Analysis of Hospitalizations for COPD Exacerbation: Opportunities for Improving Care

Yip, Natalie; Yuen, George; Lazar, Eliot J.; Regan, Brian; Brinson, Marcia D.; Taylor, Brian; George, Liziamma; Karbowitz, Stephen; Stumacher, Richard; Schluger, Neil W.; Thomashow, Byron

doi:10.3109/15412551003631683

Cited by 38 publications

(33 citation statements)

References 45 publications

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“…These findings are consistent with other retrospective database studies that reported underuse of maintenance bronchodilators and/or inhaled corticosteroids following a hospitalization for COPD 32,33. In fact, a large database analysis reported that approximately 66% of COPD patients with commercial insurance did not receive any maintenance pharmacotherapy during the 1-year study period 34…”

Section: Discussionsupporting

confidence: 90%

Long-acting bronchodilator use after hospitalization for COPD: an observational study of health insurance claims data

Baker¹,

Zou²,

Su³

2014

COPD

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BackgroundTreatment of stable chronic obstructive pulmonary disease (COPD) with long-acting bronchodilator (LABD) medications is recommended by the 2014 Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines. The primary objective of this study was to examine LABD prescription fills after a COPD-related hospitalization.MethodsThis retrospective observational study used claims from Truven Health MarketScan® Commercial and Medicare Supplemental databases. Patients (age ≥40, commercial; age ≥65, Medicare supplemental) had a first hospitalization with a primary COPD diagnosis between April 1, 2009 and June 30, 2011 (index hospitalization) and were continuously enrolled for 1 year before and 9 months after hospitalization. Patients were categorized according to pre-index and/or post-index pharmacy claims.ResultsA total of 27,738 patients had an index hospitalization and met inclusion/exclusion criteria. Of those, 19,783 patients had COPD as a primary or secondary diagnosis during the year before index hospitalization and were included in the analysis. Approximately one quarter of the patients (26.32%) did not fill a prescription for an LABD or short-acting bronchodilator both 90 days before and 90 days after hospitalization. During the 90-day pre-index period, 40.57% of patients filled an LABD (with or without a short-acting bronchodilator) prescription. Over half of the patients (56.88%) filled an LABD prescription at some point during the 180-day post-index period, but, of those, a significantly greater proportion of patients filled an LABD prescription in the 1- to 90-day post-index period than in the 91- to 180-day post-index period (51.27% versus 43.66%; P<0.0001).ConclusionA significant proportion of COPD patients in this study did not fill an LABD prescription before hospitalization for COPD. Moreover, hospitalization did not appear to greatly impact LABD initiation. Lastly, patients who did not fill an LABD prescription within the first 90 days posthospitalization were not likely to fill an LABD prescription later. Taken together, the results of this study suggest that many patients with COPD are undertreated.

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Section: Discussionsupporting

confidence: 90%

Long-acting bronchodilator use after hospitalization for COPD: an observational study of health insurance claims data

Baker¹,

Zou²,

Su³

2014

COPD

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“…2 Unfortunately, up to one-third of patients admitted to the hospital for a COPD exacerbation continue to smoke. 3,4 Hospitalization is a potentially effective time to provide evidence-based treatment for tobacco cessation. 5 Patients are already in a tobacco-free environment with access to nurses, physicians and pharmacists able to facilitate treatment.…”

Section: Background and Significancementioning

confidence: 99%

Predictors of Pharmacotherapy for Tobacco Use Among Veterans Admitted for COPD: The Role of Disparities and Tobacco Control Processes

et al. 2016

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BACKGROUND: Many smokers admitted for chronic obstructive pulmonary disease (COPD) are not given smoking cessation medications at discharge. The reasons behind this are unclear, and may reflect an interplay of patient characteristics, health disparities, and the receipt of inpatient tobacco control processes. OBJECTIVES: We aimed to assess potential disparities in treatment for tobacco use following discharge for COPD, examined in the context of inpatient tobacco control processes. PARTICIPANTS: Smokers aged ≥ 40 years, admitted for treatment of a COPD exacerbation within the VA Veterans Integrated Service Network 20, identified using ICD-9 discharge codes and admission diagnoses from 2005-2012. MAIN MEASURES: The outcome was any tobacco cessation medication dispensed within 48 hours of discharge. We assessed potential predictors administratively up to 1 year prior to admission. We created the final logistic regression model using manual model building, clustered by site. Variables with p < 0.2 in biviariate models were considered for inclusion in the final model. RESULTS: We identified 1511 subjects. 16.9 % were dispensed a medication at discharge. In the adjusted model, several predictors were associated with decreased odds of receiving medications: older age (OR per year older 0.96, 95 % CI 0.95-0.98), black race (OR 0.34, 95 % CI 0.12-0.97), higher comorbidity score (OR 0.89, 95 % CI 0.82-0.96), history of psychosis (OR 0.40, 95 % CI 0.31-0.52), hypertension (OR 0.75, 95 % CI 0.62-0.90), and treatment with steroids in the past year (OR 0.80, 95 % CI 0.70-0.90). Inpatient tobacco control processes were associated with increased odds of receiving medications: documented brief counseling at discharge (OR 3.08, 95 % CI 2.02-4.68) and receipt of smoking cessation medications while inpatient (OR 5.95,. CONCLUSIONS: Few patients were treated with tobacco cessation medications at discharge. We found evidence for disparities in treatment, but also potentially beneficial effects of inpatient tobacco control measures. Further focus should be on using novel processes of care to improve provision of medications and decrease the observed disparities.

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“…9,10 Data suggest that counseling patients before discharge reduces medication discrepancies and improves medication adherence. 12 Of the previous studies conducting discharge medication counseling, most have utilized nurses to provide education to patients about their medications.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] For COPD patients, medication non-adherence is considered a significant contributing factor for readmissions. 9,10 Researchers evaluating the impact of discharge counseling have utilized nurses to provide medication education. [3][4][5][6] Although the nurses in these studies received training to provide medication counseling, the provision of information was limited to the education they received [3][4][5][6] and, therefore, limited the comprehensiveness of the discharge counseling provided.…”

Section: Innovations In Pharmacymentioning

confidence: 99%

Discharge Medication Counseling and its Correlation with Reducing Readmissions for Patients with Chronic Obstructive Pulmonary Disease Exacerbations

Svelund¹,

Laswell²,

Hartzler³

et al. 2015

Innov Pharm

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Analysis of Hospitalizations for COPD Exacerbation: Opportunities for Improving Care

Abstract: Patients hospitalized with acute exacerbation of COPD generally receive adequate hospital care, but there may be opportunities to improve care pharmacologically and with smoking cessation counseling and vaccination during and after hospitalization.

Cited by 38 publications

References 45 publications

Long-acting bronchodilator use after hospitalization for COPD: an observational study of health insurance claims data

Long-acting bronchodilator use after hospitalization for COPD: an observational study of health insurance claims data

Predictors of Pharmacotherapy for Tobacco Use Among Veterans Admitted for COPD: The Role of Disparities and Tobacco Control Processes

Discharge Medication Counseling and its Correlation with Reducing Readmissions for Patients with Chronic Obstructive Pulmonary Disease Exacerbations

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