This indicator shows the number and percent of people aged 5 –44 years who were not regularly dispensed ICS in the four quarters after discharge for an admission with a primary diagnosis of asthma. Regular dispensing was defined as dispensing in two or more quarters in the year post discharge. This was calculated using the date of discharge and dividing the following 365 days into four quarters.
High rates of people not receiving regular ICS in the year post discharge suggests non-adherence to best practice guidelines and suboptimal disease management.
- the same quarter as the last hospital discharge date in the calendar year (looking at the last discharge date avoids Atlas of Healthcare Variation: Methodology | Asthma Page 14 of 24 double-counting people who have multiple hospital admissions)
- the four quarters after the last hospital discharge date.
Numerator detail
People aged 5-44 years who weren't dispensed following medications for at least 2 quarters in the year after hospital admission due to asthma (or wheeze in children under 11 years)
Inhaled corticosteroids: 110801,110802, 110803, 110804, 110805, 110806, 110807, 110808, 110809, 110815, 110816, 110825, 110826 & 110827 Beclomethasone dipropionate; 116801, 116802, 116803, 116804 & 116805 Budesonide; 106501, 106502, 106503, 106504, 106505, 106506, 106507, 106508, 106509, 106510, 106511, 106512, 106513, 106514 & 106525 Fluticasone
Inhaled corticosteroids with long-acting beta-adrenoceptor agonists: 375825, 375826, 375827, 375828, 375829, 375830 & 375831 Budesonide with eformoterol; 385825, 385826, 385827 & 385828 Fluticasone with salmeterol; 405625 Fluticasone furoate with vilanterol
Numerator exclusions
For people with more than one admission in a year, if one admission met the criteria of two or more dispensing of inhaled corticosteroid then they were excluded from the numerator.
Denominator detail
- Code (ICD10 AM):
- J45 Asthma (for everyone);
- J46 Status Asthmaticus (for everyone);
- R06.2 Wheeze (for children aged 5–11 years)
Disaggregation
District analysis: By year (2019 –2023), age group (5 –11, 12 –24, 25 44), gender (female, male), ethnic group (Māori, Pacific peoples, European/Other), and Health New Zealand district of domicile. PHO analysis: By year (2023), age group, gender, ethnic group, Primary Health Organisation (PHO) most recently enrolled with (for the relevant year), PHO group (small, medium, medium-large and large).
People who were excluded from analysis include:
- those who aren’t enrolled in a PHO in the calendar year. This allowed us to use the number of PHO-enrolled people as the denominator.
- individuals with missing demographics – that is, those with no recorded value for one or more of the NHI fields used to derive the demographic variables of interest (age, gender, ethnicity and district of domicile). For instance, if there are any missing values for age, they are excluded from all analyses. This approach ensures a consistent denominator throughout the analyses.
Age group is assigned using 30 June of each calendar year as the cutoff point. For example, if a person turned 45 years old on 1 July 2023, they will still be considered 44 years old for 2023.
People who died during the calendar year are excluded from this indicator.
Data is not presented where the number of people in the numerator was less than 10. This is to preserve confidentiality.
In contrast to other atlases, and following advice, we defined regular dispensing as the medication dispensed in two or more quarters of the calendar year. The reason for this difference is that some inhalers can last for more than three months.