Is Pharmacologic Care of Chronic Obstructive Pulmonary Disease Consistent with the Guidelines?

Diette, Gregory B.; Orr, Patty; McCormack, Meredith C.; Gandy, William M.; Hamar, Brent

doi:10.1089/pop.2008.0048

Cited by 16 publications

(9 citation statements)

References 19 publications

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“…Similar high prescription rates of ICS/LABA in COPD patients have been found in previous studies [5,6] and lower rates in others [12,13]. Although the use of ICS/LABA is recommended in subgroups of COPD patients, to our knowledge, no one has described the characteristics of patients who are prescribed this combination by their GP in real clinical practice.…”

Section: Discussionsupporting

confidence: 81%

Predictors of ICS/LABA prescribing in COPD patients: a study from general practice

2014

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BackgroundA combination of inhaled corticosteroid and long-acting beta2 agonist (ICS/LABA) is used frequently to treat chronic obstructive pulmonary disease (COPD) patients. The aim of the study was to determine whether prescribing ICS/LABA to COPD patients in primary care in 2009/10 was within the GOLD guidelines and whether and to what degree patient characteristics were associated with prescription of these drugs by GPs.MethodsThis was a cross-sectional study in seven Norwegian GP practices. Patients registered with a diagnosis of asthma or COPD in the previous five years were included.ResultsAmong the 376 patients included in the analysis, 149 patients had COPD, defined as a post-bronchodilator FEV1/FVC <0.7 and 55.6% of these patients were treated with ICS/LABA. The rate of prescribing was significantly higher in the COPD patients also diagnosed with asthma than in those with COPD as the only diagnosis, 66.7%, and 39.0%, respectively (P = 0.001). The prescribing rate in the latter subgroup would have been 18.6% if the 2007 GOLD guidelines had been followed. One or more exacerbations in the previous year was the strongest predictor of ICS/LABA prescribing in the COPD patients who were not registered with a concomitant diagnosis of asthma (OR 3.2, 95% CI 1.0–10.0) but this association was limited to the patients with severe disease (FEV1% predicted <50) (OR 13.5, 95% CI 1.8–101.1). Cardiovascular disease was associated with decreased ICS/LABA prescribing (OR 0.4, 95% CI 0.2–0.8) in the COPD group. A Kappa coefficient of 0.32 was found between the actual prescribing rate and that recommended in the 2007 GOLD guidelines.ConclusionsOverprescribing of ICS/LABA for the COPD patients was shown. Previous exacerbation was a strong predictor of ICS/LABA prescribing only in patients with severe COPD. Because of the low emphasis on previous exacerbation when prescribing for COPD patients with mild to moderate disease, the actual prescribing rate agreed more closely with the GOLD guidelines from 2007 than with those published in 2011. Cardiovascular disease was associated with decreased prescribing, indicating that GPs adjust the treatment in cases with multimorbidity.

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Section: Discussionsupporting

confidence: 81%

Predictors of ICS/LABA prescribing in COPD patients: a study from general practice

2014

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“…Most studies evaluating drug therapy rates in the COPD population have included use of SABAs across all severity levels, precluding a comparison with our study [12,13]. However, a recent study by Fitch et al evaluated drug therapy patterns by severity levels using a claims-based algorithm, and found that 26% of patients with moderate COPD in a commercially insured population were prescribed a long-acting bronchodilator [8].…”

Section: Discussionmentioning

confidence: 99%

Observational study of the outcomes and costs of initiating maintenance therapies in patients with moderate exacerbations of COPD

Dalal¹,

Shah²,

D’Souza³

et al. 2012

Respiratory Research

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BackgroundThere are limited data describing patients with moderate COPD exacerbations and evaluating comparative effectiveness of maintenance treatments in this patient population. The study examined COPD patients with moderate COPD exacerbations. COPD-related outcomes were compared between patients initiating fluticasone propionate-salmeterol 250/50 mcg (FSC) vs anticholinergics (ACs) following a moderate COPD exacerbation.MethodsThis retrospective observational study used a large administrative claims database (study period: 2003–2009) to identify and describe patients with an initial, moderate COPD exacerbation. A descriptive analysis of patients with moderate COPD exacerbations was done evaluating maintenance treatment rates, subsequent COPD exacerbation rates, and COPD-related costs during a 1-year period. A cohort analysis compared COPD exacerbation rates and associated costs during a variable-length follow-up period between patients initiating maintenance therapy with FSC or ACs. COPD exacerbations were reported as rate per 100 patient-years, and monthly costs were reported (standardized to USD 2009). COPD exacerbation rates between cohorts were evaluated using Cox proportional hazards models, and costs were analyzed using generalized linear models with log-link and gamma distribution.Results21,524 patients with a moderate COPD exacerbation were identified. Only 25% initiated maintenance therapy, and 13% had a subsequent exacerbation. Annual costs averaged $594 per patient. A total of 2,849 treated patients (FSC = 925; AC = 1,924) were eligible for the cohort analysis. The FSC cohort had a significantly lower rate of COPD exacerbations compared to the AC cohort (20.8 vs 32.8; P = 0.04). After adjusting for differences in baseline covariates, the FSC cohort had a 42% significantly lower risk of a COPD exacerbation (HR = 0.58; 95% CI: 0.38, 0.91). The FSC cohort incurred significantly higher adjusted pharmacy costs per patient per month by $37 (95% CI: $19, $72) for COPD-related medications vs the AC cohort. However, this increase was offset by a significant reduction in adjusted monthly medical costs per patient for the FSC vs the AC cohort ($82 vs $112; P < 0.05). Total monthly COPD-related costs, as a result, did not differ between cohorts.ConclusionsOnly a quarter of patients with a moderate COPD exacerbation were subsequently treated with maintenance therapy. Initiation of FSC among those treated was associated with better clinical and economic outcomes compared to AC.

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“…At least half of all COPD patients do not receive recommended pharmacologic therapies [3–5], and many never see a pulmonologist. Even with correct pharmacologic therapies, inappropriate use of medications still poses a barrier to COPD care.…”

Section: Introductionmentioning

confidence: 99%

Health coaching to improve self-management and quality of life for low income patients with chronic obstructive pulmonary disease (COPD): protocol for a randomized controlled trial

et al. 2017

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BackgroundChronic obstructive pulmonary disease (COPD) severely hinders quality of life for those affected and is costly to the health care system. Care gaps in areas such as pharmacotherapy, inhaler technique, and knowledge of disease are prevalent, particularly for vulnerable populations served by community clinics. Non-professionally licensed health coaches have been shown to be an effective and cost-efficient solution in bridging care gaps and facilitating self-management for patients with other chronic diseases, but no research to date has explored their efficacy in improving care for people living with COPD.MethodThis is multi-site, single blinded, randomized controlled trial evaluates the efficacy of health coaches to facilitate patient self-management of disease and improve quality of life for patients with moderate to severe COPD. Spirometry, survey, and an exercise capacity test are conducted at baseline and at 9 months. A short survey is administered by phone at 3 and 6 months post-enrollment. The nine month health coaching intervention focuses on enhancing disease understanding and symptom awareness, improving use of inhalers; making personalized plans to increase physical activity, smoking cessation, or otherwise improve disease management; and facilitating care coordination.DiscussionThe results of this study will provide evidence regarding the efficacy and feasibility of health coaching to improve self-management and quality of life for urban underserved patients with moderate to severe COPD.Trial registrationClinicalTrials.gov identifier NCT02234284. Registered 12 August 2014.

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Is Pharmacologic Care of Chronic Obstructive Pulmonary Disease Consistent with the Guidelines?

Cited by 16 publications

References 19 publications

Predictors of ICS/LABA prescribing in COPD patients: a study from general practice

Predictors of ICS/LABA prescribing in COPD patients: a study from general practice

Observational study of the outcomes and costs of initiating maintenance therapies in patients with moderate exacerbations of COPD

Health coaching to improve self-management and quality of life for low income patients with chronic obstructive pulmonary disease (COPD): protocol for a randomized controlled trial

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