1
|
Weir DL, Bai YQ, Thavorn K, Guilcher S, Kanji S, Mulpuru S, Wodchis W. Non-adherence to COPD medications and its association with adverse events: A longitudinal population based cohort study of older adults. Ann Epidemiol 2024; 96:88-96. [PMID: 38141744 DOI: 10.1016/j.annepidem.2023.12.003] [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: 07/14/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE To determine the association between non-adherence to long term chronic obstructive pulmonary disease (COPD) medications and COPD related emergency department (ED) visits and hospitalizations in patients with incident COPD, utilizing time varying measures of adherence as well as accounting for time-varying confounding impacted by prior adherence. STUDY DESIGN AND SETTING We conducted a population-based retrospective cohort study between 2007-2017 among individuals aged 66 years and older with incident COPD using multiple linked administrative health databases from the province of Ontario, Canada. Adherence to COPD medications was measured using time varying proportion of days covered based on insurance claims for medications dispensed at community pharmacies. The parametric g-formula was used to assess the association between time-varying adherence (in the last 90-days) to COPD medications and risk of COPD related hospitalizations and ED visits while accounting for time varying confounding by COPD severity. RESULTS Overall, 60,251 individuals with incident COPD were included; mean age was 76 (SD 7) and 59% were male. Mean adherence over the entire follow-up was 23% (SD 0.3). There were 7248 (12%) COPD related ED visits (2.8 events per 100 person years [PY]) and 9188 (15%) COPD related hospitalizations (3.5 events per 100 PY). Compared to those with 0% 90-day adherence, those with adherence between 1-33% had a 19% decreased risk of COPD related ED visits (adjusted risk ratio[aRR]:0.81, 95% confidence interval [CI]:0.78-0.83), those with adherence between 34%-67% had a 18% decreased risk (aRR: 0.82, 95% CI: 0.77-0.85) while those with 68%-100% 90-day adherence had a 63% increased risk of COPD related ED visits (aRR: 1.63, 95% CI: 1.47-1.78). Nearly identical results were obtained for COPD specific hospitalizations. CONCLUSION After accounting for time varying confounding by COPD severity, the highest time varying 90-days adherence was associated with an increased risk of both COPD related ED visits and hospitalizations compared to the lowest adherence categories. Differences in COPD severity between adherence categories, perception of need for medication management in the higher adherence categories, and potential residual confounding makes it difficult to disentangle the independent effects of adherence from the severity of the condition itself.
Collapse
Affiliation(s)
- Daniala L Weir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; Utrecht Institute of Pharmaceutical Sciences, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Yu Qing Bai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Sara Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Salmaan Kanji
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sunita Mulpuru
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Walter Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| |
Collapse
|
2
|
Yohannes AM. Psychosocial Support in Pulmonary Rehabilitation. Respir Care 2024; 69:664-677. [PMID: 38688547 PMCID: PMC11147630 DOI: 10.4187/respcare.11850] [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] [Indexed: 05/02/2024]
Abstract
Pulmonary rehabilitation (PR) improves exercise capacity and quality of life (QOL) while reducing dyspnea in patients with COPD. However, little is known about the efficacy of PR, cognitive behavioral therapy (CBT), or antidepressant drug therapy on psychosocial factors in patients with COPD. Knowledge gaps include which therapy is most efficacious, what barriers exist for each treatment, and the optimal duration of each intervention. Potential barriers to antidepressant therapy include patient fears of potential adverse effects, apprehension and misconception, and stigma related to depression. Both CBT and PR reduce anxiety and depressive symptoms in short-term studies. However, their potential benefits over medium-to-long-term follow-up and specifically on psychosocial factors warrant exploration. Furthermore, new emerging treatment strategies such as the collaborative care model and home-based telehealth coaching are promising interventions to promote patient-centered care treatment and reduce psychosocial factors adversely affecting patients with COPD. This update and critical synthesis reviews the effectiveness of both pharmacologic and non-pharmacologic interventions on psychosocial factors in patients with COPD. It also provides brief screening tools used in the assessment of anxiety and depression for patients with COPD.
Collapse
Affiliation(s)
- Abebaw Mengistu Yohannes
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; and Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine and University of Alabama at Birmingham Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama.
| |
Collapse
|
3
|
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
|
4
|
Pourat N, Padilla-Frausto DI, Chen X, Lim D, Osterweil D, Batra RA. The Impact of a Primary Care Telepsychiatry Program on Outcomes of Managed Care Older Adults. J Am Med Dir Assoc 2023; 24:119-124.e4. [PMID: 36356654 DOI: 10.1016/j.jamda.2022.10.004] [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: 06/22/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The goal of this study was to assess the outcomes of a primary-based telepsychiatry intervention program for older managed care enrollees with depression/anxiety and with limited access to in-person psychiatric care. DESIGN A pre-post design was used to examine service use (n = 218) and severity of depression (n = 204). Enrollment, claims, and depression and anxiety score data were obtained from the medical group. The implementation process and self-reported outcomes were examined. SETTING AND PARTICIPANTS The program was funded by the Senior Care Action Network (SCAN) group and implemented by a large medical group serving older adults who were identified as needing outpatient psychiatric care, including those with psychiatric hospitalizations, depression/anxiety disorders, comorbid substance use disorders, or other multiple comorbidities. METHODS Poisson regressions were used to examine changes in predicted rates of outpatient services, emergency department visits, and hospitalizations up to 24 months prior and 24 months following the first telepsychiatry visit. Changes in predicted severity of depression up to 2 quarters prior and 3 quarters following the first telepsychiatry visit were examined. RESULTS The number of outpatient services declined significantly by 0.24 per patient per 6-month time frame following the first telepsychiatry visit. The number of emergency department visits and hospitalizations also declined after the first visit (0.07 and 0.03 per patient per 6-month time frame, respectively). Depression severity scores also declined in the quarters following the first visit (1.52). The medical group reported improvements in both wait time for appointments and no-show rates with the integration of telepsychiatry in primary care. CONCLUSIONS AND IMPLICATIONS The telepsychiatry program lowered service use, depression severity, and increased better access to psychiatry care. The findings highlight the potential benefits of sustaining and expanding the telepsychiatry program by SCAN and other plans facing a limited supply of psychiatrists.
Collapse
Affiliation(s)
- Nadereh Pourat
- University of California Los Angeles, Center for Health Policy Research, Los Angeles, CA, USA; Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.
| | | | - Xiao Chen
- University of California Los Angeles, Center for Health Policy Research, Los Angeles, CA, USA
| | - Dominic Lim
- Senior Care Action Network (SCAN) Health Group, Long Beach, CA, USA
| | - Dan Osterweil
- Senior Care Action Network (SCAN) Health Group, Long Beach, CA, USA; Division of Geriatric Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Romilla A Batra
- Senior Care Action Network (SCAN) Health Group, Long Beach, CA, USA
| |
Collapse
|
5
|
Czira A, Requena G, Banks V, Wood R, Tritton T, Castillo CM, Yeap J, Wild R, Compton C, Rothnie KJ, Herth F, Quint JK, Ismaila AS. Comparative Effectiveness of Umeclidinium/Vilanterol versus Inhaled Corticosteroid/Long-Acting β 2-Agonist in Patients with Chronic Obstructive Pulmonary Disease in a Primary Care Setting in England. Int J Chron Obstruct Pulmon Dis 2023; 18:643-659. [PMID: 37155496 PMCID: PMC10122847 DOI: 10.2147/copd.s405498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/06/2023] [Indexed: 05/10/2023] Open
Abstract
Purpose To compare adherence to once-daily umeclidinium/vilanterol (UMEC/VI), a long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA), and twice-daily inhaled corticosteroids (ICS)/LABA single-inhaler dual therapy in patients with chronic obstructive pulmonary disease (COPD) in a primary care cohort in England. Patients and Methods Active comparator, new-user, retrospective cohort study using CPRD-Aurum primary care data and linked Hospital Episode Statistics secondary care administrative data. Patients without exacerbations in the previous year were indexed on first/earliest prescription date of once-daily UMEC/VI or twice-daily ICS/LABA as initial maintenance therapy between July 2014-September 2019. Primary outcome: medication adherence at 12 months post-index, defined as proportion of days covered (PDC) ≥80%. PDC represented proportion of time over the treatment duration that the patient was theoretically in possession of the medication. Secondary outcomes: adherence at 6, 18, and 24 months post-index, time-to-triple therapy, time-to-first on-treatment COPD exacerbation, COPD-related and all-cause healthcare resource utilization (HCRU), and direct health-care costs. A propensity score was generated and inverse probability of treatment weighting (IPTW) was used to balance potential confounders. Superiority was defined as >0% difference between treatment groups. Results In total, 6815 eligible patients were included (UMEC/VI:1623; ICS/LABA:5192). At 12 months post-index, weighted odds of a patient being adherent were significantly greater with UMEC/VI versus ICS/LABA (odds ratio [95% CI]: 1.71 [1.09, 2.66]; p=0.0185), demonstrating superiority of UMEC/VI. Patients taking UMEC/VI were statistically significantly more adherent than those taking ICS/LABA at 6, 18, and 24 months post-index (p<0.05). Differences in time-to-triple therapy, time-to-moderate COPD exacerbations, HCRU, and direct medical costs were not statistically significant between treatments after IPTW was applied. Conclusion At 12 months post-treatment initiation, once-daily UMEC/VI was superior to twice-daily ICS/LABA in medication adherence among patients with COPD without exacerbations in the previous year, newly initiating dual maintenance therapy in England. The finding was consistent at 6, 18, and 24 months.
Collapse
Affiliation(s)
- Alexandrosz Czira
- R&D Global Medical, GSK, Brentford, Middlesex, UK
- Correspondence: Alexandrosz Czira, Value Evidence and Outcomes, R&D Global Medical, GSK, Brentford, Middlesex, UK, Tel +44 7788 351610, Email
| | - Gema Requena
- R&D Global Medical, GSK, Brentford, Middlesex, UK
| | - Victoria Banks
- Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK
| | - Robert Wood
- Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK
| | - Theo Tritton
- Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK
| | | | - Jie Yeap
- Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK
| | - Rosie Wild
- Real-World Evidence, Adelphi Real World, Bollington, Cheshire, UK
| | | | | | - Felix Herth
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Afisi S Ismaila
- Value Evidence and Outcomes, GSK, Collegeville, PA, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
6
|
Alshehri S, Alshibani M. Impact of Medication Adherence on Emergency Department Visits in Patients with COPD in a Single Tertiary Hospital in Saudi Arabia. Int J Chron Obstruct Pulmon Dis 2023; 18:593-598. [PMID: 37090844 PMCID: PMC10120819 DOI: 10.2147/copd.s392946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction There is a very limited information and studies on the impact of adherence to chronic obstructive pulmonary disease (COPD) medications in Saudi Arabia. We hypothesized that the adherence to COPD medication in our tertiary hospital is poor and can lead to frequent ED visits and longer hospitalization stays. The purpose of this study was to assess the impact of medication adherence in patients with COPD on emergency department (ED) visits and hospitalization. Methods A single-center retrospective observational study included patients with a COPD exacerbation, who were admitted to a tertiary teaching hospital in Jeddah, Saudi Arabia from October 2017 to November 2020. The primary outcome was the rate of emergency department (ED) visit in one year. Secondary outcomes were hospitalization after ED visit and total hospital length of stay. Medication adherence was evaluated by using Fixed Medication Possession Ratio (FMPR). Patients with score of ≥0.80 were classified as high-adherent groups while patients with ratio <0.80 were on low-adherent groups. Results A total of 266 patients enrolled in the study. Of those 266 patients, 139 patients were on high-adherent group and 127 were on low-adherent group. There was a significant difference between the high-adherent group and low-adherent group in the incidence of ED visit in one year 62 (44.6%) vs 73 (57.5%); P < 0.036, and hospitalization after the ED visit 26 (18.7%) vs 42 (33.1%); P = 0.007. However, there was no significant difference between the two groups in the total hospital length of stay. Conclusion Among patients with COPD, there was a significant increase in ED visit per one year that leads to more hospitalization among patients with low adherence compared to patients with high adherence. This study highlights the importance of improving the medication adherence in patients with COPD.
Collapse
Affiliation(s)
- Samah Alshehri
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
- Correspondence: Samah Alshehri, Department of Pharmacy Practice, King Abdulaziz University, P.O. Box 80200, Jeddah, 21589, Saudi Arabia, Tel +966564362332, Fax +12 9666400000. Ext. 20675, Email
| | - Mohannad Alshibani
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
7
|
Cantres‐Fonseca O, Kennedy JLW. Where's the Easy Button? The Many Barriers to Care for Patients With Pulmonary Arterial Hypertension. J Am Heart Assoc 2022; 11:e027967. [DOI: 10.1161/jaha.122.027967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
8
|
Park KH, Tickle L, Cutler H. A systematic review and meta-analysis on impact of suboptimal use of antidepressants, bisphosphonates, and statins on healthcare resource utilisation and healthcare cost. PLoS One 2022; 17:e0269836. [PMID: 35767543 PMCID: PMC9242484 DOI: 10.1371/journal.pone.0269836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 05/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background Depression, osteoporosis, and cardiovascular disease impose a heavy economic burden on society. Understanding economic impacts of suboptimal use of medication due to nonadherence and non-persistence (non-MAP) for these conditions is important for clinical practice and health policy-making. Objective This systematic literature review aims to assess the impact of non-MAP to antidepressants, bisphosphonates and statins on healthcare resource utilisation and healthcare cost (HRUHC), and to assess how these impacts differ across medication classes. Methods A systematic literature review and an aggregate meta-analysis were performed. Using the search protocol developed, PubMed, Cochrane Library, ClinicalTrials.gov, JSTOR and EconLit were searched for articles that explored the relationship between non-MAP and HRUHC (i.e., use of hospital, visit to healthcare service providers other than hospital, and healthcare cost components including medical cost and pharmacy cost) published from November 2004 to April 2021. Inverse-variance meta-analysis was used to assess the relationship between non-MAP and HRUHC when reported for at least two different populations. Results Screening 1,123 articles left 10, seven and 13 articles on antidepressants, bisphosphonates, and statins, respectively. Of those, 27 were rated of good quality, three fair and none poor using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. In general, non-MAP was positively associated with HRUHC for all three medication classes and most prominently for bisphosphonates, although the relationships differed across HRUHC components and medication classes. The meta-analysis found that non-MAP was associated with increased hospital cost (26%, p = 0.02), outpatient cost (10%, p = 0.01), and total medical cost excluding pharmacy cost (12%, p<0.00001) for antidepressants, and increased total healthcare cost (3%, p = 0.07) for bisphosphonates. Conclusions This systematic literature review is the first to compare the impact of non-MAP on HRUHC across medications for three prevalent conditions, depression, osteoporosis and cardiovascular disease. Positive relationships between non-MAP and HRUHC highlight inefficiencies within the healthcare system related to non-MAP, suggesting a need to reduce non-MAP in a cost-effective way.
Collapse
Affiliation(s)
- Kyu Hyung Park
- Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
- * E-mail:
| | - Leonie Tickle
- Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
| | - Henry Cutler
- Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
- Macquarie University Centre for the Health Economy, North Ryde, Australia
| |
Collapse
|
9
|
Mannino D, Bogart M, Wu B, Germain G, Laliberté F, MacKnight SD, Jung Y, Stiegler M, Duh MS. Adherence and persistence to once-daily single-inhaler versus multiple-inhaler triple therapy among patients with chronic obstructive pulmonary disease in the USA: A real-world study. Respir Med 2022; 197:106807. [DOI: 10.1016/j.rmed.2022.106807] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/23/2022] [Accepted: 03/06/2022] [Indexed: 12/28/2022]
|
10
|
Foley L, Larkin J, Lombard-Vance R, Murphy AW, Hynes L, Galvin E, Molloy GJ. Prevalence and predictors of medication non-adherence among people living with multimorbidity: a systematic review and meta-analysis. BMJ Open 2021; 11:e044987. [PMID: 34475141 PMCID: PMC8413882 DOI: 10.1136/bmjopen-2020-044987] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This systematic review aimed to describe medication non-adherence among people living with multimorbidity according to the current literature, and synthesise predictors of non-adherence in this population. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. PubMed, EMBASE, CINAHL and PsycINFO were searched for relevant articles published in English language between January 2009 and April 2019. Quantitative studies reporting medication non-adherence and/or predictors of non-adherence among people with two or more chronic conditions were included in the review. A meta-analysis was conducted with a subgroup of studies that used an inclusive definition of multimorbidity to recruit participants, rather than seeking people with specific conditions. Remaining studies reporting prevalence and predictors of non-adherence were narratively synthesised. RESULTS The database search produced 10 998 records and a further 75 were identified through other sources. Following full-text screening, 178 studies were included in the review. The range of reported non-adherence differed by measurement method, at 76.5% for self-report, 69.4% for pharmacy data, and 44.1% for electronic monitoring. A meta-analysis was conducted with eight studies (n=8949) that used an inclusive definition of multimorbidity to recruit participants. The pooled prevalence of non-adherence was 42.6% (95% CI: 34.0 - 51.3%, k=8, I2=97%, p<0.01). The overall range of non-adherence was 7.0%-83.5%. Frequently reported correlates of non-adherence included previous non-adherence and treatment-related beliefs. CONCLUSIONS The review identified a heterogeneous literature in terms of conditions studied, and definitions and measures of non-adherence used. Results suggest that future attempts to improve adherence among people with multimorbidity should determine for which conditions individuals require most support. The variable levels of medication non-adherence highlight the need for more attention to be paid by healthcare providers to the impact of multimorbidity on chronic disease self-management. PROSPERO REGISTRATION NUMBER CRD42019133849.
Collapse
Affiliation(s)
- Louise Foley
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - James Larkin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Richard Lombard-Vance
- Department of Psychology, National University of Ireland Maynooth, Maynooth, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
- HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Lisa Hynes
- Health Programmes, Croí Heart & Stroke Centre, Galway, Ireland
| | - Emer Galvin
- School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
11
|
El Mrayyan N, Bökberg C, Eberhard J, Ahlström G. Healthcare utilisation patterns among older people with intellectual disability and with affective and anxiety diagnoses in comparison with the general population. Aging Ment Health 2021; 25:1525-1534. [PMID: 32208744 DOI: 10.1080/13607863.2020.1742657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study investigates specialist healthcare visits of older people with intellectual disability ID having affective and anxiety diagnoses in comparison with the general population, as well as across different levels of ID, behavioural impairment, and living in special housing in Sweden. METHOD The study is a retrospective national-register-based study from 2002-2012 of people with ID 55 years and older (n = 7936) and a control group the same size matched by birth year and sex from the general population at the end of study. The study groups comprised those with affective (n = 918) and anxiety (n = 825) diagnoses who visited specialist healthcare, including data about living in special housing at the end of study in 2012. RESULTS Older people with ID and with affective and anxiety diagnoses have a higher risk of inpatient and unplanned visits to psychiatric and somatic healthcare than the general population. The average length of stay in inpatient psychiatric healthcare was higher in older people with ID and anxiety diagnoses than in the general population. Within the ID group, more inpatient and unplanned visits were made by those with moderate and severe levels of ID, behavioural impairment, and living in special housing. CONCLUSION Older people with ID and affective and anxiety diagnoses are more likely to have inpatient and unplanned visits for specialist healthcare than the general population. Future research should explore the quality of healthcare services delivered by healthcare providers to older people with ID and with affective and anxiety diagnoses.
Collapse
Affiliation(s)
- Nadia El Mrayyan
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Christina Bökberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Jonas Eberhard
- Division of Psychiatry, Clinical Psychosis Research Unit, Region Skane and Affiliated to Department of Clinical Sciences, Lund University, Helsingborg, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| |
Collapse
|
12
|
Volpato E, Toniolo S, Pagnini F, Banfi P. The Relationship Between Anxiety, Depression and Treatment Adherence in Chronic Obstructive Pulmonary Disease: A Systematic Review. Int J Chron Obstruct Pulmon Dis 2021; 16:2001-2021. [PMID: 34262270 PMCID: PMC8275112 DOI: 10.2147/copd.s313841] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/01/2021] [Indexed: 01/04/2023] Open
Abstract
Background Almost half of the people with chronic obstructive pulmonary disease (COPD) do not adhere to the prescribed treatments and report anxiety and depression as comorbidities, resulting in higher rates of exacerbations, hospitalizations, and worse clinical outcomes. Objective This systematic review provided a synthesis of studies about the relationships between anxiety, depression, and adherence in people affected by COPD. Methods English language publications were searched in the PUBMED, SCOPUS, PsycInfo, Web of Science, PsycArticles, and Cochrane Library databases from December 2020 to March 2021, following PRISMA guidelines. The reference lists of eligible studies and other relevant systematic reviews were also searched. Data extraction and critical appraisal were undertaken by two reviewers working independently. The reference lists of eligible studies and other relevant systematic reviews were also searched. Data extraction and critical appraisal were undertaken by two reviewers working independently. Results A total of 34 studies (23 quantitative and 2 qualitative studies, 9 reviews) were included. The relationship between depression and treatment adherence was significant and negative. Adherence to both rehabilitation, psychological, and antidepressant pharmacological treatments in depressed patients was linked to a decreased risk of hospitalization. Moreover, depressed patients compliant with an antidepressant were more likely to adherent to COPD maintenance inhalers. On the other hand, the associations between anxiety and adherence were poorly investigated and high heterogeneity characterized the studies, leading to a weak and variable relationship as well as too few interventions. Conclusion The systematic review highlights the variability in estimates of the relationship between depression, anxiety, and treatment adherence in COPD. It could be explained by methodological differences across the included studies. This suggests that standardization is critical to improving the precision of the estimates. Recommendations for future research include attention to causal inferences, an exploration of mechanisms to explain the relationships between both anxiety and depression and adherence in COPD, and a comprehensive, systematic approach.
Collapse
Affiliation(s)
- Eleonora Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Heart-Respiratory Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Stefania Toniolo
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Paolo Banfi
- Heart-Respiratory Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| |
Collapse
|
13
|
Han CH, Chung JH, Lee S. Depression, chronic obstructive pulmonary disease, and healthcare utilization: Results from the Korean Longitudinal Study of Aging (KLoSA). CLINICAL RESPIRATORY JOURNAL 2021; 15:937-943. [PMID: 33949107 DOI: 10.1111/crj.13384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/16/2021] [Accepted: 04/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Depression is a common comorbidity among people with chronic obstructive pulmonary disease (COPD), but the health effects of depression in this group of patients remain poorly understood. The purpose of the present study was to investigate the association between COPD and depression, and the effects of comorbid COPD and depression on health care utilization. METHODS Our study sample included 10,180 Korean adults (4,437 men and 5,743 women; all aged ≥ 45 years) who participated in the cross-sectional Korean Longitudinal Study of Aging (KLoSA). The participants were required to self-report any previous diagnosis of COPD. Depression was assessed with the 10-item Center for Epidemiologic Studies Depression Scale (CES-D10). Health care utilization was defined as multiple physician visits (≥6) and multiple hospital admissions (≥2) in the previous year. RESULTS Participants with COPD had a higher prevalence of depression than those without COPD (16.8% vs. 38.1%, respectively; P < 0.001). After adjustment for covariates, participants with COPD had a significantly higher likelihood of multiple physician visits (odds ratio [OR], 95% confidence interval [CI], 1.80 [1.26-2.58]) and multiple hospital admissions (OR [95% CI], 1.62 [1.04-3.51]), while those with COPD plus depression had a higher likelihood of multiple hospital admissions (OR [95% CI], 2.71 [2.34-5.48]). CONCLUSIONS We found a positive association between COPD and depression. Depression in patients with COPD is associated with an increased likelihood of multiple hospital admissions.
Collapse
Affiliation(s)
- Chang Hoon Han
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Jae Ho Chung
- Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Sujin Lee
- Department of Neurology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| |
Collapse
|
14
|
Ta JT, Sullivan SD, Tung A, Oliveri D, Gillard P, Devine B. Health care resource utilization and costs associated with nonadherence and nonpersistence to antidepressants in major depressive disorder. J Manag Care Spec Pharm 2021; 27:223-239. [PMID: 33506730 PMCID: PMC10391056 DOI: 10.18553/jmcp.2021.27.2.223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Nonadherence and nonpersistence to antidepressants in major depressive disorder (MDD) are common and associated with poor clinical and functional outcomes and increased health care resource utilization (HCRU) and costs. However, contemporary real-world evidence on the economic effect of antidepressant nonadherence and nonpersistence is limited. OBJECTIVE: To assess the effect of nonadherence and nonpersistence to antidepressants on HCRU and costs in adult patients with MDD enrolled in U.S. commercial and Medicare supplemental insurance plans. METHODS: This was a retrospective new-user cohort study using administrative claims data from the IBM MarketScan Commercial and Medicare Supplemental databases from January 1, 2010, to December 31, 2018. We identified adult patients with MDD aged ≥ 18 years who initiated antidepressant therapy for a new MDD episode between January 1, 2011, and December 31, 2017. Twelve-month total all-cause HCRU and costs (2019 U.S. dollars) were characterized for patients who were adherent/nonadherent and persistent/nonpersistent to antidepressants at 6 months. Adherence was defined as having proportion of days covered (PDC) ≥ 80%, and persistence was defined as having continuous antidepressant therapy without a ≥ 30-day gap. Multivariable negative binomial regression and 2-part models adjusted for baseline characteristics were used to estimate incidence rate ratios (IRRs) for HCRU and incremental costs of nonadherence and nonpersistence, respectively. RESULTS: A total of 224,645 patients with MDD (commercial: n = 209,422; Medicare supplemental: n = 15,223) met all study inclusion criteria. Approximately half of patients were nonadherent (commercial: 48%; Medicare supplemental: 50%) or nonpersistent (commercial: 49%; Medicare supplemental: 52%) to antidepressants at 6 months. After controlling for baseline characteristics, nonadherent patients experienced significantly more inpatient hospitalizations (commercial, adjusted IRR [95% CI]: 1.34 [1.29 to 1.39]; Medicare supplemental: 1.19 [1.12 to 1.28]) and emergency room (ER) visits (commercial, adjusted IRR [95% CI]: 1.43 [1.40 to 1.45]; Medicare supplemental: 1.28 [1.21 to 1.36]) compared with adherent patients. Similar results were observed in nonpersistent patients. Adjusted mean differences revealed that nonadherent and nonpersistent patients accumulated significantly higher medical costs (commercial: $568 [95% CI: $354 to $764] and $491 [$284 to $703]; Medicare supplemental: $1,621 [$314 to $2,774] and $1,764 [$451 to $2,925]), inpatient costs (commercial: $650 [$490 to $801] and $564 [$417 to $716]; Medicare supplemental: $1,546 [$705 to $2,308] and $1,567 [$778 to $2,331]), and ER costs (commercial: $130 [$115 to $143] and $129 [$115 to $142]; Medicare supplemental: $82 [$23 to $150] and $80 [$18 to $150]), and incurred significantly lower pharmacy costs (commercial: -$561 [-$601 to -$521] and -$576 [-$616 to -$540]; Medicare supplemental: -$510 [-$747 to -$227] and -$596 [-$830 to -$325]) compared with adherent and persistent patients, respectively. CONCLUSIONS: This study found more hospitalizations and ER use and higher total medical costs among patients who were nonadherent and nonpersistent to antidepressants at 6 months. Strategies that promote better adherence and persistence may lower HCRU and medical costs in patients with MDD. DISCLOSURES: This study was sponsored by Allergan, which was involved in the study design; data collection, analysis, and interpretation of data; and decision to present these results. Ta was supported by a training grant provided to the University of Washington by Allergan at the time this study was conducted. Tung and Gillard are employees of Allergan. Oliveri is an employee of Genesis Research. Sullivan and Devine have no financial disclosures. This study was presented as a poster at AMCP 2020 (Virtual Meeting), April 21-24, 2020.
Collapse
Affiliation(s)
- Jamie T Ta
- Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle
| | - Sean D Sullivan
- Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle
| | | | | | | | - Beth Devine
- Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle
| |
Collapse
|
15
|
Demographic and Perioperative Factors Associated With Patient-reported Outcomes Measurement Information System (PROMIS) Survey Completion. Clin Spine Surg 2020; 33:E519-E524. [PMID: 32324674 DOI: 10.1097/bsd.0000000000000998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE To evaluate independent demographic and perioperative factors associated with lower Patient-reported Outcome Measurement Information System Physical Function (PROMIS PF) survey completion rates after spine surgery. SUMMARY OF BACKGROUND DATA There has not been a study evaluating factors related to PROMIS PF survey completion following spine surgery. METHODS Patients undergoing spine procedures were retrospectively reviewed. The number of PROMIS PF surveys that were completed at each time period and the number of surveys that were completed in succession starting with the first survey were tabulated and reported using descriptive statistics. Independent preoperative and perioperative factors associated with full survey completion up to the 12-month period were identified using χ analysis and Poisson regression with robust error variance. A final multivariate model was created using a backward, stepwise multivariate regression. RESULTS A total of 713 patients were included. Variables positively associated with PROMIS survey completion were aged above 60 years and Patient Health Questionnaire (PHQ)-9≥10. African Americans and Hispanics were negatively associated with survey completion. Postoperative day 0 narcotic use ≥50 oral morphine equivalents was positively associated with survey completion, while outpatient surgical setting and high preoperative radicular arm/leg pain were negatively associated with survey completion. In the final multivariate model, depression was the only variable that was positively associated, while both outpatient surgical setting and high preoperative radicular arm/leg pain were negatively associated with survey completion. CONCLUSION This study identified demographic and perioperative variables associated with PROMIS survey completion and response rates. Patients who underwent surgery in the outpatient setting and those with high preoperative radicular limb pain were less likely to complete surveys. Interestingly, patients with clinical signs of depression were more likely to fill out surveys. Understanding variables associated with survey completion may provide the clinician with insight into which demographic groups are the most at-risk for not responding to surveys.
Collapse
|
16
|
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
|
17
|
Recio Iglesias J, Díez-Manglano J, López García F, Díaz Peromingo JA, Almagro P, Varela Aguilar JM. Management of the COPD Patient with Comorbidities: An Experts Recommendation Document. Int J Chron Obstruct Pulmon Dis 2020; 15:1015-1037. [PMID: 32440113 PMCID: PMC7217705 DOI: 10.2147/copd.s242009] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, which impact negatively on patients and are often underdiagnosed, thus lacking a proper management due to the absence of clear guidelines. Purpose To elaborate expert recommendations aimed to help healthcare professionals to provide the right care for treating COPD patients with comorbidities. Methods A modified RAND-UCLA appropriateness method consisting of nominal groups to draw up consensus recommendations (6 Spanish experts) and 2-Delphi rounds to validate them (23 Spanish experts) was performed. Results A panel of Spanish internal medicine experts reached consensus on 73 recommendations and 81 conclusions on the clinical consequences of the presence of comorbidities. In general, the experts reached consensus on the issues raised with regard to cardiovascular comorbidity and metabolic disorders. Consensus was reached on the use of selective serotonin reuptake inhibitors in cases of depression and the usefulness of referring patients with anxiety to respiratory rehabilitation programmes. The results also showed consensus on the usefulness of investigating the quality of sleep, the treatment of pain with opioids and the evaluation of osteoporosis by lateral chest radiography. Conclusion This study provides conclusions and recommendations that are intended to improve the management of the complexity of patients with COPD and important comorbidities, usually excluded from clinical trials.
Collapse
Affiliation(s)
- Jesús Recio Iglesias
- Internal Medicine Department, Quironsalud Valencia Hospital, Valencia, Valencian Community, Spain
| | - Jesús Díez-Manglano
- Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Aragon, Spain
| | - Francisco López García
- Internal Medicine Department General University Hospital of Elche, Alicante, Valencian Community, Spain
| | - José Antonio Díaz Peromingo
- Internal Medicine Department, University Clinical Hospital of Santiago de Compostela, a Coruña, Galicia, Spain
| | - Pere Almagro
- Internal Medicine Department, Mútua Terrassa University Hospital, Terrassa, Barcelona, Catalonia, Spain
| | - José Manuel Varela Aguilar
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Andalusia, Spain
- CIBER of Epidemiology and Public Health, Madrid, Community of Madrid, Spain
| |
Collapse
|
18
|
Frantz RP, Hill JW, Lickert CA, Wade RL, Cole MR, Tsang Y, Drake W. Medication adherence, hospitalization, and healthcare resource utilization and costs in patients with pulmonary arterial hypertension treated with endothelin receptor antagonists or phosphodiesterase type-5 inhibitors. Pulm Circ 2020; 10:2045894019880086. [PMID: 32274010 PMCID: PMC7114296 DOI: 10.1177/2045894019880086] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/03/2019] [Indexed: 12/14/2022] Open
Abstract
Adherence to therapy for pulmonary arterial hypertension is essential to optimize patient outcomes, but data on real-world adherence to different pulmonary arterial hypertension drug classes are limited. This retrospective database analysis evaluated relationships between adherence, hospitalization, and healthcare costs in pulmonary arterial hypertension patients treated with endothelin receptor antagonists or phosphodiesterase type-5 inhibitors. From the IQVIA Adjudicated Health Plan Database, patients with pulmonary arterial hypertension were identified based on diagnostic codes and prescriptions for endothelin receptor antagonists (ambrisentan, bosentan, macitentan) or phosphodiesterase type-5 inhibitors (sildenafil, tadalafil) approved for pulmonary arterial hypertension. Patients were assigned to the class of their most recently initiated (index) pulmonary arterial hypertension therapy between 1 January 2009 and 30 June 2015. Medication adherence was measured by proportion of days covered; patients with proportion of days covered ≥80% were considered adherent. The proportion of adherent patients was higher for endothelin receptor antagonists (571/755; 75.6%) than for phosphodiesterase type-5 inhibitors (970/1578; 61.5%; P < 0.0001). In both groups, hospitalizations declined as proportion of days covered increased. Among adherent patients, those on endothelin receptor antagonists had a significantly lower hospitalization rate than those on phosphodiesterase type-5 inhibitors (23.1% versus 28.5%, P = 0. 0218), fewer hospitalizations (mean (standard deviation) 0.4 (0.8) versus 0.5 (0.9); P = 0.02), and mean hospitalization costs during the six-month post-index ($9510 versus $15,726, P = 0.0318). Increasing adherence reduced hospitalization risk more for endothelin receptor antagonists than for phosphodiesterase type-5 inhibitors (hazard ratio 0.176 versus 0.549, P = 0.001). Rates and numbers of rehospitalizations within 30 days post-discharge were similar between groups. Mean total costs were higher with endothelin receptor antagonists than phosphodiesterase type-5 inhibitors in all patients ($91,328 versus $72,401, P = 0.0003) and in adherent patients ($88,867 versus $56,300, P < 0.0001), driven by higher drug costs.
Collapse
Affiliation(s)
- Robert P. Frantz
- Department of Cardiovascular Diseases,
Mayo Clinic, Rochester, USA
| | | | | | | | | | - Yuen Tsang
- Actelion Pharmaceuticals US, Inc., South
San Francisco, USA
| | - William Drake
- Actelion Pharmaceuticals US, Inc., South
San Francisco, USA
| |
Collapse
|
19
|
Zareifopoulos N, Bellou A, Spiropoulou A, Spiropoulos K. Prevalence, Contribution to Disease Burden and Management of Comorbid Depression and Anxiety in Chronic Obstructive Pulmonary Disease: A Narrative Review. COPD 2019; 16:406-417. [DOI: 10.1080/15412555.2019.1679102] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Nicholas Zareifopoulos
- Department of Pulmonology, University of Patras School of Health Science, Patras, Achaea, Greece
| | - Aggeliki Bellou
- Department of Pulmonology, University of Patras School of Health Science, Patras, Achaea, Greece
| | - Agathi Spiropoulou
- Department of Pulmonology, University of Patras School of Health Science, Patras, Achaea, Greece
| | - Kostas Spiropoulos
- Department of Pulmonology, University of Patras School of Health Science, Patras, Achaea, Greece
| |
Collapse
|
20
|
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]
|
21
|
Nair D. Measuring and Modifying Psychological Distress in CKD: New Insights and Next Steps. Kidney Med 2019; 1:147-149. [PMID: 32734948 PMCID: PMC7380378 DOI: 10.1016/j.xkme.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Devika Nair
- Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
22
|
Celli BR, Navaie M, Xu Z, Cho-Reyes S, Dembek C, Gilmer TP. Medication management patterns among Medicare beneficiaries with chronic obstructive pulmonary disease who initiate nebulized arformoterol treatment. Int J Chron Obstruct Pulmon Dis 2019; 14:1019-1031. [PMID: 31190787 PMCID: PMC6526678 DOI: 10.2147/copd.s199251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/25/2019] [Indexed: 12/22/2022] Open
Abstract
Purpose: Global evidence-based treatment strategies for chronic obstructive pulmonary disease (COPD) recommend using long-acting bronchodilators (LABDs) as maintenance therapy. However, COPD patients are often undertreated. We examined COPD treatment patterns among Medicare beneficiaries who initiated arformoterol tartrate, a nebulized long-acting beta2 agonist (LABA), and identified the predictors of initiation. Methods: Using a 100% sample of Medicare administrative data, we identified beneficiaries with a COPD diagnosis (ICD-9 490-492.xx, 494.xx, 496.xx) between 2010 and 2014 who had ≥1 year of continuous enrollment in Parts A, B, and D, and ≥2 COPD-related outpatient visits within 30 days or ≥1 hospitalization(s). After applying inclusion/exclusion criteria, three cohorts were identified: (1) study group beneficiaries who received nebulized arformoterol (n=11,886), (2) a subset of the study group with no LABD use 90 days prior to initiating arformoterol (n=5,542), and (3) control group beneficiaries with no nebulized LABA use (n=220,429). Logistic regression was used to evaluate predictors of arformoterol initiation. Odds ratios (ORs), 95% confidence intervals (CIs), and p values were computed. Results: Among arformoterol users, 47% (n=5,542) had received no LABDs 90 days prior to initiating arformoterol. These beneficiaries were being treated with a nebulized (50%) or inhaled (37%) short-acting bronchodilator or a systemic corticosteroid (46%), and many received antibiotics (37%). Compared to controls, beneficiaries who initiated arformoterol were significantly more likely to have had an exacerbation, a COPD-related hospitalization, and a pulmonologist or respiratory therapist visit prior to initiation (all p<0.05). Beneficiaries with moderate/severe psychiatric comorbidity or dual-eligible status were significantly less likely to initiate arformoterol, as compared to controls (all p<0.05). Conclusion: Medicare beneficiaries who initiated nebulized arformoterol therapy had more exacerbations and hospitalizations than controls 90 days prior to initiation. Findings revealed inadequate use of maintenance medications, suggesting a lack of compliance with evidence-based treatment guidelines.
Collapse
Affiliation(s)
- Bartolome R Celli
- Chronic Obstructive Pulmonary Disease Center, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA
| | - Maryam Navaie
- Global Strategy, Advance Health Solutions, LLC, New York, NY, USA
- School of Professional Studies, Columbia University, New York, NY, USA
| | - Zhun Xu
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Soojin Cho-Reyes
- Global Strategy, Advance Health Solutions, LLC, New York, NY, USA
| | - Carole Dembek
- Global Health Economics and Outcomes Research, Sunovion Pharmaceuticals Inc, Marlborough, MA, USA
| | - Todd P Gilmer
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| |
Collapse
|