1
|
Guay CA, Maltais F, Beaudoin C, Carmichael PH, Laouan Sidi EA, Perreault L, Sirois C, Provencher S. Trends in COPD severe exacerbations, and all-cause and respiratory mortality, before and after implementation of newer long-acting bronchodilators in a large population-based cohort. BMC Pulm Med 2024; 24:450. [PMID: 39272042 DOI: 10.1186/s12890-024-03277-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 09/06/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Little is known about the trends in morbidity and mortality at the population level that followed the introduction of newer once-daily long-acting bronchodilators for COPD. The purpose of the study was to evaluate whether the availability of new bronchodilators was associated with changes in the temporal trends in severe COPD exacerbations and mortality between 2007 and 2018 in the older population with COPD; and whether this association was homogeneous across sex and socioeconomic status classes. METHODS We used an interrupted time-series and three segments multivariate autoregressive models to evaluate the adjusted changes in slopes (i.e., trend effect) in monthly severe exacerbation and mortality rates after 03/2013 and 02/2015 compared to the tiotropium period (04/2007 to 02/2013). Cohorts of individuals > 65 years with COPD were created from the nationally representative database of the Quebec Integrated Chronic Disease Surveillance System in the province of Quebec, Canada. Whether these trends were similar for men and women and across different socioeconomic status classes was also assessed. RESULTS There were 130,750 hospitalizations for severe exacerbation and 104,460 deaths, including 24,457 (23.4%) respiratory-related deaths, over the study period (928,934 person-years). Significant changes in trends were seen after 03/2013 for all-cause mortality (-1.14%/month;95%CI -1.90% to -0.38%), which further decreased after 02/2015 (-1.78%/month;95%CI -2.70% to -0.38%). Decreases in respiratory-related mortality (-2.45%/month;95%CI -4.38% to -0.47%) and severe exacerbation (-1,90%/month;95%CI -3.04% to -0.75%) rates were only observed after 02/2015. These observations tended to be more pronounced in women than in men and in higher socioeconomic status groups (less deprived) than in lower socioeconomic status groups (more deprived). CONCLUSIONS The arrival of newer bronchodilators was chronologically associated with reduced trends in severe exacerbation, all-cause and respiratory-related mortality rates among people with COPD > 65 years. Our findings document population benefits on key patient-relevant outcomes in the years following the introduction of newer once-daily long-acting bronchodilators and their combinations, which were likely multifactorial. Public health efforts should focus on closing the gap between lower and higher socioeconomic status groups.
Collapse
Affiliation(s)
- Charles-Antoine Guay
- Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, 2725, chemin Sainte-Foy, Québec, QC, G1V 4G5, Canada.
- Institut national de santé publique du Québec, Québec City, Canada.
- Département des sciences de la santé communautaire, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Canada.
- Department of Medicine, Université Laval, Québec City, Canada.
| | - François Maltais
- Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, 2725, chemin Sainte-Foy, Québec, QC, G1V 4G5, Canada
- Department of Medicine, Université Laval, Québec City, Canada
| | - Claudia Beaudoin
- Institut national de santé publique du Québec, Québec City, Canada
| | | | | | - Laurie Perreault
- Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, 2725, chemin Sainte-Foy, Québec, QC, G1V 4G5, Canada
| | - Caroline Sirois
- Institut national de santé publique du Québec, Québec City, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, Canada
- Faculty of pharmacy, Université Laval, Québec City, Canada
| | - Steeve Provencher
- Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, 2725, chemin Sainte-Foy, Québec, QC, G1V 4G5, Canada
- Department of Medicine, Université Laval, Québec City, Canada
| |
Collapse
|
2
|
Brown RD, Pepper GV. The Uncontrollable Mortality Risk Hypothesis: Theoretical foundations and implications for public health. Evol Med Public Health 2024; 12:86-96. [PMID: 38807860 PMCID: PMC11132133 DOI: 10.1093/emph/eoae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/26/2024] [Indexed: 05/30/2024] Open
Abstract
The 'Uncontrollable Mortality Risk Hypothesis' employs a behavioural ecological model of human health behaviours to explain the presence of social gradients in health. It states that those who are more likely to die due to factors beyond their control should be less motivated to invest in preventative health behaviours. We outline the theoretical assumptions of the hypothesis and stress the importance of incorporating evolutionary perspectives into public health. We explain how measuring perceived uncontrollable mortality risk can contribute towards understanding socioeconomic disparities in preventative health behaviours. We emphasize the importance of addressing structural inequalities in risk exposure, and argue that public health interventions should consider the relationship between overall levels of mortality risk and health behaviours across domains. We suggest that measuring perceptions of uncontrollable mortality risk can capture the unanticipated health benefits of structural risk interventions, as well as help to assess the appropriateness of different intervention approaches.
Collapse
Affiliation(s)
- Richard D Brown
- Psychology Department, Northumbria University, Newcastle, UK
| | | |
Collapse
|
3
|
Muñoz-Cobos F, Aguiar-Leiva VP, Argüello-Suárez C, Colacicchi P, Calleja-Cartón LA, Leiva-Fernández F. Validation of an Inhaled Therapy Beliefs Questionnaire in Patients with Chronic Obstructive Pulmonary Disease. J Clin Med 2024; 13:2281. [PMID: 38673555 PMCID: PMC11051114 DOI: 10.3390/jcm13082281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Background: To carry out a validation questionnaire that assesses beliefs about inhaled treatments in patients with chronic obstructive pulmonary disease (COPD), as knowing patients' beliefs could help to improve medication adherence and health outcomes. Methods: We evaluated data from 260 COPD patients from electronic medical record databases from five primary healthcare centers, in a descriptive, cross-sectional study with a sample size calculated for a 10-item questionnaire, with an estimated Cronbach's alpha of 0.70 and a 95% confidence level. Study participants were selected via systematic random sampling. Variables: Ten-item Inhaled Therapy Beliefs Questionnaire, CCTI-Questionnaire v.2.0, time for completion, age, sex, educational level, spirometry severity (GOLD criteria), exacerbations (previous year), characteristics of inhaled treatment, and smoking habit. A two-year follow-up in a subsample of 77 patients from one health center was utilized. The Morisky-Green test, pharmacy dispensing data, test-retest (kappa coefficient), and an exploratory analysis of the adherence-belief relationship (ji-squared) were measured. Results: The 10-item questionnaire showed good viability (3 min completion time) when performed face-to-face or telephonically; its psychometric properties were acceptable, with an internal consistency (Cronbach's alpha) score of 0.613. Three factors explained 47.58% of the total variance (p < 0.0001): use (factor 1), effects (factor 2), and objectives (factor 3) of inhalers. The two-year follow-up ultimately considered 58 out of the 77 patients (10 deceased, 4 unlocated, 2 mistakes, 2 no inhaled treatment, and 1 withdrawal). Non-adherence was 48.3% in terms of the Morisky-Green test; 31% in terms of pharmacy dispensing data; and 40.4% considering both methods. There was low test-retest reliability, indicated by items 4, 8, and 9 of the CCTI-Questionnaire (Kappa = 0.4, 0.26, and 0.34; p-value < 0.0001, 0.008, and 0.001, respectively). There was mild correlation between beliefs and adherence. Conclusions: The ten-item CCTI-Questionnaire v.2.0 demonstrated acceptable psychometric properties regarding feasibility, reliability, and content validity.
Collapse
Affiliation(s)
- Francisca Muñoz-Cobos
- Andalusian Health Service, Málaga Biomedical Research Institute (IBIMA-Plataforma BIONAND), University of Málaga, 29590 Málaga, Spain
| | - Virginia P. Aguiar-Leiva
- Research Unit Instituto CUDECA de Estudios e Investigación en Cuidados Paliativos Fundación CUDECA, Biomedical Research Institute (IBIMA-Plataforma BIONAND), University of Málaga, 29590 Málaga, Spain
| | - Carmen Argüello-Suárez
- Multiprofessional Teaching Unit for Family and Community Care of the Málaga-Guadalhorce Primary Care District, 29009 Málaga, Spain
| | | | | | - Francisca Leiva-Fernández
- Andalusian Health Service, Málaga Biomedical Research Institute (IBIMA-Plataforma BIONAND), University of Málaga, 29590 Málaga, Spain
| |
Collapse
|
4
|
Alamer S, Robinson-Barella A, Nazar H, Husband A. Influence of ethnicity on adherence to nonsurgical interventions for COPD: a scoping review. ERJ Open Res 2023; 9:00421-2023. [PMID: 37965227 PMCID: PMC10641584 DOI: 10.1183/23120541.00421-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/08/2023] [Indexed: 11/16/2023] Open
Abstract
Objective Poor therapeutic adherence and the contributing factors have been extensively researched in several chronic diseases, including COPD. However, the influence of ethnicity on adherence to nonsurgical treatment interventions for COPD (e.g. smoking cessation and pulmonary rehabilitation) is not well understood. This scoping review was performed to better understand variations in adherence among people from minority ethnic communities diagnosed with COPD. Method This scoping review was designed based on the refined frameworks of Arksey and O'Malley, developed by JBI (Joanna Briggs Institute). Systematic searches were performed across three databases: CINHAL (EBSCO), MEDLINE (Ovid) and Embase (Ovid). Results Out of 3654 identified records, 37 studies were deemed eligible for inclusion; these were conducted in various countries and involved populations of diverse ethnic groups diagnosed with COPD. The included studies considered provision and/or adherence to medication (n=8, 21.6%), smoking cessation (n=11, 29.7%), influenza vaccinations (n=7, 18.9%), pulmonary rehabilitation (n=11, 29.7%) and oxygen therapy (n=2, 5.4%). Outcomes varied widely between studies within a single intervention (e.g. initiation, adherence and completion of pulmonary rehabilitation programme). However, most of the included studies suggested the presence of inequalities linked to ethnicity across interventions. Conclusion This review indicated the presence of poor adherence to nonsurgical interventions among people from minority ethnic backgrounds living with COPD. However, due to the heterogeneity in population groups considered and compared within the individual studies, it is challenging to identify and understand the key inequalities influencing adherence to nonsurgical interventions. Further research is needed to better explore this.
Collapse
Affiliation(s)
- Sarah Alamer
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
- College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Anna Robinson-Barella
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hamde Nazar
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - Andy Husband
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
5
|
Zysman M, Mahay G, Guibert N, Barnig C, Leroy S, Guilleminault L. Impact of pharmacological and non-pharmacological interventions on mortality in chronic obstructive pulmonary disease (COPD) patients. Respir Med Res 2023; 84:101035. [PMID: 37651981 DOI: 10.1016/j.resmer.2023.101035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE This review aimed to summarise evidence about the impact of pharmacological and non-pharmacological interventions on survival in COPD patients. METHODS We performed a narrative literature review on the effect of pharmacological and non-pharmacological interventions on survival in COPD patients. RESULTS Inhaled therapies are central to reduce symptoms in COPD. In particular, inhaled steroids seem to have the greatest effect on mortality. Despite the anti-inflammatory effects attributed to statins, their benefit in COPD has been shown only in cases of combined cardiovascular diseases. The use of beta-blockers in COPD has not been associated with increased COPD-related mortality and a beneficial effect on all-cause mortality has even been shown in COPD patients with cardiovascular diseases. Influenza and pneumococcal vaccination reduced the occurrence of exacerbations and mortality due to COPD. In addition, long-term oxygen therapy (LTOT) (≥15h/day) in COPD patients with severe hypoxemia had a positive effect on survival. Regarding non-pharmacological interventions, it has been demonstrated that smoking cessation, treatment compliance and nutritional supplementation for underweight patients also have a positive effect on survival. Non-invasive ventilation results were dependent on patient PaCO2 levels. In patients with advanced COPD, further prospective studies are needed to know the effect of bronchoscopic lung volume reduction and lung transplant on COPD survival. Regarding lung transplant, a survival benefit in patients with a pre-transplant BODE score of ≥7 has been shown in retrospective studies. CONCLUSION Most of the studies did not evaluate survival as the main criteria and further long-term studies on the global management of COPD are required.
Collapse
Affiliation(s)
- Maeva Zysman
- Service de Pneumologie, CHU Haut-Lévèque, Bordeaux, France; Univ. Bordeaux, Centre de Recherche cardio-thoracique, INSERM U1045, CIC 1401, Pessac, France
| | - Guillaume Mahay
- Service de Pneumologie, Oncologie thoracique et soins intensifs respiratoires, CHU Rouen, Rouen, France
| | - Nicolas Guibert
- Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France
| | - Cindy Barnig
- INSERM, EFS BFC, LabEx LipSTIC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Univ. Bourgogne Franche-Comté, Besançon, France; Service de Pneumologie, Oncologie thoracique et allergologie respiratoire, CHRU Besançon, Besançon, France
| | - Sylvie Leroy
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, CNRS UMR 7275 - FHU OncoAge, Service de Pneumologie Oncologie Thoracique et Soins Intensifs Respiratoires, CHU de Nice, Hôpital Pasteur, Nice, France
| | - Laurent Guilleminault
- Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, CRISALIS F-CRIN, Toulouse, France.
| |
Collapse
|
6
|
Vauterin D, Van Vaerenbergh F, Vanoverschelde A, Quint JK, Verhamme K, Lahousse L. Methods to assess COPD medications adherence in healthcare databases: a systematic review. Eur Respir Rev 2023; 32:230103. [PMID: 37758274 PMCID: PMC10523153 DOI: 10.1183/16000617.0103-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/20/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The Global Initiative for Chronic Obstructive Lung Disease 2023 report recommends medication adherence assessment in COPD as an action item. Healthcare databases provide opportunities for objective assessments; however, multiple methods exist. We aimed to systematically review the literature to describe existing methods to assess adherence in COPD in healthcare databases and to evaluate the reporting of influencing variables. METHOD We searched MEDLINE, Web of Science and Embase for peer-reviewed articles evaluating adherence to COPD medication in electronic databases, written in English, published up to 11 October 2022 (PROSPERO identifier CRD42022363449). Two reviewers independently conducted screening for inclusion and performed data extraction. Methods to assess initiation (dispensing of medication after prescribing), implementation (extent of use over a specific time period) and/or persistence (time from initiation to discontinuation) were listed descriptively. Each included study was evaluated for reporting variables with an impact on adherence assessment: inpatient stays, drug substitution, dose switching and early refills. RESULTS 160 studies were included, of which four assessed initiation, 135 implementation and 45 persistence. Overall, one method was used to measure initiation, 43 methods for implementation and seven methods for persistence. Most of the included implementation studies reported medication possession ratio, proportion of days covered and/or an alteration of these methods. Only 11% of the included studies mentioned the potential impact of the evaluated variables. CONCLUSION Variations in adherence assessment methods are common. Attention to transparency, reporting of variables with an impact on adherence assessment and rationale for choosing an adherence cut-off or treatment gap is recommended.
Collapse
Affiliation(s)
- Delphine Vauterin
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Frauke Van Vaerenbergh
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Anna Vanoverschelde
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jennifer K Quint
- School of Public Health and National Heart and Lung Institute, Imperial College London, London, UK
| | - Katia Verhamme
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lies Lahousse
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
7
|
Sloth MMB, Neble Larsen E, Godtfredsen NS, Osler M, Jørgensen TSH. Impact of offspring and their educational level on readmission and death among older adults with chronic obstructive pulmonary disease: a nationwide cohort study using multistate survival models. J Epidemiol Community Health 2023; 77:558-564. [PMID: 37311624 DOI: 10.1136/jech-2022-220243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/05/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND It is well described that there is social inequality in the disease course of chronic obstructive pulmonary disease (COPD), but the impact of social relations is less explored. We aimed to investigate the impact of adult offspring and their educational level on readmission and death among older adults with COPD. METHODS In total, 71 084 older adults born 1935-53 with COPD diagnosed at age ≥65 years in 2000-2018 were included. Multistate survival models were performed to estimate the impact of adult offspring (offspring (reference) vs no offspring) and their educational level (low, medium or high (reference)) on the transition intensities between three states: COPD diagnosis, readmission and all-cause death. RESULTS During follow-up, 29 828 (42.0%) had a readmission and 18 504 (26.0%) died with or without readmission. Not having offspring was associated with higher hazards of death without readmission (HRwomen: 1.52 (95% CI: 1.39 to 1.67), HRmen: 1.29 (95% CI: 1.20 to 1.39)) and a higher hazard of death after readmission for women only (HRwomen: 1.19 (95% CI: 1.08 to 1.30). Having offspring with low educational level was associated with higher hazards of readmission (HRwomen: 1.12 (95% CI: 1.06 to 1.19)), (HRmen: 1.06 (95%CI: 1.002 to 1.12)), death without readmission (HRwomen: 1.24 (95% CI: 1.11 to 1.39)), HRmen: 1.16 (95% CI: 1.05 to 1.29) and death after readmission for men only (HRmen: 1.15 (95% CI: 1.05 to 1.25)). Having offspring with medium educational level was associated with a higher hazard of death without readmission for women (HRwomen: 1.11 (95% CI: 1.02 to 1.21)). CONCLUSION Adult offspring and their educational level were associated with higher risk of readmission and death among older adults with COPD.
Collapse
Affiliation(s)
- Mathilde Marie Brünnich Sloth
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Copenhagen University Hospital, Frederiksberg, Denmark
| | - Emma Neble Larsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Copenhagen University Hospital, Frederiksberg, Denmark
| | - Nina Skavlan Godtfredsen
- Department of Respiratory Diseases, Hvidovre Hospital, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Merete Osler
- Center for Clinical Research and Prevention, Copenhagen University Hospital, Frederiksberg, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Terese Sara Høj Jørgensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Copenhagen University Hospital, Frederiksberg, Denmark
| |
Collapse
|
8
|
Lauridsen MD, Valentin JB, Strange JE, Jacobsen PA, Køber L, Weinreich U, Johnsen SP, Fosbøl E. Mortality in patients with chronic obstructive pulmonary disorder undergoing transcatheter aortic valve replacement: The importance of chronic obstructive pulmonary disease exacerbation. Am Heart J 2023; 262:100-109. [PMID: 37116603 DOI: 10.1016/j.ahj.2023.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Severe chronic obstructive pulmonary disease (COPD) has been associated with futile outcome after transcatheter aortic valve replacement (TAVR). Data on outcomes according to COPD severity are warranted to aid identification of patients who may not benefit from TAVR. We aimed to examine the association between risk of COPD exacerbation and 1-year mortality after TAVR. METHODS Using Danish nationwide registries we identified patients undergoing first-time TAVR during 2008-2021 by COPD status. COPD severity levels were defined as low or high risk of acute exacerbation of COPD (AE-COPD) and treatment intensity levels (none or short-term, mono/dual, triple therapy, or home oxygen). Kaplan-Meier functions and adjusted Cox regression models were used to assess 1-year mortality comparing COPD severity groups with patients without COPD. RESULTS We identified 7,047 patients with TAVR of whom 644 had a history of COPD (low risk of AE-COPD: 439, high risk of AE-COPD: 205). The median age of the TAVR cohort was 81.4 years (IQR: 76.8-85.1) and 55.8% were males. One-year mortality for TAVR patients without COPD was 8.5% (95% CI: 7.8-9.2) and 15.4% (95% CI: 12.5-18.2) for those with COPD (adjusted HR: 1.63 [95% CI: 1.28-2.07]). Patients with low or high risk of AE-COPD had 1-year mortality of 13.1% (95% CI: 9.8-16.3) and 20.2% (95% CI: 14.6-25.8) corresponding to adjusted HRs of 1.31 (95% CI: 0.97-1.78) and 2.44 (95% CI: 1.70-3.50) compared with patients without COPD. Patients with high risk of AE-COPD and no/short term therapy or use of home oxygen represented the subgroups of patients with the highest 1-year mortality (31.6% [95% CI: 14.5-48.7] and 30.9% [95% CI: 10.3-51.6]). CONCLUSION Among patients undergoing TAVR, increasing risk of exacerbation with COPD was associated with increasing 1-year mortality compared with non-COPD patients. Patients with a high risk of exacerbation with COPD not using any guideline recommended COPD medication and those using home oxygen had the highest 1-year mortality.
Collapse
Affiliation(s)
- Marie Dam Lauridsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Danish Center for Clinical Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; The Clinical Institute, Aalborg University, Aalborg, Denmark; Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.
| | - Jan Brink Valentin
- Danish Center for Clinical Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Jarl Emanuel Strange
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Peter A Jacobsen
- The Clinical Institute, Aalborg University, Aalborg, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulla Weinreich
- The Clinical Institute, Aalborg University, Aalborg, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
9
|
Dixe MDA, Pinho J, Pereira F, Verloo H, Meyer-Massetti C, Pereira SG. Patterns of Medication Management and Associated Medical and Clinical Features among Home-Dwelling Older Adults: A Cross-Sectional Study in Central Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1701. [PMID: 36767067 PMCID: PMC9914088 DOI: 10.3390/ijerph20031701] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/18/2023]
Abstract
Ageing is frequently associated with multimorbidity and polypharmacy. The present study aimed to identify the current medication management patterns and the profiles of home-dwelling older adults and to find any association with their conditions, including frailty and cognitive impairment. Within the scope of this cross-sectional study, 112 older adults living in the community were assessed via face-to-face structured interviews. Frailty, cognitive status, medication management and clinical and sociodemographic variables were evaluated. Descriptive and inferential statistics were calculated. The mean participant age was 76.6 ± 7.1 years, 53.6% of participants were women, and 40.2% of participants lived alone. More than half were classified as having frailty (58.9%), almost one-fifth (19.6%) presented with a moderate cognitive impairment had more than one disease, and 60.7% were polymedicated. No associations were found between polymedication and medication self-management, the use of over-the-counter medications, living alone, having a poor understanding of pharmacological therapy and/or pathology, or having more than one prescriber. Self-management was associated with age, the number of medications, frailty and cognitive status. Binary logistic regressions showed that cognitive impairment had statistically significant differences with medication management, having a poor understanding of pharmacological therapy and/or pathology, having one prescriber and the use of medications not prescribed by physicians. Interventions to prevent medication-related problems in home-dwelling older adults are recommended.
Collapse
Affiliation(s)
- Maria dos Anjos Dixe
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, 2411-901 Leiria, Portugal
- School of Health Sciences, Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Joana Pinho
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, 2411-901 Leiria, Portugal
- School of Health Sciences, Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Filipa Pereira
- School of Health Sciences, HES-SO Valais-Wallis, 2800 Sion, Switzerland
- Institute of Biomedical Sciences Abel Salazar, University of Porto, 4099-002 Porto, Portugal
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais-Wallis, 2800 Sion, Switzerland
- Service of Old Age Psychiatry, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology and Toxicology Unit, General Internal Medicine Clinic, University Hospital of Bern (Inselspital), 3010 Bern, Switzerland
- Institute for Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland
| | - Sónia Gonçalves Pereira
- Center for Innovative Care and Health Technology, Polytechnic of Leiria, 2411-901 Leiria, Portugal
| |
Collapse
|
10
|
Wells J, Mahendran S, Dolgin K, Kayyali R. SPUR-27 - Psychometric Properties of a Patient-Reported Outcome Measure of Medication Adherence in Chronic Obstructive Pulmonary Disease. Patient Prefer Adherence 2023; 17:457-472. [PMID: 36844797 PMCID: PMC9950982 DOI: 10.2147/ppa.s394538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/18/2023] [Indexed: 02/20/2023] Open
Abstract
PURPOSE People living with COPD who struggle to take their medicines often experience poorer health outcomes such as exacerbations of symptoms, more frequent and lengthy hospital admissions, and worsening mortality rates. This study aimed to evaluate the psychometric properties of the previously validated SPUR-27 model, a multi-factorial model of medication adherence. PATIENTS AND METHODS This cross-sectional study was conducted with 100 adult patients living with COPD in a hospital setting in Southwest London. Medication adherence was assessed using a shortened SPUR model (SPUR-27) against the validated Inhaler Adherence Scale (IAS) as a comparator. In addition, objective medication adherence data, presented as the Medication Possession Ratio (MPR), were derived from patient medical and pharmacy records. The COPD Assessment Tool (CAT) score was used to examine the relationship between medication adherence and COPD symptom severity. Reliability of SPUR-27 was assessed using internal consistency estimates. Exploratory factor analysis, partial confirmatory factor analysis, and maximum likelihood analysis were conducted in conjunction with construct, concurrent, and known-group validity testing to explore the psychometric properties of the SPUR model in this population. RESULTS A 7-factor model for SPUR-27 was derived with adequate factor loadings. SPUR (α=0.893) observed strong internal consistency (>0.8). The model was significantly positively correlated with IAS score (p<0.001) as well as MPR (p<0.01). A significant (p<0.01) relationship between poor medication adherence and worsening symptom severity, as defined by the CAT score, was identified for SPUR (χ 2 = 8.570) using Chi-Square analysis. Furthermore, SPUR-27 demonstrated early evidence of validity with good incremental fit indices: NFI (0.96), TFI (0.97), and CFI (0.93) were all reported as >0.9 in addition to the RMSEA, which was <0.08 (0.059). CONCLUSION SPUR demonstrated strong psychometric properties in patients living with COPD. Further work should look to examine the test-retest reliability of the model and its application in broader sample populations.
Collapse
Affiliation(s)
- Joshua Wells
- Department of Pharmacy, Kingston University, Kingston, UK
| | - Siva Mahendran
- Respiratory Department, Kingston Hospital NHS Foundation Trust, Kingston, UK
| | | | - Reem Kayyali
- Department of Pharmacy, Kingston University, Kingston, UK
- Correspondence: Reem Kayyali, Department of Pharmacy, Kingston University, Penrhyn Road, Kingston, KT1 2EE, UK, Tel/Fax +44 208 417 2561, Email
| |
Collapse
|
11
|
Di Filippo A, Perna S, Pierantozzi A, Milozzi F, Fortinguerra F, Caranci N, Moro L, Agabiti N, Belleudi V, Cesaroni G, Nardi A, Spadea T, Gnavi R, Trotta F. Socio-economic inequalities in the use of drugs for the treatment of chronic diseases in Italy. Int J Equity Health 2022; 21:157. [DOI: 10.1186/s12939-022-01772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Since the use of medicines is strongly correlated to population health needs, higher drug consumption is expected in socio-economical deprived areas. However, no systematic study investigated the relationship between medications use in the treatment of chronic diseases and the socioeconomic position of patients. The purpose of the study is to provide a description, both at national level and with geographical detail, of the use of medicines, in terms of consumption, adherence and persistence, for the treatment of major chronic diseases in groups of population with different level of socioeconomic position.
Methods
A cross-sectional study design was used to define the “prevalent” users during 2018. A longitudinal cohort study design was performed for each chronic disease in new drug users, in 2018 and the following year. A retrospective population-based study, considering all adult Italian residents (i.e. around 50.7 million people aged ≥ 18 years). Different medications were used as a proxy for underlying chronic diseases: hypertension, dyslipidemia, osteoporosis, diabetes and chronic obstructive pulmonary disease. Only “chronic” patients who had at least 2 prescriptions within the same subgroup of drugs or specific medications during the year were selected for the analysis. A multidimensional measures of socio-economic position, declined in a national deprivation index at the municipality level, was used to identify and estimate the relationship with drug use indicators. The medicine consumption rate for each pharmacological category was estimated for prevalent users while adherence and persistence to pharmacologic therapy at 12 months were evaluated for new users.
Results
The results highlighted how the socioeconomic deprivation is strongly correlated with the use of medicines: after adjustment by deprivation index, the drug consumption rates decreased, mainly in the most disadvantaged areas, where consumption levels are on average higher than in other areas. On the other hand, the adherence and persistence indicators did not show the same trend.
Conclusions
This study showed that drug consumption is influenced by the level of deprivation consistently with the distribution of diseases. For this reason, the main levers on which it is necessary to act to reduce disparities in health status are mainly related to prevention. Moreover, it is worth pointing out that the use of a municipal deprivation indicator necessarily generates an ecological bias, however, the experience of the present study, which for the first-time deals with the complex and delicate issue of equity in Italian pharmaceutical assistance, sets the stage for new insights that could overcome the limits.
Collapse
|
12
|
Jacobsen PA, Kragholm K, Torp-Pedersen C, Møller Weinreich U. Disability Retirement After First Admission with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Danish Nationwide Registry Cohort Study Using a Retrospective Follow-Up Design. Int J Chron Obstruct Pulmon Dis 2022; 17:2541-2551. [PMID: 36254163 PMCID: PMC9569162 DOI: 10.2147/copd.s377311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Many chronic obstructive pulmonary disease (COPD) patients below retirement age are outside the workforce. The existing knowledge about association between acute exacerbation of COPD (AECOPD) and disability retirement is limited. Aim The aim of this study is to explore disability retirement in COPD patients 3 years following first-ever AECOPD. Methods This retrospective registry-based follow-up cohort study design is based on nationwide Danish registry data. Patients admitted to the hospital for the first time between 1999 and 2017 with AECOPD and age between 35 and 59 years, active in the workforce, were included in the study. Socio-demographics, comorbidities and inhaled medication use were explored. COPD patients’ hazard ratio of disability retirement during 3-year follow-up was calculated. Cox regression was used to examine the effects of covariates on disability retirement. Results A total of 4032 patients were included in the study. During follow-up, 17.2% (692/4032) experienced disability retirement from the workforce. Factors associated with disability retirement were expressed as hazard ratio (95% confidence intervals): Higher age (ref. age 46–50: Age 51–55, 1.42, (1.12–1.81); age 56–59, 1.37 (1.08–1.74)); living alone (1.34 (1.14–1.56)); number of comorbidities for 1, 2, and 3 comorbidities (1.36 (1.14–1.62), 1.57 (1.19–2.07), 1.77 (1.20–2.60)); emphysema (2.01 (1.44–2.79)); depression (1.60 (1.12–2.28)); cardiac comorbidity (1.38 (1.07–1.78)); triple inhalation therapy (2.76 (2.20–3.47)); ICS + LAMA or ICS + LABA treatment (1.82 (1.48–2.23)); and ICS treatment (1.49 (1.17–1.90)). Higher educational level was associated with a significantly reduced risk of disability retirement, medium, short higher and long higher educational level, relative to low education level (0.78 (0.67–0.91), 0.63 (0.48–0.83) and 0.27 (0.12–0.60)). Conclusion Patients vulnerable to disability retirement are patients with markers of severe COPD, comorbidities, and social vulnerability.
Collapse
Affiliation(s)
- Peter Ascanius Jacobsen
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark,The Clinical Institute, Aalborg University, Aalborg, Denmark,Correspondence: Peter Ascanius Jacobsen, Department of Respiratory Diseases, Aalborg University Hospital, Mølleparkvej 4, Aalborg, DK-9100, Denmark, Tel +4597664800, Email Mail:
| | - Kristian Kragholm
- The Clinical Institute, Aalborg University, Aalborg, Denmark,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark,The Clinical Institute, Aalborg University, Aalborg, Denmark
| |
Collapse
|
13
|
Sanchez FG, Gardiner SK, Demirel S, Rees JP, Mansberger SL. Geospatial analysis of blindness within rural and urban counties. PLoS One 2022; 17:e0275807. [PMID: 36215279 PMCID: PMC9550029 DOI: 10.1371/journal.pone.0275807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 09/24/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To determine the associations of blindness within rural and urban counties using a registry of blind persons and geospatial analytics. METHODS We used the Oregon Commission for the Blind registry to determine the number of persons who are legally blind, as well as licensure data to determine the density of eye care providers (optometrists and ophthalmologists) within each county of the State of Oregon. We used geospatial statistics, analysis of variance, and logistic regression to determine the explanatory variables associated with blindness within counties. RESULTS We included 8350 individuals who are legally blind within the state of Oregon in the calendar year 2015. The mean observed prevalence of registered blindness was 0.21% and ranged almost 9-fold from 0.04% to 0.58% among counties (p < .001). In univariate models, higher blindness was associated with increasing median age (p = .027), minority race (p < .001), decreased median household income (p < .001), increased poverty within a county (p < .001), and higher density of ophthalmologists (p = .003). Density of optometrists was not associated with prevalence of blindness (p = .89). The final multivariable model showed higher blindness to be associated with lower median household income, higher proportion of black race, and lower proportion of Hispanic race (p < .001 for all). CONCLUSION Geospatial analytics identified counties with higher and lower than expected proportions of blindness even when adjusted for sociodemographic factors. Clinicians and researchers may use the methods and results of this study to better understand the distribution of individuals with blindness and the associated factors to help design public health interventions.
Collapse
Affiliation(s)
- Facundo G. Sanchez
- Legacy Devers Eye Institute, Portland, Oregon, United States of America
- Discoveries in Sight Research Laboratories, Portland, Oregon, United States of America
| | - Stuart K. Gardiner
- Discoveries in Sight Research Laboratories, Portland, Oregon, United States of America
| | - Shaban Demirel
- Discoveries in Sight Research Laboratories, Portland, Oregon, United States of America
| | - Jack P. Rees
- Legacy Devers Eye Institute, Portland, Oregon, United States of America
| | - Steven L. Mansberger
- Legacy Devers Eye Institute, Portland, Oregon, United States of America
- Discoveries in Sight Research Laboratories, Portland, Oregon, United States of America
- * E-mail:
| |
Collapse
|
14
|
Bayer-Oglesby L, Zumbrunn A, Bachmann N. Social inequalities, length of hospital stay for chronic conditions and the mediating role of comorbidity and discharge destination: A multilevel analysis of hospital administrative data linked to the population census in Switzerland. PLoS One 2022; 17:e0272265. [PMID: 36001555 PMCID: PMC9401154 DOI: 10.1371/journal.pone.0272265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 07/15/2022] [Indexed: 11/19/2022] Open
Abstract
Social factors are recognized determinants of morbidity and mortality and also have an impact on use of medical services. The objective of this study was to assess the associations of educational attainment, social and financial resources, and migration factors with length of hospital stays for chronic conditions. In addition, the study investigated the role of comorbidity and discharge destination in mediating these associations. The study made use of nationwide inpatient data that was linked with Swiss census data. The study sample included n = 141,307 records of n = 92,623 inpatients aged 25 to 84 years, hospitalized between 2010 and 2016 for a chronic condition. Cross-classified multilevel models and mediation analysis were performed. Patients with upper secondary and compulsory education stayed longer in hospital compared to those with tertiary education (β 0.24 days, 95% CI 0.14-0.33; β 0.37, 95% CI 0.27-0.47, respectively) when taking into account demographic factors, main diagnosis and clustering on patient and hospital level. However, these effects were almost fully mediated by burden of comorbidity. The effect of living alone on length of stay (β 0.60 days, 95% CI 0.50-0.70) was partially mediated by both burden of comorbidities (33%) and discharge destination (30.4%). (Semi-) private insurance was associated with prolonged stays, but an inverse effect was observed for colon and breast cancer. Allophone patients had also prolonged hospital stays (β 0.34, 95% CI 0.13-0.55). Hospital stays could be a window of opportunity to discern patients who need additional time and support to better cope with everyday life after discharge, reducing the risks of future hospital stays. However, inpatient care in Switzerland seems to take into account rather obvious individual needs due to lack of immediate support at home, but not necessarily more hidden needs of patients with low health literacy and less resources to assert their interests within the health system.
Collapse
Affiliation(s)
- Lucy Bayer-Oglesby
- Institute for Social Work and Health, School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Andrea Zumbrunn
- Institute for Social Work and Health, School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Nicole Bachmann
- Institute for Social Work and Health, School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - on behalf of the SIHOS Team
- Institute for Social Work and Health, School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| |
Collapse
|
15
|
Knudsen SV, Valentin JB, Videbech P, Mainz J, Johnsen SP. Inequities in Mental Health Care Quality and Clinical Outcomes Among Inpatients with Depression Within a Tax-Financed Universal Health Care System. Clin Epidemiol 2022; 14:803-813. [PMID: 35789690 PMCID: PMC9250345 DOI: 10.2147/clep.s322392] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/03/2022] [Indexed: 01/20/2023] Open
Abstract
Purpose The objective was to examine potential socioeconomic inequities in guideline recommended quality of care as well as several clinical outcomes among first-time inpatients with major depressive disorder (MDD) in a tax-financed universal health care system. Patients and Methods A nationwide cohort study was performed based on individual-level record linkage of public registers in Denmark. The study included all adult incident inpatients with MDD at Danish psychiatric hospitals in the period 2011–2017 (n=10,949). Socioeconomic position was assessed according to the level of education and income. Outcomes included quality of depression care for inpatients as reflected by the fulfillment of guideline recommended quality of care measures as well as clinical outcomes in terms of all-cause mortality, suicidal behavior, readmission for depression and all-cause readmission. Results Patients with low-level education or low-level income were statistically significantly less likely to receive high quality of in-hospital care, defined as fulfillment of at least 70% of relevant performance measures (adjusted relative risk (RR) 0.92 and 0.87, respectively). In addition, the same patients had a higher all-cause mortality (adjusted RR 1.22 and 1.41, respectively). Patients with low education or middle income were associated with a higher risk of suicidal behavior (adjusted RR 1.28 and 1.19, respectively). While no differences were found in the risk of all-cause readmission, low-level education and income was associated with a lower risk of readmission due to MDD (adjusted RR 0.91 and 0.87, respectively). Conclusion Inequities in quality of care and clinical outcomes were observed among MDD inpatients in a tax-financed universal health care system, indicating that lack of access to care and insurance is not the only explanation for inequity in health.
Collapse
Affiliation(s)
- Søren Valgreen Knudsen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Poul Videbech
- Center for Neuropsychiatric Research, Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Jan Mainz
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Community Mental Health, Haifa University, Haifa, Israel.,Department of Health Economics, University of Southern Denmark, Odense, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
16
|
Binding C, Olesen JB, Lee CJY, Lip GYH, Sindet-Pedersen C, Gislason G, Bonde AN. Discontinuation of direct oral anticoagulants among patients with atrial fibrillation according to gender and cohabitation status: a nationwide cohort study. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 8:353-362. [PMID: 34415024 DOI: 10.1093/ehjcvp/pvab065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/28/2021] [Accepted: 08/18/2021] [Indexed: 06/13/2023]
Abstract
AIMS The aim of this study was to evaluate the risk of discontinuing treatment with direct oral anticoagulants (DOACs) among patients with atrial fibrillation (AF) according to cohabitation status and gender. METHODS AND RESULTS Using the Danish national registers, we identified 32 364 patients with AF aged 40-90 years undergoing treatment with DOACs. The study period was from 2013 to 2017, and patients were followed for 2 years, or until death, outcome, or emigration. The main outcome was discontinuation of DOAC treatment for at least 30 days. The absolute 2-year risk of DOAC discontinuation was highest among men living alone [35.7%, 95% confidence interval (CI): 37.3-34.1%]. Men living alone had a 4.6% (95% CI: 6.4-2.8%) higher absolute risk of discontinuation and a 12% [hazard ratio (HR): 1.12, 95% CI: 1.04-1.20] higher relative risk of discontinuation compared with men living with a partner. Female patients living alone likewise had a higher absolute risk of DOAC discontinuation (2.6%, 95% CI: 4.4-0.09%) compared with female patients living with a partner, yet no statistically significant difference in relative risk. In an analysis evaluating gender, we found male gender to be associated with a significantly higher relative risk of DOAC discontinuation (HR: 1.33, 95% CI: 1.26-1.40) compared with female gender (P-value for interaction with cohabitant status = 0.5996). CONCLUSION In this nationwide population study, male gender and living alone were associated with a higher risk of DOAC discontinuation among patients with AF.
Collapse
Affiliation(s)
- Casper Binding
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Post 635, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Jonas Bjerring Olesen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Post 635, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Christina Ji-Young Lee
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Post 635, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Caroline Sindet-Pedersen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Post 635, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- The Danish Heart Foundation, 1127 Copenhagen K, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Post 635, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- The Danish Heart Foundation, 1127 Copenhagen K, Denmark
| | - Anders Nissen Bonde
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Post 635, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| |
Collapse
|
17
|
van Boven JFM, Tsiligianni I, Potočnjak I, Mihajlović J, Dima AL, Nabergoj Makovec U, Ágh T, Kardas P, Ghiciuc CM, Petrova G, Bitterman N, Kamberi F, Culig J, Wettermark B. European Network to Advance Best Practices and Technology on Medication Adherence: Mission Statement. Front Pharmacol 2021; 12:748702. [PMID: 34707502 PMCID: PMC8544003 DOI: 10.3389/fphar.2021.748702] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/10/2021] [Indexed: 02/05/2023] Open
Abstract
Medication non-adherence is associated with almost 200,000 deaths annually and €80-125 billion in the European Union. Novel technological advances (smart pill bottles, digital inhalers and spacers, electronic pill blisters, e-injection pens, e-Health applications, big data) could help managing non-adherence. Healthcare professionals seem however inadequately informed about non-adherence, availability of technological solutions in daily practice is limited, and collaborative efforts to push forward their implementation are scarce. The European Network to Advance Best practices and technoLogy on medication adherencE (ENABLE, COST Action 19132) aims to 1) raise awareness of adherence enhancing solutions, 2) foster knowledge on medication adherence, 3) accelerate clinical application of novel technologies and 4) work collaboratively towards economically viable policy, and implementation of adherence enhancing technology across healthcare systems.
Collapse
Affiliation(s)
- Job FM van Boven
- Department of Clinical Pharmacy and Pharmacology, Medication Adherence Expertise Center of the Northern Netherlands (MAECON), University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ioanna Tsiligianni
- Department of Social Medicine, School of Medicine, University of Crete, Rethymnon, Greece
| | - Ines Potočnjak
- Institute for Clinical Medical Research and Education, University Hospital Centre Sisters of Charity, Zagreb, Croatia
| | - Jovan Mihajlović
- Mihajlović Health Analytics, (MiHA), Novi Sad, Serbia
- University Medical Center Groningen, Groningen, Netherlands
- Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Alexandra L. Dima
- Research on Healthcare Performance (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France
| | | | - Tamás Ágh
- Syreon Research Institute, Budapest, Hungary
| | - Prezmyslaw Kardas
- Medication Adherence Research Centre, Medical University of Lodz, Lodz, Poland
| | - Cristina Mihaela Ghiciuc
- Department of Morphofunctional Sciences II–Pharmacology, Clinical Pharmacology and Algesiology, School of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Guenka Petrova
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Noemi Bitterman
- Industrial Design, Technion, Israel Institute of Technology, Haifa, Israel
| | - Fatjona Kamberi
- Faculty of Health, Research Center of Public Health, University of Vlore “Ismail Qemali”, Vlore, Albania
| | - Josip Culig
- Pharmacoepidemiology Department, Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Björn Wettermark
- Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| |
Collapse
|
18
|
Jacobsen PA, Kragholm KH, Torp-Pedersen C, Janssen DJA, Spruit MA, Weinreich UM. Employment Status, Readmission and Mortality After Acute Exacerbation of COPD. Int J Chron Obstruct Pulmon Dis 2021; 16:2257-2265. [PMID: 34385815 PMCID: PMC8352575 DOI: 10.2147/copd.s319840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/19/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction The understanding of whether and to what extent employment status affects readmission and mortality is limited in patients with COPD. Aim To explore how employment status affects readmission and mortality after first admission to the hospital with acute exacerbation of COPD (AECOPD). Methods This study used Danish national registry-based data. All patients admitted for the first time to the hospital between 1999 and 2014 with a diagnosis of AECOPD, age 35–59, without a previous asthma diagnosis were included in the study. Employment status effect on 30-, 90-, and 365-day readmission and mortality was examined using logistic regression, adjusting for relevant confounders. Results A total of 11,850 COPD patients were included in the study of which 3563 (30%) were working, 1368 (12%) unemployed, 840 (7%) on sick leave, and 6079 (51%) receiving early retirement. Patients receiving early retirement had, compared to patients working, an adjusted increased likelihood of readmission at 30, 90, and 365 days (odds ratio (OR) 1.26 (CI95% (1.06–1.49)), 1.33 (CI95% (1.16–1.53)), and 1.48 (CI95% (1.33–1.66)), respectively). An increased likelihood was also seen in unemployed at 365 days follow-up (OR 1.44 (CI95% (1.22–1.68))). Early retirement was associated with an increased mortality at 30, 90, and 365 days (OR 1.39 (CI95% (1.07–1.80)) 1.37 (CI95% (1.09–1.79)) and 1.48 (CI95% (1.25–1.75)), respectively). An increased likelihood was also seen in patients receiving sick leave (OR 1.57 (CI95% (1.21–2.04))). Conclusion Patients with COPD who are not working at the time of first admission have a higher likelihood of readmission and mortality.
Collapse
Affiliation(s)
- Peter Ascanius Jacobsen
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.,The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Kristian Hay Kragholm
- The Clinical Institute, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Daisy J A Janssen
- Department of Research and Development, Ciro, Horn, the Netherland.,Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Martijn A Spruit
- Department of Research and Development, Ciro, Horn, the Netherland.,Nutrim School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.,The Clinical Institute, Aalborg University, Aalborg, Denmark
| |
Collapse
|
19
|
Yi M, Jiang D, Jia Y, Xu W, Wang H, Li Y, Zhang Z, Wang J, Chen O. Impact of Caregiving Burden on Quality of Life of Caregivers of COPD Patients: The Chain Mediating Role of Social Support and Negative Coping Styles. Int J Chron Obstruct Pulmon Dis 2021; 16:2245-2255. [PMID: 34376977 PMCID: PMC8349532 DOI: 10.2147/copd.s311772] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/19/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose Caregivers of COPD patients experience various caregiving burden, which is related to their quality of life. We aimed to explicitly explore whether social support and negative coping styles play the chain mediating roles in the relationship between the caregiving burden of caregivers of COPD patients and their health-related quality of life. Methods We conducted a multicenter cross-sectional survey in four hospitals using a convenience sample. Participants who met the inclusion criteria completed five relevant scales, including a sociodemographic scale. One-way ANOVA and Pearson’s method were used to analyze the data accordingly, and chain mediated effect values were estimated by bootstrap method to determine whether the model holds. Results Among the 201 caregivers who participated in this study, the mean age was 55.94 years, most of them were female (61.2%), the mean caregiving burden score was 52.39 ± 14.65, and the quality of life score was 37.97 ± 3.55. Among them, age, gender, education, relationship with the patient, and the number of chronic diseases were the main factors affecting the quality of life score of the caregivers. According to Pearson results, there was a negative correlation between quality of life and caregiving burden, and negative coping styles. The model result showed that caregiving burden could directly and negatively predict quality of life, and also predict quality of life through the chain mediation of social support and negative coping styles. Conclusion In China, caregivers of patients with COPD experience severe levels of caregiving burden and low quality of life. The combination of adequate perceived social support and lower negative coping can be effective in alleviating caregiving burden and improving their quality of life. Therefore, healthcare professionals should provide targeted guidance to caregivers with the help of social support and interventions that regulate negative coping styles.
Collapse
Affiliation(s)
- Mo Yi
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Di Jiang
- Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China
| | - Yuanmin Jia
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Wei Xu
- Department of Psychology, Shanghai Normal University, Shanghai, 200234, People's Republic of China
| | - Haixia Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Yizhang Li
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Zeyi Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Jingjing Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Ou Chen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| |
Collapse
|
20
|
Agarwal P, Lin J, Muellers K, O'Conor R, Wolf M, Federman AD, Wisnivesky JP. A structural equation model of relationships of health literacy, illness and medication beliefs with medication adherence among patients with chronic obstructive pulmonary disease. PATIENT EDUCATION AND COUNSELING 2021; 104:1445-1450. [PMID: 33308880 PMCID: PMC8144232 DOI: 10.1016/j.pec.2020.11.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To determine the relative contributions of health literacy (HL) and illness and medication beliefs to medication adherence among older COPD patients and determine the pathways through which they operate. METHODS The study was conducted using data from a prospective cohort of COPD patients in New York City and Chicago. We used structural equation modeling to examine the pathways linking HL, through medications and illness beliefs, with COPD medication adherence. RESULTS Out of 393 older adults with COPD, 123 (31%) had limited HL and 208 (53%) reported low adherence to daily COPD medications. Those with limited HL were more likely to have low medication adherence (p < 0.0001). Medications concerns (p = 0.001) and medication necessity (p = 0.003) demonstrated a mediational role between HL and adherence. However, in the final multivariate model, HL did not have direct effect on medication adherence (p = 0.12) and illness beliefs (p = 0.16) did not demonstrate a mediational role between HL and adherence. CONCLUSION Our findings suggest that low HL is not a direct predictor of poor medication adherence among COPD patients. PRACTICE IMPLICATIONS Addressing medication concerns and reinforcing the need for daily COPD medications may be a more effective strategy for increasing adherence in this population.
Collapse
Affiliation(s)
- Parul Agarwal
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine, New York, NY, USA.
| | - Jenny Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Kimberly Muellers
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Rachel O'Conor
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Michael Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
21
|
Jacobsen PA, van 't Hul AJ, Djamin RS, Antons JC, de Man M, Weinreich UM, Spruit MA, Janssen DJA. Characteristics and treatable traits of patients with chronic obstructive pulmonary disease (COPD) with and without paid employment. Respir Res 2021; 22:147. [PMID: 33980226 PMCID: PMC8117298 DOI: 10.1186/s12931-021-01736-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/02/2021] [Indexed: 01/11/2023] Open
Abstract
Introduction Patients with COPD are vulnerable to workforce detachment. Better knowledge of features associated with paid work loss might be of help to design and select appropriate interventions. Method This cross-sectional study aimed to explore the presence of treatable traits in COPD patients without paid work. Patients with COPD below 65 years at first referral to a hospital-based patient clinic were included. Using binary logistic regression analysis, the relationship between paid work and the following characteristics was explored: low daily physical activity, exercise, active smoking, Medical Research Council dyspnea scale (MRC), poor nutritional status, exacerbations, and fatigue (checklist individual strength (CIS)). Variables were adjusted for age, sex, forced expiratory volume in 1 s (FEV 1), and education level. Results In total, 191 patients (47.3%) were without paid work. The following treatable traits were related to not being in paid work: < 5000 steps/day (OR 2.36, 95% CI (1.52–3.68)), MRC ≥ 3 (OR 1.78, 95%CI (1.14–2.77)), CIS ≥ 36 points (OR 1.78, 95% CI (1.10–2.87)), six-minute walk distance (6MWD) < 70% of predicted (OR 2.62, 95% CI (1.69–4.06)), and ≥ 2 exacerbations per year (OR 1.80, 95% CI (1.12–2.92)). Significant differences were also seen in age (OR 1.06, 95% CI (1.02–1.10) per year), FEV 1% predicted (OR 0.98, 95% CI (0.97–1.00) per % predicted increase), and medium/high education level (OR 0.62, 95% CI (0.41–0.93)). When adjusting for all variables the only treatable trait that remained significant was 6MWD. Conclusion Patients without paid work are more likely to have treatable traits with 6MWD revealing the most significant association. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01736-6.
Collapse
Affiliation(s)
- Peter A Jacobsen
- Department of Respiratory Diseases, Aalborg University Hospital, Mølleparkvej 4, 9100, Aalborg, Denmark. .,The Clinical Institute, Aalborg University, Aalborg, Denmark.
| | - Alex J van 't Hul
- Department of Respiratory Diseases, Radboud University Medical Center, Radboud Institute for Health Sciences, 6525 GA, Nijmegen, The Netherlands
| | - Remco S Djamin
- Department of Respiratory Diseases, Amphia Hospital, 4818 CK, Breda, The Netherlands
| | - Jeanine C Antons
- Department of Respiratory Diseases, Radboud University Medical Center, Radboud Institute for Health Sciences, 6525 GA, Nijmegen, The Netherlands
| | - Marianne de Man
- Department of Respiratory Diseases, 5406, Uden, The Netherlands
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Mølleparkvej 4, 9100, Aalborg, Denmark.,The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Martijn A Spruit
- Department of Research and Development, Ciro, Horn, The Netherlands.,Faculty of Health, Medicine and Life Sciences, Nutrim School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Daisy J A Janssen
- Department of Research and Development, Ciro, Horn, The Netherlands.,Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
22
|
Barankay I, Reese PP, Putt ME, Russell LB, Phillips C, Pagnotti D, Chadha S, Oyekanmi KO, Yan J, Zhu J, Volpp KG, Clapp JT. Qualitative Exploration of Barriers to Statin Adherence and Lipid Control: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2021; 4:e219211. [PMID: 33944923 PMCID: PMC8097500 DOI: 10.1001/jamanetworkopen.2021.9211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/17/2021] [Indexed: 12/20/2022] Open
Abstract
Importance Financial incentives may improve health by rewarding patients for focusing on present actions-such as medication regimen adherence-that provide longer-term health benefits. Objective To identify barriers to improving statin therapy adherence and control of cholesterol levels with financial incentives and insights for the design of future interventions. Design, Setting, and Participants This qualitative study involved retrospective interviews with participants in a preplanned secondary analysis of a randomized clinical trial of financial incentives for statin therapy adherence. A total of 636 trial participants from several US insurer or employer populations and an academic health system were rank ordered by change in low-density lipoprotein cholesterol (LDLC) levels. Participants with the most LDLC level improvement (high-improvement group) and those with LDLC levels that did not improve (nonimprovement group) were purposively targeted, stratified across all trial groups, for semistructured telephone interviews that were performed from April 1 to June 30, 2018. Interviews were coded using a team-based, iterative approach. Data were analyzed from July 1, 2018, to October 31, 2020. Main Outcomes and Measures The primary outcome was mean change in LDLC level from baseline to 12 months; the secondary outcome, statin therapy adherence during the first 6 months. Results A total of 54 patients were interviewed, divided equally between high-improvement and nonimprovement groups, with a mean (SD) age of 43.5 (10.3) years; 36 (66.7%) were women, 28 (51.9%) had diabetes, and 18 (33.3%) had cardiovascular disease. Compared with the high-improvement group, the nonimprovement group had fewer interviewees with an annual income of greater than $50 000 (11 [40.7%] vs 22 [81.5%]), worse self-reported health (fair to poor, 13 [48.1%] vs 3 [11.1%]), more Black interviewees (16 [59.3%] vs 4 [14.8%]), and lower baseline LDLC levels (>160 mg/dL, 2 [7.4%] vs 25 [92.6%]). Participants in the nonimprovement group had a greater burden of chronic illness (≥2 chronic conditions, 13 [48.1%] vs 6 [22.2%]) and were less frequently employed (full-time, 6 [22.2%] vs 12 [44.4%]). In interviews, the nonimprovement group was less focused on risks of high LDLC levels, described less engagement in LDLC level management, articulated fewer specific nutritional choices for optimizing health, and recounted greater difficulty obtaining healthy food. Participants in both groups had difficulty describing the structure of the financial incentives but did recall features of the electronic pill containers used to track adherence and how those containers affected medication routines. Conclusions and Relevance Participants in a statin adherence trial whose LDLC levels did not improve found it more difficult to create medication routines and respond to financial incentives in the context of complex living conditions and a high burden of chronic illness. These findings suggest that future studies should be more attentive to socioeconomic circumstances of trial participants. Trial Registration ClinicalTrials.gov Identifier: NCT01798784.
Collapse
Affiliation(s)
- Iwan Barankay
- Department of Management, The Wharton School, University of Pennsylvania, Philadelphia
- Department of Business Economics and Public Policy, The Wharton School, University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
| | - Peter P. Reese
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Division of Renal Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Mary E. Putt
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Louise B. Russell
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Caitlin Phillips
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - David Pagnotti
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Sakshum Chadha
- currently a medical student at Rutgers New Jersey Medical School, Newark
| | - Kehinde O. Oyekanmi
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jiali Yan
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jingsan Zhu
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kevin G. Volpp
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Cresencz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia
| | - Justin T. Clapp
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
23
|
Moughames E, Woo H, Galiatsatos P, Romero-Rivero K, Raju S, Tejwani V, Hoffman EA, Comellas AP, Ortega VE, Parekh T, Krishnan JA, Drummond MB, Couper D, Buhr RG, Paine R, Kaufman JD, Paulin LM, Putcha N, Hansel NN. Disparities in access to food and chronic obstructive pulmonary disease (COPD)-related outcomes: a cross-sectional analysis. BMC Pulm Med 2021; 21:139. [PMID: 33906617 PMCID: PMC8077917 DOI: 10.1186/s12890-021-01485-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/22/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Millions of Americans are living in food deserts in the United States, however the role of the local food environment on COPD has not been studied. The aim of this study is to determine the association between food deserts and COPD-related outcomes. METHOD In this cross-sectional analysis we linked data collected from SPIROMICS (SubPopulations and InteRmediate Outcome Measures in COPD Study) between 2010 and 2015 and food desert data, defined as an underserved area that lacks access to affordable healthy foods, from the Food Access Research Atlas. COPD outcomes include percentage of predicted forced expiratory volume in one second (FEV1%), St. George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), 6-min walk distance test (6MWD), exacerbations, and air trapping. We used generalized linear mixed models to evaluate the association between living in food deserts and respiratory outcomes, adjusting for age, gender, race, education, income, marital status, BMI, smoking status, pack years, and urban status RESULTS: Among 2713 participants, 22% lived in food deserts. Participants living in food deserts were less likely to be white and more likely to have a lower income than those who did not live in food deserts. In the adjusted model controlling for demographics and individual income, living in food deserts was associated lower FEV1% (β = - 2.51, P = 0.046), higher air trapping (β = 2.47, P = 0.008), worse SGRQ (β = 3.48, P = 0.001) and CAT (β = 1.20, P = 0.003) scores, and 56% greater odds of severe exacerbations (P = 0.004). Results were consistent when looking at food access alone, regardless of whether participants lived in low income areas. CONCLUSIONS Findings suggest an independent association between food desert and food access alone with COPD outcomes. Health program planning may benefit from addressing disparities in access to food.
Collapse
Affiliation(s)
- Eric Moughames
- Department of Medicine, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
| | - Han Woo
- Division of Pulmonary and Critical Care, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Panagis Galiatsatos
- Division of Pulmonary and Critical Care, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Karina Romero-Rivero
- Division of Pulmonary and Critical Care, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Sarath Raju
- Division of Pulmonary and Critical Care, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Vickram Tejwani
- Division of Pulmonary and Critical Care, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Eric A Hoffman
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Victor E Ortega
- Department of Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Trisha Parekh
- Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - Jerry A Krishnan
- Department of Medicine, University of Illinois, Chicago, IL, USA
| | - Michael B Drummond
- Department of Medicine, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - David Couper
- Department of Biostatistics, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Russell G Buhr
- Department of Medicine, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA, USA
| | - Robert Paine
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Joel D Kaufman
- Department of Medicine and Epidemiology, University of Washington, Seattle, WA, USA
| | - Laura M Paulin
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| |
Collapse
|
24
|
Edwards NM, Varnum C, Overgaard S, Pedersen AB. The impact of socioeconomic status on the utilization of total hip arthroplasty during 1995-2017: 104,055 THA cases and 520,275 population controls from national databases in Denmark. Acta Orthop 2021; 92:29-35. [PMID: 33106101 PMCID: PMC7919906 DOI: 10.1080/17453674.2020.1840111] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - In Denmark, all citizens are guaranteed free access to medical care, which should minimize socioeconomic status (SES) inequalities. We examined the association between SES and the utilization of total hip arthroplasty (THA) by age and over time.Patients and methods - Data on education, income, liquid assets, and occupation on 104,055 THA cases and 520,275 population controls were obtained from Danish health registers. We used logistic regression to estimate adjusted odds ratios (aOR) for THA with 95% confidence intervals (CI).Results - Risk (CI) of THA was higher for 45-55-year-olds with lowest vs. highest education (aOR 1.4 [1.3-1.5]), and for those with lowest vs. highest income (aOR 1.1 [1.0-1.2]). The association between education and income and higher risk of THA decreased with increasing age. The risk of THA was lower for persons with lowest vs. highest liquid assets in all age groups and time periods. The risk of THA was higher for persons with lowest education in 1995-2000 (aOR 1.2 [1.1-1.3]), but diminished in 2013-2017 (aOR 1.0 [1.0-1.0]). For those on lowest income there was a higher risk of THA in 1995-2000 (aOR 1.2 [1.1-1.3]), changing to lower risk in 2013-2017 (aOR 0.8 [0.8-0.9]).Interpretation - In a society where all citizens are guaranteed free access to medical care, we observed a social inequality in regard to the risk of THA with a development over time and in relation to age in most of our SES markers, showing a need for more patient involvement by implementing more focused interventions targeted to the most vulnerable patient groups identified as currently living alone, on low income, and with a low level of liquid assets.
Collapse
Affiliation(s)
- Nina M Edwards
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N; ,Correspondence:
| | - Claus Varnum
- Department of Orthopaedic Surgery, Lillebaelt Hospital, Vejle;; ,Department of Regional Health Research, University of Southern Denmark; ,Danish Hip Arthroplasty Register; ,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; ,Department of Clinical Research, University of Southern Denmark, Denmark
| | - Søren Overgaard
- Danish Hip Arthroplasty Register; ,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; ,Department of Clinical Research, University of Southern Denmark, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N;
| |
Collapse
|
25
|
Zeng Y, Cai S, Chen Y, Duan J, Zhao Y, Li X, Ma L, Liu Q, Zhu Y, Chen M, Zhou M, Chen P. Current Status of the Treatment of COPD in China: A Multicenter Prospective Observational Study. Int J Chron Obstruct Pulmon Dis 2020; 15:3227-3237. [PMID: 33324046 PMCID: PMC7732160 DOI: 10.2147/copd.s274024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/16/2020] [Indexed: 12/30/2022] Open
Abstract
Background There is a large gap in the treatments for patients with COPD according to the Global Initiative for COPD (GOLD) recommendations. Determining the situation of therapies in the real world is necessary. This study aimed to characterize the real-world practical therapies of COPD and prognosis of patients after treatment for 1 year. Methods This study was a multicenter prospective observational study performed using a database set up by the Second Xiangya Hospital of Center South University. Detailed usage information for pharmacotherapies and nonpharmacotherapies for patients was collected, as well as the consistency of recommendations and patient adherence. Moreover, the effect of therapies after 1 year was calculated by comparing lung function and symptoms. Results Ultimately, 4,796 patients with COPD from 12 hospitals in China were eligible. LAMA (39.1%), LAMA + LABA/ICS (39.0%) and LABA/ICS (14.4%) were the top three inhalants. We found that 42.7% of Group A patients, 61.6% of Group B patients and 30% of Group C patients were following inappropriate therapy, especially overuse of ICS. Only 3.9% (95% CI 2.4, 5.4) of patients used oxygen therapy, and 1.8% (95% CI 1.5, 2.3) used noninvasive positive pressure ventilation at home. Among these patients, 33.2% had poor adherence. A total of 452 patients completed 1 year of follow-up. After 1 year of treatment, the lung function of FEV1/FVC decreased (P=0.001) and the mMRC score increased (P<0.001). There was no change in CAT scores (P>0.05). Conclusion This study highlights a significant discrepancy between recommendations for managing patients with COPD in GOLD report, and in real-world clinical practice in China. Over-prescription of ICS and under-prescription of nonpharmacologic therapy were common. The adherence to treatment of patients was poor, and the real-life treatment effectiveness was unsatisfactory. More attention should be paid to the implementation of recommendations and standardized administration of therapies.
Collapse
Affiliation(s)
- Yuqin Zeng
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine, Changsha, Hunan, People's Republic of China
| | - Shan Cai
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine, Changsha, Hunan, People's Republic of China
| | - Yan Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine, Changsha, Hunan, People's Republic of China
| | - Jiaxi Duan
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine, Changsha, Hunan, People's Republic of China
| | - Yiyang Zhao
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine, Changsha, Hunan, People's Republic of China
| | - Xin Li
- Division 4 of Occupational Disease, Hunan Occupational Disease Prevention and Treatment Hospital, Changsha, Hunan, People's Republic of China
| | - Libing Ma
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, People's Republic of China
| | - Qimi Liu
- Department of Respiratory and Critical Care Medicine, The Second People's Hospital of Guilin, Guilin, Guangxi, People's Republic of China
| | - Yingqun Zhu
- Department of Respiratory and Critical Care Medicine, The Third Hospital of Changsha, Changsha, Hunan, People's Republic of China
| | - Ming Chen
- Department of Respiratory and Critical Care Medicine, No.1 Traditional Chinese Medicine Hospital of Changde City, Changde, Hunan, People's Republic of China
| | - Meiling Zhou
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Huaihua City, Huaihua, Hunan, People's Republic of China
| | - Ping Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine, Changsha, Hunan, People's Republic of China
| |
Collapse
|
26
|
Akimoto K, Hirai K, Matsunaga T, Kaneko K, Mikuni H, Kawahara T, Uno T, Fujiwara A, Miyata Y, Ohta S, Homma T, Inoue H, Yamaguchi F, Kusumoto S, Suzuki S, Tanaka A, Sagara H. The Relationship Between the "Adherence Starts with Knowledge-20" Questionnaire and Clinical Factors in Patients with COPD: A Multi-Center, Cross-Sectional Study. Int J Chron Obstruct Pulmon Dis 2020; 15:3201-3211. [PMID: 33311977 PMCID: PMC7726831 DOI: 10.2147/copd.s280464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/16/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose Inhaler therapy is the mainstay of chronic obstructive pulmonary disease (COPD) management. Poor adherence causes disease exacerbation and affects patient mortality. Although the Adherence Starts with Knowledge-20 (ASK-20) questionnaire is a reliable tool for assessing medication adherence, the relationship between the ASK-20 and clinical factors in patients with COPD remains unknown. We investigated the relationship between the ASK-20 and clinical factors, and assessed real-world inhaler therapy use. Patients and Methods A multicenter, cross-sectional study of outpatients with COPD undergoing inhaler treatment who completed the ASK-20 questionnaire was performed. We investigated COPD-related health status using the COPD Assessment Test (CAT), psychological status using the Hospital Anxiety and Depression Scale (HADS-anxiety and HADS-depression), respiratory function, patient satisfaction levels, and real-world inhaler therapy use. Results Of the total 319 patients, 87% were male with a median age of 74 years. Most patients had mild or moderate COPD, according to Global Initiative for Chronic Obstructive Lung Disease stage. The total ASK-20 scores correlated significantly with the CAT, HADS-anxiety, and HADS-depression scores (r = 0.27, 0.33, and 0.29, respectively, p < 0.01). Multivariable analysis showed that CAT and HADS-anxiety scores had an independent and significant impact on the ASK-20 scores [β, standardized regression coefficient: 0.18 (95% CI, 0.03–0.35; p = 0.02), and 0.29 (95% CI, 0.17–0.42; p < 0.01), respectively]; however, the ASK-20 scores were not correlated with age, sex, body mass index, cohabitation, modified Medical Research Council Dyspnea Scale score, pulmonary function, disease duration, number of COPD exacerbations per year, comorbidities, inhaler numbers, nor inhaler components. Conclusion The ASK-20 scores in patients with COPD were significantly associated with CAT and HADS scores. In Japan, Respimat was prescribed to younger patients and patients with lower CAT scores. The ASK-20, a simple evaluation method, is useful for identifying clinical factors affecting adherence in patients with COPD.
Collapse
Affiliation(s)
- Kaho Akimoto
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kuniaki Hirai
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tomohiro Matsunaga
- Division of Allergology and Respiratory Medicine, Department of Medicine, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Keisuke Kaneko
- Department of Pulmonary Medicine, Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, Tokyo, Japan
| | - Hatsuko Mikuni
- Department of Respiratory Medicine, Asahi General Hospital, Chiba, Japan
| | - Tomoko Kawahara
- Department of Respiratory Medicine, Yamanashi Red Cross Hospital, Yamanashi, Japan
| | - Tomoki Uno
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Akiko Fujiwara
- Department of Respiratory, Odawara Municipal Hospital, Kanagawa, Japan
| | - Yoshito Miyata
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Shin Ohta
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tetsuya Homma
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hideki Inoue
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Fumihiro Yamaguchi
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Sojiro Kusumoto
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Shintaro Suzuki
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Akihiko Tanaka
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hironori Sagara
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| |
Collapse
|
27
|
Muellers KA, Chen L, O'Conor R, Wolf MS, Federman AD, Wisnivesky JP. Health Literacy and Medication Adherence in COPD Patients: When Caregiver Presence Is Not Sufficient. COPD 2020; 16:362-367. [PMID: 31755323 DOI: 10.1080/15412555.2019.1665007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Limited health literacy (HL) is associated with a lower medication adherence in patients with chronic obstructive pulmonary disease (COPD). In this study, we examined the potential mitigating role of caregiver support on the relationship between HL and adherence to COPD medications. We conducted a prospective observational study of adults with COPD and their caregivers. HL was assessed using the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and COPD medication adherence was evaluated with the Medication Adherence Rating Scale (MARS). We also collected caregiver HL data for a subset of participants. We tested whether having a caregiver impacted the relationship between HL and medication adherence using cross-sectional data collected between 2011 and 2015. Our sample included 388 COPD patients and 97 caregivers. COPD patients with low HL had a lower medication adherence (odds ratio [OR]: 0.44, 95% confidence interval [CI]: 0.24-0.81) after adjusting for sociodemographic factors. Caregiver presence was not associated with increased patient medication adherence (OR: 1.28, 95% CI: 0.79-2.08). Among the subset of patients with caregivers, low patient HL remained associated with a lower medication adherence (OR: 0.28, 95% CI: 0.09-0.82) when adjusted for caregiver HL and sociodemographic factors. Low HL is associated with lower COPD medication adherence, and this effect is not mitigated by the presence of a caregiver. These findings suggest a need for effective strategies to manage high-risk COPD patients with low HL, even among those with adequate support from caregivers, and to design interventions for both patients and caregivers with low HL.
Collapse
Affiliation(s)
- Kimberly A Muellers
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Li Chen
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
28
|
Zhang HQ, Lin JY, Guo Y, Pang S, Jiang R, Cheng QJ. Medication adherence among patients with chronic obstructive pulmonary disease treated in a primary general hospital during the COVID-19 pandemic. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1179. [PMID: 33241028 PMCID: PMC7576045 DOI: 10.21037/atm-20-6016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background The objective of this study was to investigate medication adherence and the associated influencing factors in patients with chronic obstructive pulmonary disease (COPD) who were treated in a primary general hospital in Shanghai China during the 2019 novel coronavirus (COVID-19) pandemic. Methods From March to April 2020, all of the COPD patients treated in our department in the last 7 years were interviewed by telephone. The basic patient data and each questionnaire item were collected, and influencing factors were analyzed by the Chi-square test, U test, and univariate and multivariate logistic regression analyses. Results A total of 191 patients with COPD were queried, and 84 (44.0%) valid questionnaires were obtained. Among them, individuals with group B symptoms were most represented (45.2%); 53.6% had Medical Research Council (MRC) dyspnea levels of 2 or above. Chronic obstructive pulmonary disease assessment test (CAT) had an average of 9 [3, 13], and 52.4% of patients used two-drug combination therapy. Medication adherence was both good in ordinary times and over the past 2 months of the pandemic, and 88.8% of patients had no acute exacerbation during the pandemic. The CAT scores of male patients <70 years old, and patients with general outpatient follow-up and regular gargling were reduced (P<0.05). Drug combination and doctor’s supervision were favorable factors affecting medication adherence during the 2 months of the pandemic, while possible depression was an unfavorable factor (P<0.05). Conclusions During the pandemic, medication adherence in patients with COPD was similar to that in regular times, and was significantly related to drug combination, doctor’s supervision, and accompanying mood disorders. An effective way to improve patient adherence and disease control could be strengthening follow-up education and diagnosing and treating depression and other complications.
Collapse
Affiliation(s)
- Hai-Qin Zhang
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Jia-Yuan Lin
- Department of Pharmacy, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Yi Guo
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Shuai Pang
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Ren Jiang
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Qi-Jian Cheng
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| |
Collapse
|
29
|
Khalaf K, Axelsson Fisk S, Ekberg-Jansson A, Leckie G, Perez-Vicente R, Merlo J. Geographical and sociodemographic differences in discontinuation of medication for Chronic Obstructive Pulmonary Disease - A Cross-Classified Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA). Clin Epidemiol 2020; 12:783-796. [PMID: 32765111 PMCID: PMC7381094 DOI: 10.2147/clep.s247368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/11/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND While discontinuation of COPD maintenance medication is a known problem, the proportion of patients with discontinuation and its geographical and sociodemographic distribution are so far unknown in Sweden. Therefore, we analyse this question by applying an innovative approach called multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). PATIENTS AND METHODS We analysed 49,019 patients categorized into 18 sociodemographic contexts and 21 counties of residence. All patients had a hospital COPD diagnosis and had been on inhaled maintenance medication during the 5 years before the study baseline in 2010. We defined "discontinuation" as the absolute lack of retrieval from a pharmacy of any inhaled maintenance medication during 2011. We performed a cross-classified MAIHDA and obtained the average proportion of discontinuation, as well as county and sociodemographic absolute risks, and compared them with a proposed benchmark value of 10%. We calculated the variance partition coefficient (VPC) and the area under the receiver operating characteristics curve (AUC) to quantify county and sociodemographic differences. To summarize the results, we used a framework with 15 scenarios defined by the size of the differences and the level of achievement in relation to the benchmark value. RESULTS Around 18% of COPD patients in Sweden discontinued maintenance medication, so the benchmark value was not achieved. There were very small county differences (VPC=0.35%, AUC=0.54). The sociodemographic differences were small (VPC=4.98%, AUC=0.57). CONCLUSION Continuity of maintenance medication among COPD patients in Sweden could be improved by reducing the unjustifiably high prevalence of discontinuation. The very small county and small sociodemographic differences should motivate universal interventions across all counties and sociodemographic groups. Geographical analyses should be combined with sociodemographic analyses, and the cross-classified MAIHDA is an appropriate tool to assess health-care quality.
Collapse
Affiliation(s)
- Kani Khalaf
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Sten Axelsson Fisk
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Ann Ekberg-Jansson
- Department of Research and Development, Region Halland, Halmstad, Sweden
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - George Leckie
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
- Centre for Multilevel Modelling, University of Bristol, Bristol, UK
| | - Raquel Perez-Vicente
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Juan Merlo
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
- Center for Primary Health Care Research, Region Skåne, Malmö, Sweden
| |
Collapse
|
30
|
Adherence of North-African Pulmonologists to the 2017-Global Initiative for Chronic Obstructive Lung Disease (GOLD) Pharmacological Treatment Guidelines (PTGs) of Stable Chronic Obstructive Pulmonary Disease (COPD). BIOMED RESEARCH INTERNATIONAL 2020; 2020:1031845. [PMID: 32190644 PMCID: PMC7066397 DOI: 10.1155/2020/1031845] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 02/07/2023]
Abstract
Background No previous study has investigated the adherence rate of North-African pulmonologists to the 2017-GOLD PTGs. Aims To investigate the adherence rate of Tunisian pulmonologists to the 2017-GOLD PTGs and to identify the barriers to their adherence. Methods This was a cohort study involving clinically stable COPD patients who presented to a pulmonology outpatient consultation. The patients were classified as having been appropriately and inappropriately (over- or undertreatment) treated for the GOLD group. Logistic regression was performed to determine the adherence barriers to the 2017-GOLD PTGs. Results A total of 296 patients were included (88.1% males, mean age: 68 ± 10 years; GOLD A (7.1%), B (36.1%), C (4.1%), and D (52.7%)). The pulmonologists' adherence rate to the 2017-GOLD PTGs was 29.7%. There was a significant statistical difference between the adherence rates among the four GOLD groups (A: 19.0%, B: 20.6%, C: 8.3%, and D: 39.1%; p = 0.001). Differences were statistically significant between the GOLD group D and groups B (p = 0.001). Differences were statistically significant between the GOLD group D and groups B (p = 0.001). Differences were statistically significant between the GOLD group D and groups B (. Conclusion The adherence rate of Tunisian pulmonologists to the 2017-GOLD PTGs is low. It seems that the patients' age, socioeconomic level, national health insurance coverage, and GOLD groups influenced their adherence.
Collapse
|
31
|
Gonçalves-Macedo L, Lacerda EM, Markman-Filho B, Lundgren FLC, Luna CF. Trends in morbidity and mortality from COPD in Brazil, 2000 to 2016. ACTA ACUST UNITED AC 2019; 45:e20180402. [PMID: 31778424 PMCID: PMC7447544 DOI: 10.1590/1806-3713/e20180402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/17/2019] [Indexed: 11/21/2022]
Abstract
Objective: To examine the trends in overall COPD mortality, as well as trends in in-hospital morbidity and mortality due to COPD, in Brazil, and to validate predictive models. Methods: This was a population-based study with a time-series analysis of cause-specific morbidity and mortality data for individuals ≥ 40 years of age, obtained from national health information systems for the 2000-2016 period. Morbidity and mortality rates, stratified by gender and age group, were calculated for the same period. We used regression analyses to examine the temporal trends and double exponential smoothing in our analysis of the predictive models for 2017. Results: Over the study period, COPD mortality rates trended downward in Brazil. For both genders, there was a downward trend in the southern, southeastern, and central-western regions. In-hospital morbidity rates declined in all regions, more so in the south and southeast. There were significant changes in the number of hospitalizations, length of hospital stay, and hospital expenses. The predictive models for 2017 showed error rates below 9% and were therefore validated. Conclusions: In Brazil, COPD age-adjusted mortality rates have declined in regions with higher socioeconomic indices, where there has been an even sharper decrease in all in-hospital morbidity and mortality variables. In addition to factors such as better treatment adherence and reduced smoking rates, socioeconomic factors appear to be involved in controlling COPD morbidity and mortality. The predictive models estimated here might also facilitate decision making and the planning of health policies aimed at treating COPD.
Collapse
Affiliation(s)
- Liana Gonçalves-Macedo
- . Serviço de Pneumologia, Hospital Otávio de Freitas, Secretaria de Saúde do Estado de Pernambuco, Recife (PE) Brasil
| | - Eliana Mattos Lacerda
- . Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Brivaldo Markman-Filho
- . Serviço de Cardiologia, Departamento de Clínica Médica, Universidade Federal de Pernambuco, Recife (PE) Brasil
| | | | - Carlos Feitosa Luna
- . Departamento de Estatística e Geoprocessamento, Fundação Oswaldo Cruz - Fiocruz - Recife (PE) Brasil
| |
Collapse
|
32
|
Grosbois JM, Heluain-Robiquet J, Machuron F, Terce G, Chenivesse C, Wallaert B, Le Rouzic O. Influence Of Socioeconomic Deprivation On Short- And Long-Term Outcomes Of Home-Based Pulmonary Rehabilitation In Patients With Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2019; 14:2441-2449. [PMID: 31802862 PMCID: PMC6827503 DOI: 10.2147/copd.s224348] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/13/2019] [Indexed: 11/23/2022] Open
Abstract
Background Pulmonary rehabilitation (PR) improves exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease (COPD), regardless of disease severity. Socioeconomic deprivation has been linked to the incidence of COPD; however, little is known about its impact on PR outcomes. Methods In this retrospective observational study, 459 COPD patients were enrolled and dichotomized into socially deprived (n=276) and non-socially deprived (n=183) groups based on a cut-off of 30.17 in the EPICES questionnaire (Evaluation of Deprivation and Inequalities in Health Centers), which evaluates socioeconomic disadvantage. The PR program consisted of once-weekly home sessions for 8 weeks, and consisted of an individualized plan of retraining exercises, physical activities, therapeutic education, and psychosocial and motivational support. Exercise tolerance, anxiety and depression, and quality of life were assessed using the 6 min stepper test (6MST), Hospital Anxiety and Depression Scale (HADS), and Visual Simplified Respiratory Questionnaire (VSRQ). Assessments were made before the PR program (baseline) and then at 2 (T2), 8 (T8), and 14 (T14) months after baseline. Results Compared with the non-socially deprived group, socially deprived patients were younger, more frequently women, active smokers, and living alone, and belonged to lower socioprofessional categories. At baseline, 6MST, VSRQ, and HADS measures were lower for the socially deprived than the non-socially deprived group. At T2, T8, and T14, there were no significant between-group differences in any outcome, and the percentage of patients showing clinically important improvements was the same in both groups. Conclusion Home-based PR is effective for COPD patients in the short and long term, regardless of socioeconomic status.
Collapse
Affiliation(s)
- Jean-Marie Grosbois
- FormAction Santé, Pérenchies F-59840, France.,CH Béthune, Service de Pneumologie et Réhabilitation Respiratoire, Béthune F-62400, France
| | - Justine Heluain-Robiquet
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Department of Heart and Lung Diseases, Lille F-59000, France
| | - François Machuron
- CHU Lille, Department of Biostatistics, University Lille, EA 2694 - Santé Publique: Epidémiologie Et Qualité Des Soins, Lille F-59000, France
| | - Gaelle Terce
- CH Béthune, Service de Pneumologie et Réhabilitation Respiratoire, Béthune F-62400, France
| | - Cécile Chenivesse
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Department of Heart and Lung Diseases, Lille F-59000, France.,University Lille, Lille F-59000, France.,Inserm, CNRS, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille F-59000, France
| | - Benoit Wallaert
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Department of Heart and Lung Diseases, Lille F-59000, France.,University Lille, Lille F-59000, France.,Inserm, CNRS, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille F-59000, France
| | - Olivier Le Rouzic
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Department of Heart and Lung Diseases, Lille F-59000, France.,University Lille, Lille F-59000, France
| |
Collapse
|
33
|
Tavakoli H, Johnson KM, FitzGerald JM, Sin DD, Gershon AS, Kendzerska T, Sadatsafavi M. Trends in prescriptions and costs of inhaled medications in chronic obstructive pulmonary disease: a 19-year population-based study from Canada. Int J Chron Obstruct Pulmon Dis 2019; 14:2003-2013. [PMID: 31564848 PMCID: PMC6732655 DOI: 10.2147/copd.s210897] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/15/2019] [Indexed: 11/30/2022] Open
Abstract
Background The patterns of medication use in chronic obstructive pulmonary disease (COPD) may change over time due to the availability of new medications, updates in guideline-based recommendations, and changes in patient and care provider preferences. Objectives To document population-level trends of filled prescriptions and costs for major classes of inhaled COPD therapies. Method We used administrative health databases of the province of British Columbia, Canada, from 1997 to 2015, to create a retrospective cohort of COPD patients. We documented the percentage of patients receiving major inhaled COPD-related medications, including short-acting beta-2 adrenoreceptor agonists (SABA), long-acting beta-2 adrenoreceptor agonists (LABA), inhaled corticosteroids (ICS), short-acting muscarinic receptor antagonists (SAMA), and long-acting muscarinic receptor antagonists (LAMA). We quantified the average, and relative annual change in, dispensed quantities and costs (in 2015 Canadian dollars [$]) of medications. Combination therapy was assessed as the proportion of time covered by two or more long-acting medications of different classes. Results A total of 176,338 patients were included in the final cohort (mean age at entry 68.7, 48.5% female). In 2015, the most common medication was ICS (45.7% of the patients), followed by LABA (36.5%). LAMA was the least used medication (18.9%). The number of filled prescriptions per patient per year for LAMA (+7.8% per year) and LABA (+4.9%) increased, while they decreased for SAMA (−6.3%) and SABA (−3.8%), and remained relatively constant for ICS. The average annual per-patient costs of inhaled medications were $570.8 in 2015, which was double the costs from 1997. Single-inhaler ICS/LABA had the highest rate of increase (11.6% per year), and comprised 53.7% of the total costs of inhalers in 2015. In 2015, 28.5% of the patient time was on combination therapies, with 7.1% on triple ICS/LABA/LAMA therapy. Conclusion Utilization of inhaled therapies for COPD has changed significantly over time. The low utilization of LAMA and high utilization of combination therapies (particularly those containing ICS) do not seem to be aligned with COPD treatment guidelines.
Collapse
Affiliation(s)
- Hamid Tavakoli
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate M Johnson
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Mark FitzGerald
- Institute for Heart and Lung Health, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation (the James Hogg Research Centre), St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Andrea S Gershon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Tetyana Kendzerska
- Department of Medicine, Division of Respirology, The Ottawa Hospital Research Institute/University of Ottawa, Ottawa, Ontario, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,Institute for Heart and Lung Health, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
34
|
Revue générale sur l’adhésion aux traitements inhalés de la BPCO. Rev Mal Respir 2019; 36:801-849. [DOI: 10.1016/j.rmr.2019.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 05/23/2019] [Indexed: 01/12/2023]
|
35
|
Bauer WS, Schiffman RF. Factors Influencing Self-Management of Chronic Obstructive Pulmonary Disease by Community-Dwelling Adults. West J Nurs Res 2019; 42:423-430. [PMID: 31313648 DOI: 10.1177/0193945919865532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Individuals with chronic obstructive pulmonary disease (COPD) struggle with effective self-management, contributing to poor health outcomes and costly health care. More research is needed to understand the factors influencing COPD self-management better in order to improve outcomes and reduce health care costs for those living with this prevalent chronic illness. The purpose of this article is to describe factors influencing community-dwelling adults' COPD self-management. In-depth interviews were conducted with 28 people living with COPD. Braun and Clarke's thematic analysis approach was used to analyze interview data, and it resulted in the identification of themes providing insight into COPD self-management as described by those living with the disease. Specifically, factors impacting engagement in treatment recommendations are described. These findings have implications for informing evidence-based recommendations for self-management support and improving the quality of care provided to those with COPD.
Collapse
Affiliation(s)
- Wendy S Bauer
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Rachel F Schiffman
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| |
Collapse
|
36
|
López-Campos JL, Quintana Gallego E, Carrasco Hernández L. Status of and strategies for improving adherence to COPD treatment. Int J Chron Obstruct Pulmon Dis 2019; 14:1503-1515. [PMID: 31371936 PMCID: PMC6628097 DOI: 10.2147/copd.s170848] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/05/2019] [Indexed: 12/19/2022] Open
Abstract
Despite the wide application of adherence as a concept, the definition, evaluation and improvement of the adherence to treatment by patients with chronic obstructive pulmonary disease (COPD) still present some challenges. First, it is necessary to clearly define the concepts of treatment adherence, compliance and persistence. Second, it is critical to consider the various methods of evaluating and quantifying adherence when interpreting adherence studies. In addition, the advantages and disadvantages of the different ways of measuring treatment adherence should be taken into account. Another subject of some debate is the number of variables associated with COPD treatment adherence. Adherence is a complex concept that goes beyond the dosage or the use of inhalation devices, and a number of variables are involved in determining adherence, from the clinical aspects of the disease to the patient's confidence in the doctor's expertise and the level of social support experienced by the patient. Notably, despite these challenges, the importance of adherence has been well established by clinical trials and routine clinical practice. The available evidence consistently shows the substantial impact that a lack of adherence has on the control of the disease and its long-term prognosis. For these reasons, the correct evaluation of therapeutic adherence should be a key objective in clinical interviews of patients. In recent years, various initiatives for improving adherence have been explored. All these initiatives have been based on patient education. Therefore, health care professionals should be aware of the issues pertaining to adherence and take the opportunity to educate patients each time they contact the health care system.
Collapse
Affiliation(s)
- José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Esther Quintana Gallego
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Carrasco Hernández
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
37
|
Lemoine S CM, Brigham EP, Woo H, Hanson CK, McCormack MC, Koch A, Putcha N, Hansel NN. Omega-3 fatty acid intake and prevalent respiratory symptoms among U.S. adults with COPD. BMC Pulm Med 2019; 19:97. [PMID: 31122230 PMCID: PMC6533751 DOI: 10.1186/s12890-019-0852-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 04/25/2019] [Indexed: 12/21/2022] Open
Abstract
Background Omega-3 fatty acids, including alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and derivatives, play a key role in the resolution of inflammation. Higher intake has been linked to decreased morbidity in several diseases, though effects on respiratory diseases like COPD are understudied. Methods The National Health and Nutrition Examination Survey (NHANES), with a focus on dietary assessment, provides a unique opportunity to explore relationships between omega-3 intake and morbidity in respiratory diseases marked by inflammation in the United States (US) population. We investigated relationships between ALA or EPA + DHA intake and respiratory symptoms among US adults with COPD, as well as variation in relationships based on personal characteristics or exposures. Results Of 878 participants, mean age was 60.6 years, 48% were current smokers, and 68% completed high school. Omega-3 intake was, 1.71 ± 0.89 g (ALA), and 0.11 ± 0.21 g (EPA + DHA). Logistic regression models, adjusting for age, gender, race, body mass index, FEV1, education, smoking status, pack-years, total caloric intake, and omega-6 (linoleic acid, LA) intake demonstrated no primary associations between omega-3 intake and respiratory symptoms. Interaction terms were used to determine potential modification of relationships by personal characteristics (race, gender, education) or exposures (LA intake, smoking status), demonstrating that at lower levels of LA intake, increasing ALA intake was associated with reduced odds of chronic cough (pint = 0.015) and wheeze (pint = 0.037). EPA + DHA, but not ALA, was associated with reduced symptoms only among current smokers who did not complete high school. Conclusions Individual factors should be taken into consideration when studying the association of fatty acid intake on respiratory diseases, as differential responses may reveal susceptible subgroups. Electronic supplementary material The online version of this article (10.1186/s12890-019-0852-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | - Emily P Brigham
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Han Woo
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Meredith C McCormack
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abigail Koch
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nirupama Putcha
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nadia N Hansel
- Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| |
Collapse
|
38
|
Whalley D, Svedsater H, Doward L, Crawford R, Leather D, Lay-Flurrie J, Bosanquet N. Follow-up interviews from The Salford Lung Study (COPD) and analyses per treatment and exacerbations. NPJ Prim Care Respir Med 2019; 29:20. [PMID: 31073124 PMCID: PMC6509249 DOI: 10.1038/s41533-019-0123-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 03/05/2019] [Indexed: 11/25/2022] Open
Abstract
The Salford Lung Study in chronic obstructive pulmonary disease (SLS COPD) was a 12-month, Phase III, open-label, randomised study comparing the effectiveness and safety of initiating once-daily fluticasone furoate 100 µg/vilanterol 25 µg (FF/VI) with continuing usual care (UC). Follow-up interviews were conducted among a subset of 400 patients who completed SLS COPD to further understand patients' experiences with treatment outcomes and the impact of COPD, and potential risk factors associated with higher rates of exacerbations during SLS COPD. Another objective was to explore how such patient-centred outcomes differed by randomised treatment. Patients' perceived control over COPD and effects on quality of life (QoL) were similar between treatment groups at the time of the follow-up interview, but more patients in the FF/VI group compared with UC reported perceived improvements in COPD control and QoL during the study. Of patients who experienced ≥2 exacerbations during SLS COPD, a greater percentage were women, were unemployed or homemakers, or were on long-term sick leave. Having ≥2 exacerbations also appeared to be associated with smoking, seeing a hospital specialist, a feeling of having no/little control over COPD, perceived worsening of feelings of control and reduced overall QoL since the start of the study, being aware of impending exacerbation occurrence and a more severe last exacerbation. Initiation of FF/VI was associated with a greater perceived improvement in patients' control of their COPD and QoL throughout SLS COPD than continuation of UC. Suggestions that smoking status and feelings of control are potentially related to exacerbation require further investigation.
Collapse
Affiliation(s)
| | - Henrik Svedsater
- Value Evidence & Outcomes, GlaxoSmithKline plc., Brentford, Middlesex, UK.
| | | | | | - David Leather
- Global Respiratory Franchise, GlaxoSmithKline plc., Uxbridge, Middlesex, UK
| | | | | |
Collapse
|
39
|
Lee YS, Oh JY, Min KH, Lee SY, Kang KH, Shim JJ. The association between living below the relative poverty line and the prevalence of chronic obstructive pulmonary disease. J Thorac Dis 2019; 11:427-437. [PMID: 30962986 DOI: 10.21037/jtd.2019.01.40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Because poverty is a multifaceted concept with a complex definition, this concept may not be useful when formulating economic policy. Thus, most governments use the relative poverty line to identify poor participants who may receive economic support. The aim of this study was to investigate the association between living below the relative poverty line and the prevalence of chronic obstructive pulmonary disease (COPD). Methods We retrospectively analyzed data from 3,223 individuals included in South Korea. Living below the poverty line was defined as receiving a monthly income less than the minimum cost of living. Results Of the 3,223 participants included in this analysis, 832 (25.8%) met the definition of living below the relative poverty line and 384 (11.9%) had COPD. Of the 3,223 participants, 161 of the 832 (19.4%) living below the poverty line and 223 of the 2,391 (9.3%) living above the poverty line had COPD. In our study, participants living below the poverty line had a 1.4-time higher risk of COPD development compared with those living above the poverty line (OR =1.4; P=0.012). Elderly people living below the poverty line were 1.5-time more likely to be at risk of COPD development than those living above the poverty line (OR =1.5; P=0.021). Conclusions People living below the relative poverty line have an increased prevalence of COPD, especially older people with COPD. From the perspective of COPD disease control, policy makers should consider providing national economic support for the early detection and management of COPD in people living below the relative poverty line.
Collapse
Affiliation(s)
- Young Seok Lee
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Jee Youn Oh
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Kyung Hoon Min
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Sung Yong Lee
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Kyung Ho Kang
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Jae Jeong Shim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| |
Collapse
|
40
|
Fernandez-Lazaro CI, Adams DP, Fernandez-Lazaro D, Garcia-González JM, Caballero-Garcia A, Miron-Canelo JA. Medication adherence and barriers among low-income, uninsured patients with multiple chronic conditions. Res Social Adm Pharm 2018; 15:744-753. [PMID: 30241872 DOI: 10.1016/j.sapharm.2018.09.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 08/30/2018] [Accepted: 09/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Poor adherence to long-term therapies is a public health concern that affects all populations. Little is known about the context of adherence in chronic diseases for the uninsured population in the United States. OBJECTIVE To evaluate medication adherence and barriers among low-income, uninsured adults recently initiating new therapy for a chronic disease. METHODS A cross-sectional study in two Community Health Centers located in Chatham County, Georgia, was performed between September and December 2015. Patients, randomly selected for inclusion in the study, were eligible if they had been prescribed medication for 2 or more chronic conditions and had recently started a new medication regimen. The Morisky-Green-Levine questionnaire was used to assess adherence. Potential barriers were analyzed using the Multidimensional Model proposed by the World Health Organization-social and economic, healthcare team and system-related, condition-related, therapy-related, and patient-related factors. Multivariate logistic regression models were used to analyze factors associated with non-adherence. RESULTS A total of 150 participants were interviewed at 6 months after treatment initiation. Non-adherence was reported by 52% of the participants. Higher adjusted odds of non-adherence were observed in participants who did not receive information about their medications (adjusted odds ratio [AOR] = 2.40, 95% confidence interval [CI] = 1.01-5.74), did not regularly visit a primary health-care provider (AOR = 2.74, 95% CI = 1.09-6.88), and had changes in their treatment (AOR = 3.75, 95% CI = 1.62-8.70). Alternatively, adjusted odds of non-adherence were lower for patients who reported using pillboxes (AOR = 0.31, 95% CI = 0.10-0.95), having help from a caregiver (AOR = 0.15, 95% CI = 0.04-0.60), and integrating medication dosing into daily routines (AOR = 0.18, 95% CI = 0.06-0.59). CONCLUSIONS Medication non-adherence was common among low-income, uninsured patients initiating therapy for chronic conditions. Several modifiable barriers highlight opportunities to address medication non-adherence through multidisciplinary interventions.
Collapse
Affiliation(s)
- Cesar I Fernandez-Lazaro
- Department of Biomedical and Diagnostic Sciences, School of Medicine, University of Salamanca, C/ Alfonso X El Sabio s/n., 37007, Salamanca, Spain; Department of Health Sciences, Armstrong State University, 11935 Abercorn St, Savannah, GA, 31419, USA.
| | - David P Adams
- Department of General Studies, Point University-Savannah Campus, 55 Al Henderson Blvd, Savannah, GA, 31419, USA
| | - Diego Fernandez-Lazaro
- Department of Biochemistry and Physiology, School of Physical Therapy, University of Valladolid, Campus Duques de Soria, 42003, Soria, Spain.
| | - Juan M Garcia-González
- Department of Sociology, Pablo de Olavide University, Ctra. de Utrera, 1, 41013, Sevilla, Spain.
| | - Alberto Caballero-Garcia
- Department of Anatomy, School of Physiotherapy, University of Valladolid, Campus Duques de Soria, 42004, Soria, Spain.
| | - Jose A Miron-Canelo
- Department of Biomedical and Diagnostic Sciences, School of Medicine, University of Salamanca, C/ Alfonso X El Sabio s/n., 37007, Salamanca, Spain.
| |
Collapse
|
41
|
Duarte-de-Araújo A, Teixeira P, Hespanhol V, Correia-de-Sousa J. COPD: understanding patients' adherence to inhaled medications. Int J Chron Obstruct Pulmon Dis 2018; 13:2767-2773. [PMID: 30233167 PMCID: PMC6132238 DOI: 10.2147/copd.s160982] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background and objective Adherence to inhaled medications by COPD patients is a challenging issue, but relatively understudied. The aim of this study is the characterization of adherence to inhaled medications by COPD patients, with a focus on patient-related determinants. Methods Stable COPD outpatients ≥40 years of age from a respiratory unit and diagnosed according to the Global Initiative for Chronic Obstructive Lung Disease criteria were included in a cross-sectional study. The Measure of Treatment Adherence (MTA), the Beliefs about Medications Questionnaire (BMQ) and demographic, clinical, and COPD questionnaires were used. After completing these questionnaires, semi-structured interviews were carried out and participants were encouraged to justify their opinions and behaviors. Field notes were made during the interviews and each interview was analyzed before the next one. Quantitative and qualitative analyses of the variables were then performed. Results A total of 300 out of 319 participants (mean age =67.7 years, 78.1% males) completed the MTA questionnaire. Of these, 31.3% were considered poorly adherent and 16.7% as non-adherent to the inhaled therapy. A statistically significant negative association was found between adherence and current smoking status (P=0.044), and between adherence and FEV1% (P=0.000). The mean BMQ Necessity score was higher in adherent patients (P=0.000), but the the mean Concern score was similar for both (P=0.877). We found nine patterns of poor-adherence, six reasons given for poor-adherence behaviors, five reasons for good-adherence behaviors and three patient-related domains on adherence to medications. Conclusion Adherence is related to need perception and to the functional severity of the disease. A non-adherent patient is usually a current smoker with lower degree of airflow limitation and lower perception of medication necessity. New information obtained was related to the patterns and reasons for different adherence behaviors, which are based on three major groups of patient related-determinants: health-related experiences, health-related behaviors and health-related beliefs.
Collapse
Affiliation(s)
- António Duarte-de-Araújo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,
- ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal,
- Respiratory Department, H. Sª Oliveira, Guimarães, Portugal,
| | - Pedro Teixeira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,
- ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal,
| | - Venceslau Hespanhol
- Department of Pneumology, Centro Hospitalar de S. João, Porto, Portugal
- Faculty of Medicine (FMUP), University of Porto, Porto, Portugal
| | - Jaime Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,
- ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal,
- Horizonte Family Health Unit, Matosinhos, Portugal
| |
Collapse
|
42
|
Nascimben J, Cubbison C, Lape EC, Katz JN. Strategies for Managing the Costs of Chronic Illness in the Context of Limited Financial Resources: A Qualitative Study in Dominican Persons With Arthritis. Arthritis Care Res (Hoboken) 2018; 71:1379-1386. [PMID: 30171806 DOI: 10.1002/acr.23742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/28/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Persons who reside in low- and middle-income countries often have insufficient resources to pay for treatments prescribed for their medical conditions. The aim of this study was to determine, using qualitative methods, how patients with arthritis in the Dominican Republic manage the costs associated with chronic illnesses. METHODS We conducted individual interviews with 17 Dominican adults with advanced arthritis who were undergoing total knee replacement or total hip replacement at a hospital in Santo Domingo, Dominican Republic. Interviewers followed a moderator's guide with questions pertaining to the financial demands of arthritis treatment and the strategies participants used to pay for treatments. Interviews were audio recorded, transcribed verbatim, and translated into English. We used thematic analysis to identify salient themes. RESULTS The thematic analysis suggested that health system factors (such as the extent of reimbursement for medications available in the public health care system) along with personal factors (such as disposable income) shaped individuals' experiences of managing chronic illness. These systemic and personal factors contributed to a sizeable gap between the cost of care and the amount most participants were able to pay. Participants managed this resource gap using a spectrum of strategies ranging from acceptance (or, "making do with less") to resourcefulness (or, "finding more"). Participants were aided by strong community bonds and religiously oriented resilience. CONCLUSION This qualitative study illuminates the range of strategies Dominican individuals with limited resources use to obtain health care and manage chronic illness. The findings raise hypotheses that warrant further study and could help guide provider-patient conversations regarding treatment adherence.
Collapse
Affiliation(s)
| | - Caroline Cubbison
- Massachusetts General Hospital, Boston Massachusetts and Universidad Iberoamericana, Santo Domingo, Dominican Republic
| | - Emma C Lape
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeffrey N Katz
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
43
|
Tøttenborg SS, Clark AJ, Thomsen RW, Johnsen SP, Lange P. Socioeconomic inequality in the use of prescription medications for smoking cessation among patients with COPD: a nationwide study. Int J Chron Obstruct Pulmon Dis 2018; 13:1775-1781. [PMID: 29881267 PMCID: PMC5985806 DOI: 10.2147/copd.s158954] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Bupropion and varenicline can substantially improve the chances of smoking cessation in patients with COPD, but are unsubsidized and relatively costly. We examined overall use and socioeconomic patterns of use among patients with COPD. Patients and methods We identified 4,741 COPD patients reporting to be smokers at their first contact for COPD during 2008-2012 in the Danish register of COPD, which covers all pulmonary outpatient clinics in Denmark. Patients were followed for 6 months in the National Prescription Registry. Logistic regression analyses were used to calculate the ORs with corresponding 95% CI of redeeming a prescription for any of the smoking cessation medications in strata of baseline characteristics. Results During 6 months from first consultation, only 5% redeemed a prescription for bupropion or varenicline. Younger age, female sex, higher education, and higher income were associated with an increased likelihood, while non-Danish ethnicity, living alone, and very severe COPD were associated with a lower likelihood of redeeming bupropion or varenicline. Conclusion Despite their proven effectiveness, bupropion and varenicline are sparingly used among COPD patients followed in the hospital outpatient setting with the lowest use among the socioeconomically disadvantaged. This highlights a missed opportunity for intervention.
Collapse
Affiliation(s)
- Sandra Søgaard Tøttenborg
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Alice Jessie Clark
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Søren Paaske Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Lange
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
- Respiratory Section, Hvidovre Hospital, Hvidovre, Denmark
| |
Collapse
|
44
|
Kiotseridis H, Arvidsson P, Backer V, Braendholt V, Tunsäter A. Adherence and quality of life in adults and children during 3-years of SLIT treatment with Grazax-a real life study. NPJ Prim Care Respir Med 2018; 28:4. [PMID: 29434271 PMCID: PMC5809499 DOI: 10.1038/s41533-018-0072-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/06/2017] [Accepted: 01/02/2018] [Indexed: 12/28/2022] Open
Abstract
Respiratory allergic disease represents a global health problem, 30% of the population suffers from allergic rhinoconjunctivitis and 20% suffer from asthma. Allergy immunotherapy induce immunological tolerance and thereby modify the response to allergens and sublingual immunotherapy (SLIT) offers the possibility of home administration of allergen therapy, but adherence is more uncertain. The aim of the study was to investigate the adherence with GRAZAX in adults and children ≥ 5 years during three consecutive years of treatment. This was a non-interventional, prospective, observational, multi-center, open-label study to investigate adherence, quality of life, safety and tolerability of GRAZAX in adult and pediatric patients in a real-life setting. During the 3-years study period estimation of adherence was done regularly. Quality of life as well as symptom score was also assessed. In total, 399 patients (236 adults and 163 children) were included in the study. At baseline, 100% suffered from moderate-severe eyes and nose symptoms, and 31% had asthma in the grass pollen season. Overall, 55% completed a 3-years treatment period, whereas 37% stopped before end of study and 8% were lost to follow up. After 3 years, the adherence rate decreased from 98.2% (first month), 93.7% (first year), 93.2% (second year) and 88.9% (third year) and adverse events were the main reason for pre-term termination. The study suggests a good adherence to treatment in a real life setting among the patients finalizing 3-years SLIT therapy. The treatment was effective both on symptoms and HRQL. A three-year trial of the allergy immunotherapy GRAZAX shows good adherence and tolerance among adults and children. Respiratory allergic disease is a significant global health burden, with 30 per cent of Europe’s population suffering from hayfever and 20 per cent from allergic asthma. While antihistamines and steroids can treat symptoms successfully, they do not tackle the underlying allergy. Recent progress in immunotherapies such as GRAZAX—a therapy specifically targeting grass pollen allergy—have shown promise. Hampus Kiotseridis at Lund University, Sweden, and co-workers tracked patient adherence and health in 399 adults and children taking GRAZAX over three years. 55 per cent of patients completed the study treatment, with 85 per cent taking GRAZAX six to seven times a week. GRAZAX proved to be well-tolerated overall, effectively tackling symptoms and improving patients’ quality of life.
Collapse
Affiliation(s)
- Hampus Kiotseridis
- Departments of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden.
| | | | - Vibeke Backer
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Vagn Braendholt
- Vagn Braendholt, Department of medicine, Holbæk Sygehus, Holbæk, Denmark
| | - Alf Tunsäter
- Departments of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| |
Collapse
|
45
|
Nishi SPE, Maslonka M, Zhang W, Kuo YF, Sharma G. Pattern and Adherence to Maintenance Medication Use in Medicare Beneficiaries with Chronic Obstructive Pulmonary Disease: 2008-2013. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2018; 5:16-26. [PMID: 29629401 DOI: 10.15326/jcopdf.5.1.2017.0153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Maintenance medications provide symptomatic relief, improve lung function and reduce the risk of exacerbations in patients with chronic obstructive pulmonary disease (COPD). Despite their proven benefits, limited information exists on maintenance medication use and adherence among users. Objective: We examined the patterns and factors associated with the receipt of and adherence to maintenance medication in individuals with COPD. Methods: A retrospective cross-sectional study of 5% of Medicare beneficiaries enrolled in Parts A, B and D with COPD who received maintenance medication from 2008 to 2013 was conducted. Maintenance medication includes: inhaled corticosteroids (ICSs), long-acting beta2- agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) alone or in combination. We examined the proportion of beneficiaries with COPD who had at least one prescription filled for maintenance medication. Among users of maintenance medications, we also examined adherence, defined as proportion of days covered (PDC) ≥80% over the year from the first maintenance medication prescription fill date. Results: Overall, maintenance medication (LAMAs, LABAs, ICSs and/or LABA/ICS) use increased from 67.8% in 2008 to 72.1% in 2013. The increase is related to increases in use of LABA/ICS, which rose from 41.1% in 2008 to 49.6% in 2013. Factors associated with receipt of maintenance medication include female gender, recent COPD hospitalization (odds ratio [OR] 1.63; 95% confidence interval [CI] 1.54-1.73), oxygen therapy (OR 1.74 95% CI, 1.68-1.81), dual eligibility status (OR 1.45; 95% CI 1.39-1.51), higher education level and evaluation by a pulmonary provider (OR 1.88; 95% CI 1.81-1.96). The overall adherence among maintenance medication users remained flat. The most important factor associated with adherence was dual eligibility status (OR, 1.67; 95% CI: 1.59-1.75). Conclusions: Receipt of maintenance medications increased during the study period and was higher in those with dual eligibility. Overall, adherence to maintenance medications was suboptimal and remained unchanged.
Collapse
Affiliation(s)
- Shawn P E Nishi
- 1-Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston
| | - Matthew Maslonka
- 2-Department of Internal Medicine, University of Texas Medical Branch, Galveston
| | - Wei Zhang
- 1-Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston
| | - Yong-Fang Kuo
- 3-Sealy Center on Aging, University of Texas Medical Branch, Galveston
| | - Gulshan Sharma
- 1-Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston.,2-Department of Internal Medicine, University of Texas Medical Branch, Galveston
| |
Collapse
|
46
|
Hakamy A, McKeever TM, Gibson JE, Bolton CE. The recording and characteristics of pulmonary rehabilitation in patients with COPD using The Health Information Network (THIN) primary care database. NPJ Prim Care Respir Med 2017; 27:58. [PMID: 29021576 PMCID: PMC5636897 DOI: 10.1038/s41533-017-0058-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 08/29/2017] [Accepted: 09/13/2017] [Indexed: 11/09/2022] Open
Abstract
Pulmonary rehabilitation is recommended for patients with COPD to improve physical function, breathlessness and quality of life. Using The Health Information Network (THIN) primary care database in UK, we compared the demographic and clinical parameters of patients with COPD in relation to coding of pulmonary rehabilitation, and to investigate whether there is a survival benefit from pulmonary rehabilitation. We identified patients with COPD, diagnosed from 2004 and extracted information on demographics, pulmonary rehabilitation and clinical parameters using the relevant Read codes. Thirty six thousand one hundred and eighty nine patients diagnosed with COPD were included with a mean (SD) age of 67 (11) years, 53% were male and only 9.8% had a code related to either being assessed, referred, or completing pulmonary rehabilitation ever. Younger age at diagnosis, better socioeconomic status, worse dyspnoea score, current smoking, and higher comorbidities level are more likely to have a record of pulmonary rehabilitation. Of those with a recorded MRC of 3 or worse, only 2057 (21%) had a code of pulmonary rehabilitation. Survival analysis revealed that patients with coding for pulmonary rehabilitation were 22% (95% CI 0.69-0.88) less likely to die than those who had no coding. In UK THIN records, a substantial proportion of eligible patients with COPD have not had a coded pulmonary rehabilitation record. Survival was improved in those with PR record but coding for other COPD treatments were also better in this group. GP practices need to improve the coding for PR to highlight any unmet need locally. CHRONIC LUNG DISEASE ROLLING OUT THE REHAB: Analysis of recent UK data suggests that more patients with chronic lung disease could benefit from lung rehabilitation programmes. During pulmonary rehabilitation (PR), patients with chronic obstructive pulmonary disease (COPD) work with specialists to learn exercises and optimise breathing techniques. The programmes are recommended under current guidelines, particularly for patients with a high breathlessness score. Despite this, when Charlotte Bolton and co-workers at the University of Nottingham analysed 36,189 patient primary care records gathered since 2004, they found only 9.8% of COPD patients had ever had a coded record of being assessed, referred for, or undertaken PR. Those patients who completed PR were 22% less likely to die that those who didn't, although appeared they had also received better overall COPD care. Current smokers, those suffering from co-morbidities and younger patients were more likely to receive PR than other patient groups.
Collapse
Affiliation(s)
- Ali Hakamy
- Nottingham Respiratory Research Unit, NIHR Nottingham BRC, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Tricia M McKeever
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Jack E Gibson
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Charlotte E Bolton
- Nottingham Respiratory Research Unit, NIHR Nottingham BRC, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK.
| |
Collapse
|
47
|
Oates GR, Hamby BW, Stepanikova I, Knight SJ, Bhatt SP, Hitchcock J, Schumann C, Dransfield MT. Social Determinants of Adherence to Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease. COPD 2017; 14:610-617. [PMID: 29020525 DOI: 10.1080/15412555.2017.1379070] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Adherence to pulmonary rehabilitation (PR) is low. Previous studies have focused on clinical predictors of PR completion. We aimed to identify social determinants of adherence to PR. A cross-sectional analysis of a database of COPD patients (N = 455) in an outpatient PR program was performed. Adherence, a ratio of attended-to-prescribed sessions, was coded as low (<35%), moderate (35-85%), and high (>85%). Individual-level measures included age, sex, race, BMI, smoking status, pack-years, baseline 6-minute walk distance (6MWD: <150, 150-249, ≥250), co-morbidities, depression, and prescribed PR sessions (≤20, 21-30, >30). Fifteen area-level measures aggregated to Census tracts were obtained from the U.S. Census after geocoding patients' addresses. Using exploratory factor analysis, a neighborhood socioeconomic disadvantage index was constructed, which included variables with factor loading >0.5: poverty, public assistance, households without vehicles, cost burden, unemployment, and minority population. Multivariate regression models were adjusted for clustering on Census tracts. Twenty-six percent of patients had low adherence, 23% were moderately adherent, 51% were highly adherent. In the best fitted full model, each decile increase in neighborhood socioeconomic disadvantage increased the risk of moderate vs high adherence by 14% (p < 0.01). Smoking tripled the relative risk of low adherence (p < 0.01), while each increase in 6MWD category decreased that risk by 72% (p < 0.01) and 84% (p < 0.001), respectively. These findings show that, relative to high adherence, low adherence is associated with limited functional capacity and current smoking, while moderate adherence is associated with socioeconomic disadvantage. The distinction highlights different pathways to suboptimal adherence and calls for tailored intervention approaches.
Collapse
Affiliation(s)
- Gabriela R Oates
- a Preventive Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Bryant W Hamby
- b Sociology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Irena Stepanikova
- b Sociology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Sara J Knight
- a Preventive Medicine , University of Alabama at Birmingham , Birmingham , AL , USA.,c Birmingham Veterans Affairs Medical Center , Birmingham , AL , USA
| | - Surya P Bhatt
- d Lung Health Center and Pulmonary, Allergy and Critical Care Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Jason Hitchcock
- e Cardiopulmonary Rehabilitation , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Christopher Schumann
- e Cardiopulmonary Rehabilitation , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Mark T Dransfield
- c Birmingham Veterans Affairs Medical Center , Birmingham , AL , USA.,d Lung Health Center and Pulmonary, Allergy and Critical Care Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
| |
Collapse
|
48
|
Duarte-de-Araújo A, Teixeira P, Figueiredo M, Hespanhol V, Correia-de-Sousa J. Understanding patient adherence to inhaled medication: The social representations of COPD. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:358-359. [PMID: 28993104 DOI: 10.1016/j.rppnen.2017.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/31/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- A Duarte-de-Araújo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal; Respiratory Department, H. Sª Oliveira, Guimarães, Portugal.
| | - P Teixeira
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - M Figueiredo
- Respiratory Department, H. Sª Oliveira, Guimarães, Portugal
| | - V Hespanhol
- Department of Pneumology, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine (FMUP), University of Porto, Portugal
| | - J Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal; Horizonte Family Health Unit, Matosinhos, Portugal
| |
Collapse
|
49
|
Khan A, Dickens AP, Adab P, Jordan RE. Self-management behaviour and support among primary care COPD patients: cross-sectional analysis of data from the Birmingham Chronic Obstructive Pulmonary Disease Cohort. NPJ Prim Care Respir Med 2017; 27:46. [PMID: 28729620 PMCID: PMC5519687 DOI: 10.1038/s41533-017-0046-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 06/09/2017] [Accepted: 06/13/2017] [Indexed: 11/29/2022] Open
Abstract
Self-management support for chronic obstructive pulmonary disease (COPD) patients is recommended by UK national guidelines, but extent of implementation is unknown. We aimed to describe self-management behaviour and support among COPD patients and explore behaviour associated with having a self-management plan. We undertook cross-sectional analysis of self-reported data from diagnosed COPD patients in the Birmingham COPD Cohort study. Questionnaire items relevant to self-management behaviour, knowledge of COPD, receipt of self-management plans and advice from healthcare professionals were examined. Multiple regression models were used to identify behaviour associated with having a self-management plan. One-thousand seventy-eight participants (676 males, 62.7%, mean age 69.8 (standard deviation 9.0) years) were included. The majority reported taking medications as instructed (940, 94.0%) and receiving annual influenza vaccinations (962, 89.2%). Only 400 (40.4%) participants had self-management plans, 538 (49.9%) reported never having received advice on diet/exercise and 110 (42.7%) current smokers had been offered practical help to stop smoking in the previous year. General knowledge about COPD was moderate (mean total Bristol COPD Knowledge Questionnaire score: 31.5 (standard deviation 10.7); max score 65), corresponding to 48.5% of questions answered correctly. Having a self-management plan was positively associated with self-reported adherence to medication (odds ratio 3.10, 95% confidence interval 1.43 to 6.72), attendance at a training course (odds ratio 2.72, 95% confidence interval 1.81 to 4.12), attendance at a support group (odds ratio 6.28, 95% confidence interval 2.96 to 13.35) and better disease knowledge (mean difference 4.87, 95% confidence interval 3.16 to 6.58). Primary care healthcare professionals should ensure more widespread implementation of individualised self-management plans for all patients and improve the lifestyle advice provided. CHRONIC LUNG DISEASE CALL FOR WIDER IMPLEMENTATION OF SELF-MANAGEMENT PLANS: Health professionals should ensure all patients with chronic lung disease receive individualized self-management plans and lifestyle advice. UK national guidelines state that patients with chronic obstructive pulmonary disease (COPD) should receive personalized self-management plans and comprehensive support to help them manage their disease. Ainee Khan and colleagues at the University of Birmingham analyzed patient questionnaire data gathered during the Birmingham COPD Cohort study to explore self-management behavior, receipt of self-management plans and advice, and patient knowledge of COPD. Of 1,078 participants, only 400 had self-management plans, and less than half reported receiving lifestyle advice or support. Those with plans were more likely to adhere to medication, had greater knowledge about COPD and were more likely to attend support groups and training courses. The authors recommend carefully-planned, wider implementation of COPD self-management plans and associated support.
Collapse
Affiliation(s)
- Ainee Khan
- Public Health, Solihull Metropolitan Borough Council, Solihull, B91 3QB, UK
| | - Andrew P Dickens
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Rachel E Jordan
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| |
Collapse
|
50
|
Adherence to COPD treatment: Myth and reality. Respir Med 2017; 129:117-123. [PMID: 28732818 DOI: 10.1016/j.rmed.2017.06.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/31/2017] [Accepted: 06/12/2017] [Indexed: 12/12/2022]
Abstract
COPD is a chronic disease in which effective management requires long-term adherence to pharmacotherapies but the level of adhesion to the prescribed medications is very low and this has a negative influence on outcomes. There are several approaches to detect non-adherence, such as pharmacy refill methods, electronic monitoring, and self-report measures, but they are all burdened with important limitations. Medication adherence in COPD is multifactorial and is affected by patients (health beliefs, cognitive abilities, self-efficacy, comorbidities, psychological profile, conscientiousness), physicians (method of administration, dosing regimen, polypharmacy, side effects), and society (patient-prescriber relationship, social support, access to medication, device training, follow-up). Patient-health care professional communication, especially that between patient and physician or pharmacist, is central to optimizing patient adherence. However, the most realistic approach is to keep in mind that non-adherence is always possible, indeed, probable.
Collapse
|