An observation of prescription behaviors and adherence to guidelines in patients with COPD: real world data from October 2012 to September 2014

Visentin, E.; Nieri, Dario; Vagaggini, Barbara; Peruzzi, Elena; Paggiaro, Pierluigi

doi:10.1080/03007995.2016.1182900

Cited by 19 publications

(13 citation statements)

References 14 publications

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“… 23 The rate of guideline adherence for pulmonologists in Turkey was 59.5% according to the earlier 2006 GOLD report. 24 The guideline adherence rate was even lower for general practitioners (GPs) than for pulmonologists in Italy, 25 and the rate was as low as 8% for GPs in a Shanghai suburb. 26 Our data, revealed that the concordance rate of pharmacological management of COPD patients was 60.9% for pulmonologists according to the GOLD 2011.…”

Section: Discussionmentioning

confidence: 99%

The impact of 2011 and 2017 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines on allocation and pharmacological management of patients with COPD in Taiwan: Taiwan Obstructive Lung Disease (TOLD) study

Hsieh¹,

Huang²,

Yang³

et al. 2018

COPD

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BackgroundThis nationwide study was performed to evaluate the evolution of distributions of patients with COPD according to the 2011 and 2017 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines and to assess the concordance between the prescribed medications and the pharmacological management recommended by the two distinct classification systems in Taiwan.Subjects and methodsData were retrospectively retrieved from stable COPD patients in 11 participating hospitals across Taiwan. Patients were grouped according to GOLD 2011 and 2017 guidelines respectively. Definitions of undertreatment and overtreatment were based on the pharmacological recommendations in the individual guidelines.ResultsA total of 1,053 COPD patients were included. The percentages of patients in GOLD 2011 groups A, B, C and D were 18.4%, 40.6%, 6.7% and 34.2%, respectively. When reclassified according to the GOLD 2017, the percentages of group A and B increased to 23.3% and 63.2%, and groups C and D decreased to 1.9% and 11.6%, respectively. Up to 67% of patients in GOLD 2011 groups C and D were reclassified to GOLD 2017 groups A and B. The pharmacological concordance rate was 60.9% for GOLD 2011 and decreased to 44.9% for GOLD 2017. Overtreatment was found in 29.5% of patients according to GOLD 2011 and the rate increased to 46.1% when classified by the GOLD 2017. The major cause of overtreatment was unnecessary inhaled corticosteroids and the main cause of undertreatment was a lack of maintenance long-acting bronchodilators.ConclusionThe distribution of COPD patients in Taiwan was more uneven with the GOLD 2017 than with the GOLD 2011. A pharmacological discordance to the guidelines was identified. Updated guidelines with reclassification of COPD patients resulted in more discordance between prescribed medications and the guidelines. Physicians should make proper adjustments of the prescriptions according to the updated guidelines to ensure the mostly appropriate treatment for COPD patients.

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Section: Discussionmentioning

confidence: 99%

The impact of 2011 and 2017 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines on allocation and pharmacological management of patients with COPD in Taiwan: Taiwan Obstructive Lung Disease (TOLD) study

Hsieh¹,

Huang²,

Yang³

et al. 2018

COPD

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“… 5 , 10 Second, there was a relatively high proportion of women participating in the survey. However, real-world data obtained from GP and PUL medical records from IMS Health 14 and a recent review of epidemiological and clinical data concluded that the paradigm of COPD is changing from a male-predominant disease to a disorder with a growing female prevalence. 15 Third, another limitation is the patients’ self-reported diagnosis of COPD.…”

Section: Discussionmentioning

confidence: 99%

Perception of symptoms and quality of life – comparison of patients’ and physicians’ views in the COPD MIRROR study

Celli¹,

Blasi²,

Gaga³

et al. 2017

COPD

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ObjectivesThe aim of this study was to compare potential differences between the perception that COPD patients have of their disease and the perception that physicians have of how the disease affects their patients.MethodsSurveys in COPD patients and physicians caring for COPD patients were conducted in Spain, Italy, and Germany. Online questionnaires mirrored to explore the same domains, were administered to patients and physicians. Physicians were asked to respond to the questionnaire taking a recently seen patient who represents the majority of COPD patients usually managed, as a reference. Patients with COPD completed a survey containing the same questions offered to the physicians (Medical Investigation of Respiratory COPD Perception [MIRROR] survey). Comparisons between the responses of patients and general practitioners (GPs) and between patients and pulmonologists (PULs) were run separately using the chi-square, Fisher’s exact, or Student’s t-tests.ResultsA total of 334 COPD patients, 333 GPs, and 333 PULs participated in the surveys. The typical perception that PULs have of the COPD patient was that of an older man with more severe disease and less likely to be a smoker, than the included COPD patients. COPD was regarded as a major health problem by patients and physicians, but its impact on overall quality of life among more severe patients was less strongly perceived by physicians than by patients. Instead, physicians paid more attention to domains related to clinical features (cough, phlegm, and dyspnea), while underestimating COPD impact on leisure and social activities. The majority of patients stated not being completely frank with their doctors during visits. Both GPs and PULs seemed to recognize this issue but underestimated its extent.ConclusionTo improve the doctor–patient communication, a more frank reporting by the patients of their symptoms and feelings and an increased awareness of physicians about the impact on nonconventional domains that patients perceive as importantly affected by COPD should be encouraged.

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“…These patients are representative of the Italian population by age, gender, medical conditions and death rates, after adjustment for demographics and social deprivation. The database includes clinical and laboratory information of all patients followed by a group of about 900 general practitioners (GPs), uniformly distributed throughout the whole Italian national territory [10, 11]. These GPs have voluntarily agreed to take part in this research panel, attend specific training courses and use standard software to collect data during consultations.…”

Section: Methodsmentioning

confidence: 99%

“…To be considered for participation in the IMS Health LPD, GPs must meet up to standard quality criteria pertaining to the levels of coding, prevalence of diseases, mortality rates, and years of recording [12]. Quality and consistency of data collected in the database have been demonstrated and validated through several studies in which the retrieved information has been compared with other current data sources or findings from national surveys [10, 11]. …”

Section: Methodsmentioning

confidence: 99%

Clinical Implications of Switching Lipid Lowering Treatment from Rosuvastatin to Other Agents in Primary Care

et al. 2016

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IntroductionSwitching from any statin to another non-equipotent lipid lowering treatment (LLT) may cause a low-density lipoprotein cholesterol increase and has been associated with a higher probability of negative cardiovascular outcomes. The aim of the study was to assess the impact of switching from rosuvastatin to any other LLT on clinical outcomes in primary care.MethodsThis was a retrospective analysis based on data from IMS Health Longitudinal Patient Database, which is a general practice database including information of more than 1.0 million patients representative of the Italian population by age, and medical conditions. Patients that started on rosuvastatin (10–40 mg/day) between January 2011 and December 2013 were considered. The date of the first prescription was defined as the index date (ID). The observation period lasted from the ID to September 2015 or until LLT discontinuation, or the occurrence of an acute myocardial infarction (AMI), or death.ResultsThe primary end point of the study was the occurrence of an AMI during the observation period. The final study population included 10,368 patients. During the observation period, 2452 (23.6%) patients were switched from rosuvastatin to another LLT. The majority of patients (55.6%) were switched to atorvastatin, followed by simvastatin (24.9%), simvastatin/ezetimibe combination (10.0%) and other statins (9.5%). Female gender (HR, hazard ratio, 1.10, 95% CI, confidence interval, 1.02–1.19, p = 0.04) and the presence of chronic kidney disease (HR 1.47, 95% CI 1.16–1.86, p = 0.05) were associated with a higher probability of switch. During the observation period, 113 patients experienced an AMI (incidence of 6.7 AMI/1000 patient-years). Multivariate analysis with Cox proportional hazards method, including switching as a time-dependent covariate, demonstrated that changing from rosuvastatin to another LLT was an independent predictor of AMI (HR 2.2, 95% CI 1.4–3.5, p = 0.001).ConclusionWe conclude that switching from rosuvastatin to another non-equipotent LLT may impart an increased risk of AMI and should be avoided.FundingAstraZeneca SpA.

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An observation of prescription behaviors and adherence to guidelines in patients with COPD: real world data from October 2012 to September 2014

Abstract: Real world data indicate that adherence to GOLD guidelines is only partially met by GPs in their general practice and shows higher prescription appropriateness by pulmonologists.

Cited by 19 publications

References 14 publications

The impact of 2011 and 2017 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines on allocation and pharmacological management of patients with COPD in Taiwan: Taiwan Obstructive Lung Disease (TOLD) study

The impact of 2011 and 2017 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines on allocation and pharmacological management of patients with COPD in Taiwan: Taiwan Obstructive Lung Disease (TOLD) study

Perception of symptoms and quality of life – comparison of patients’ and physicians’ views in the COPD MIRROR study

Clinical Implications of Switching Lipid Lowering Treatment from Rosuvastatin to Other Agents in Primary Care

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An observation of prescription behaviors and adherence to guidelines in patients with COPD: real world data from October 2012 to September 2014

Abstract: Real world data indicate that adherence to GOLD guidelines is only partially met by GPs in their general practice and shows higher prescription appropriateness by pulmonologists.

Cited by 19 publications

References 14 publications

The impact of 2011 and 2017 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines on allocation and pharmacological management of patients with COPD in Taiwan: Taiwan Obstructive Lung Disease (TOLD) study

The impact of 2011 and 2017 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines on allocation and pharmacological management of patients with COPD in Taiwan: Taiwan Obstructive Lung Disease (TOLD) study

Perception of symptoms and quality of life &ndash; comparison of patients&rsquo; and physicians&rsquo; views in the COPD MIRROR study

Clinical Implications of Switching Lipid Lowering Treatment from Rosuvastatin to Other Agents in Primary Care

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Perception of symptoms and quality of life – comparison of patients’ and physicians’ views in the COPD MIRROR study