Purpose: Urban children with asthma have higher rates of non-adherence to inhaled corticosteroids (ICS) medication. Inadequate controller ICS usage results in poorly controlled asthma and increased asthma morbidity. Many barriers may contribute to the ICS non-adherence (including income, social barriers, and geographic barriers). To date, little research has examined relationships between distance to the pharmacy and number of medical refills in inner city populations. The objective of this work is to examine the relationship between distance to the retail pharmacies use and the number of ICS medical refills, the latter being used as a market of adherence in urban children with asthma.
Method: Pharmacy records over the previous 12 months were acquired for 82 urban children ages 3 to 10 with mild to severe persistent asthma who were recruited into a randomized clinical trail. Distance from the child's home to each pharmacy that the caregivers reported being used were matched with the number of ICS fills and short acting beta antagonist (SABA) fills. Chi-square tests were used to assess any associations between distance to the pharmacy and the number of fills.
Result: Children were primarily African American (100%), male (65%), with a main age of 5.2 years. Most children had >1 ED visit/6 months (975). Distance to pharmacies ranged from 0.3 to 20.1 miles. Most children had 2 or fewer pharmacies (55/82, 67%). Mean distance to 1st and 2nd pharmacies were 3.2 and 3.3 miles respectively (median 1.5 and 2.3 miles). Mean number of SABA fills (4.0, SD 3.6) was higher than mean ICS fills (3.0, SD 2.7). Having 3 or more ICS fills over the past 12 months was not statistically significantly associated with the distance to the first pharmacy being less than 1 mile. Familes reporting having one 1 primary pharmacy had the highest mean ICS fills (3.0, SD 2.7) although the number of fills was not statistically significantly associated with the number of pharmacies used.
Conclusion: Distance from home to pharmacies is not a main factor driving non-adherence to asthma control medication in this sample of urban chidlren. Funding Source: National Institute of Nursing Research NR 010546
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