Barriers to prescribing controller anti-inflammatory medication among puerto rican asthmatic children with public insurance: Results of national survey of pediatricians

There are substantial disparities in dispensing patterns of long-term control medications for asthma among children in Puerto Rico with public insurance compared to those with private insurance. Public health insurance policy in Puerto Rico includes the cost of medications in the capitation paid to the primary care physicians and clinics. Survey questionnaires were mailed to all pediatricians enrolled in the Puerto Rico College of Physicians (N=798) in addition to some pediatricians not enrolled in the College (N=25) for a total of 823 pediatricians. Of these, 722 were eligible pediatricians with 458 responding to the survey for a response rate of 63.4%. Most of the respondents expressed being moderately to very familiar with the National Asthma Education and Prevention Program guidelines (71.7%) and with the National Asthma Education and Prevention Program recommendations for controller asthma medication use (73.5%). Inadequate capitation to cover asthma medication (86.2%) and lack of adequate health insurance coverage of the patient (83.2%), however, were the most frequent barriers reported by pediatricians for prescribing controller asthma medication to children with public health insurance. The most frequent strategies used to provide controller asthma medication to these children were prescription of oral medications (59.5%) and giving away samples (44.7%). Current public health insurance policy in Puerto Rico creates a disincentive to the appropriate prescription of long-term control medication for children with asthma. To improve the quality of asthma care of children in Puerto Rico, revision of this public health insurance policy is necessary.