boysn = 860	Girlsn = 538	Totaln = 1398	Boysn = 876	Girlsn = 719	Totaln = 1595	All Totaln = 2993
Number of prescriptions
1			38%			35%	36%
2			26%			23%	25%
3			36%			41%	39%
Prescription type
Intermittent medication (1 or 2 prescriptions per medication type)
Bronchodilators only	31.7%	32.3%	31.9%	30.4%	30.2%	30.3%	31.0%
Corticosteroids only	20.1%	21.2%	20.5%	17.4%	15.3%	16.4%	18.3%
Bronchodilators + corticosteroids	22.2%	18.6%	20.8%	22.0%	20.9%	21.5%	21.2%
Continuous medication (≥3 prescriptions per medication type)
Bronchodilators only	1.9%	3.2%	2.5%	5.1%	6.9%	6.0%	4.4%
Corticosteroids only	6.3%	6.7%	6.4%	5.0%	5.2%	5.1%	5.7%
Bronchodilators + Corticosteroids^a	11.4%	9.1%	10.5%	12.9%	13.3%	13.1%	11.9%
Only other respiratory medication^b	6.4%	8.9%	7.4%	7.2%	8.2%	7.6%	7.5%

^a≥ 3 prescriptions bronchodilators and/or ≥ 3 prescriptions corticosteroids.

^bi.e. without bronchodilators and/or corticosteroids.

Table III. Characteristics of 174 general practitioners (GPs) in 87 general practices.

Mean age, years (SD)	46.5 (5.5)
Male sex	76.3%
Urban	62.1%
Single-handed practice	49.1%
Practice size, mean (SD)	4272 (2333)
Workload (number of patients per full-time equivalent GP) (SD)	2666 (481)
Consulting general practice national guidelines more than once a week	52.7%
GP trainer	67.1%
Seeing pharmaceutical representatives	74.1%
Reluctant to prescribe new drugs	88.2%

Table IV. Relation between GP and child determinants and prescribing continuous asthma medication (≥3 prescriptions/year) for children with asthma aged 0–17 years (n = 2993). Multivariate logistic regression analysis.

	Children 0–5 years(n = 1398)OR (95% CI)	P-value	Children 6–17 years(n = 1595)OR (95% CI)	P-value
Child's characteristics
Age of child	1.07 (0.99–1.17)	0.09	0.99 (0.95–1.03)	0.78
Female child	0.99 (0.69–1.29)	0.95	1.13 (0.85–1.41)	0.33
GP's characteristics
Age of GP	1.00 (0.96–1.05)	0.56	0.98 (0.95–1.02)	0.34
Male GP	1.00 (0.99–1.01)	0.06	1.01 (1.00–1.01)	0.02
Urban practice	1.17 (0.98–1.38)	0.16	1.08 (0.94–1.22)	0.23
Single-handed practice	1.41 (0.96–2.61)	0.15	0.73 (0.53–1.15)	0.09
Workload (1000 patients/fte)	1.00 (0.99–1.01)	0.82	1.00 (0.99–1.01)	0.94
Consulting national guidelines > 1/week	1.00 (0.99–1.01)	0.99	0.99 (0.99–1.01)	0.89
GP trainer	1.00 (0.99–1.01)	0.21	1.00 (0.62–1.38)	0.99
Seeing pharmaceutical representatives	1.00 (0.99–1.01)	0.38	1.00 (0.99–1.01)	0.94
Reluctant to prescribe new drugs	1.00 (0.99–1.01)	0.38	1.00 (0.99–1.01)	0.10

Odds ratio, OR; fte, full-time equivalent GP.