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Ko FWS, Xu X, Chau C, Navarro A, Hui DSC, Milea D. Clinical characteristics and healthcare resource utilization in patients with chronic obstructive pulmonary disease in Hong Kong. Respir Med 2024; 222:107516. [PMID: 38184091 DOI: 10.1016/j.rmed.2023.107516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/14/2023] [Accepted: 12/28/2023] [Indexed: 01/08/2024]
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) is a significant cause of mortality, with its prevalence projected to rise in Asia. The primary objective of this study was to describe clinical characteristics, maintenance treatment, and healthcare resource utilization (HCRU) among patients with COPD in Hong Kong. Secondary objectives were to assess patient demographics and clinical characteristics by eosinophil (EOS) levels, and compare the demographics, clinical characteristics, and treatment patterns of patients on multiple-inhaler triple therapy (MITT). METHODS This study analyzed a cohort of patients with COPD who had entered a previously initiated prospective cohort study involving patients with COPD and/or asthma at the Prince of Wales Hospital between 2017 and 2019. RESULTS Patients with COPD were enrolled (N = 220, mean age 74.3 years, 97 % male). Twelve months prior to baseline assessment, 66 % of patients were on MITT, 17 % on long-acting muscarinic antagonists (LAMAs)/long-acting beta-agonists (LABAs), and 7 % on inhaled corticosteroids (ICS)/LABA. Compared with ICS/LABA or LAMA/LABA, more patients on MITT experienced ≥1 exacerbation (26.7 %, 10.5 %, 39.7 %, respectively). Patients on MITT also had a higher mean (SD) COPD Assessment Test score (9.4 [5.9]) and modified Medical Research Council Dyspnea Scale score (1.7 [0.7]) and incurred the most COPD-related and total HCRU costs. Compared with patients with EOS ≤300 cells/μL, those with EOS >300 cells/μL had a higher number of exacerbations. CONCLUSIONS Patients with COPD in Hong Kong treated with MITT presented more severe disease profiles and incurred higher costs. These data can be used for decision making in patients with moderate-to-severe COPD in Hong Kong.
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Affiliation(s)
- Fanny Wai San Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
| | - Xiaomeng Xu
- GSK, Greater China and Intercontinental, Singapore
| | | | - Aldo Navarro
- GSK, Greater China and Intercontinental, Singapore
| | - David Shu Cheong Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
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Kanwal H, Khan S, Eldesoky GE, Mushtaq S, Khan A. Management of COPD and Comorbidities in COPD patients by Dispensing Pharmaceutical Care following Global Initiative for chronic Obstructive Lung Disease-Guidelines (GOLD guidelines 2020): A study protocol for a Prospective Randomized Clinical Trial. Heliyon 2023; 9:e21539. [PMID: 37942165 PMCID: PMC10628705 DOI: 10.1016/j.heliyon.2023.e21539] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 10/14/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023] Open
Abstract
COPD (chronic obstructive pulmonary disease) is a medical condition that encompasses several chronic, progressive, and severe respiratory illnesses, such as emphysema and chronic bronchitis. COPD is the 4th most deadly disease in the world and its prevalence is expected to increase. Despite the abundance of information on the disease's etiology, pathophysiology, and treatment possibilities, it has long been underdiagnosed and underreported for a long time, particularly in developing countries. The symptoms of COPD result in significant impairments and significant impact on quality of life. COPD is the third leading cause of death in Pakistan. According to the published literature, COPD has been found to be associated with a serious economic burden, either the direct cost to healthcare systems in the form of frequent hospital admissions or indirect costs to patients suffering from COPD. Despite the availability of excellent medication, COPD treatment goals are frequently not achieved resulting in poor management of COPD. The recent studies revealed that due to the missing role of Pharmacists in most of the public sector hospitals of Pakistan, the COPD disease management protocols are not being properly followed. Pharmacists can help the healthcare system by implementing these management protocols that focus on patient education about the disease, prescribed medications, and proper inhalation techniques. Furthermore, the pharmacists as an effective healthcare's team member properly educate the patients about the ongoing assessments and their willingness to follow treatment recommendations and quit smoking, while referring them to smoking cessation programs as needed, following the GOLD guidelines. This aim of this clinical trial is to evaluate the impact of implementing standard treatment guidelines and the role of pharmacists in implementing GOLD guidelines for COPD management.
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Affiliation(s)
- Hafsa Kanwal
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Shahzeb Khan
- Centre for Pharmaceutical Engineering, Faculty of Life Sciences, School of Pharmacy and Medical Sciences, University of Bradford, West Yorkshire, BD7, 1DP, UK
| | - Gaber E. Eldesoky
- Department of Chemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Saima Mushtaq
- Department of Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences (ASAB), National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Amjad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
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Gagné M, Karanikas A, Green S, Gupta S. Reductions in inhaler greenhouse gas emissions by addressing care gaps in asthma and chronic obstructive pulmonary disease: an analysis. BMJ Open Respir Res 2023; 10:e001716. [PMID: 37730281 PMCID: PMC10510936 DOI: 10.1136/bmjresp-2023-001716] [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: 03/17/2023] [Accepted: 08/04/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Climate change from greenhouse gas (GHG) emissions represents one of the greatest public health threats of our time. Inhalers (and particularly metred-dose inhalers (MDIs)) used for asthma and chronic obstructive pulmonary disease (COPD), constitute an important source of GHGs. In this analysis, we aimed to estimate the carbon footprint impact of improving three distinct aspects of respiratory care that drive avoidable inhaler use in Canada. METHODS We used published data to estimate the prevalence of misdiagnosed disease, existing inhaler use patterns, medication class distributions, inhaler type distributions and GHGs associated with inhaler actuations, to quantify annual GHG emissions in Canada: (1) attributable to asthma and COPD misdiagnosis; (2) attributable to overuse of rescue inhalers due to suboptimally controlled symptoms; and (3) avoidable by switching 25% of patients with existing asthma and COPD to an otherwise comparable therapeutic option with a lower GHG footprint. RESULTS We identified the following avoidable annual GHG emissions: (1) ~49 100 GHG metric tons (MTs) due to misdiagnosed disease; (2) ~143 000 GHG MTs due to suboptimal symptom control; and (3) ~262 100 GHG MTs due to preferential prescription of strategies featuring MDIs over lower-GHG-emitting options (when 25% of patients are switched to lower GHG alternatives). Combined, the GHG emission reductions from bridging these gaps would be the equivalent to taking ~101 100 vehicles off the roads each year. CONCLUSIONS Our analysis shows that the carbon savings from addressing misdiagnosis and suboptimal disease control are comparable to those achievable by switching one in four patients to lower GHG-emitting therapeutic strategies. Behaviour change strategies required to achieve and sustain delivery of evidence-based real-world care are complex, but the added identified incentive of carbon footprint reduction may in itself prove to be a powerful motivator for change among providers and patients. This additional benefit can be leveraged in future behaviour change interventions.
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Affiliation(s)
- Myriam Gagné
- Division of Respirology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Aliki Karanikas
- Division of Respirology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Samantha Green
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samir Gupta
- Division of Respirology, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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Pang H, Pan Z, Adams R, Duncan E, Chi C, Kong X, Adab P, Cheng KK, Cooper BG, Correia-de-Sousa J, Dickens AP, Enocson A, Farley A, Gale N, Jolly K, Jowett S, Maglakelidze M, Maghlakelidze T, Martins S, Sitch A, Stavrik K, Stelmach R, Turner A, Williams S, Jordan RE. Community lung health service design for COPD patients in China by the Breathe Well group. NPJ Prim Care Respir Med 2022; 32:27. [PMID: 35985992 PMCID: PMC9388970 DOI: 10.1038/s41533-022-00286-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/24/2022] [Indexed: 12/04/2022] Open
Abstract
COPD is increasingly common in China but is poorly understood by patients, medications are not used as prescribed and there is no access to recommended non-pharmacological treatment. We explored COPD patients’ and general practitioners’ (GPs) knowledge of COPD, views on its management and the acceptability of a flexible lung health service (LHS) offering health education, exercise, self-management, smoking cessation and mental health support. Using a convergent mixed methods design, data were collected from patients and GPs using focus groups (FGs) in four Chinese cities, questionnaires were also used to collect data from patients. FGs were audio-recorded and transcribed. Quantitative data were analysed descriptively, thematic framework analysis was used for the qualitative data. Two-hundred fifty-one patients completed the questionnaire; 39 patients and 30 GPs participated in ten separate FGs. Three overarching themes were identified: patients’ lack of knowledge/understanding of COPD, current management of COPD not meeting patients’ needs and LHS design, which was well received by patients and GPs. Participants wanted COPD education, TaiChi, psychological support and WeChat for social support. 39% of survey responders did not know what to do when their breathing worsened and 24% did not know how to use their inhalers. 36% of survey respondents requested guided relaxation. Overall, participants did not fully understand the implications of COPD and current treatment was sub-optimal. There was support for developing a culturally appropriate intervention meeting Chinese patients’ needs, health beliefs, and local healthcare delivery. Further research should explore the feasibility of such a service.
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Cheng KC, Lai CC, Wang CY, Wang CM, Ho CH, Sung MI, Hsing SC, Liao KM, Ko SC. The Impact of the Pay-for-Performance Program on the Outcome of COPD Patients in Taiwan After One Year. Int J Chron Obstruct Pulmon Dis 2022; 17:883-891. [PMID: 35480556 PMCID: PMC9037731 DOI: 10.2147/copd.s349468] [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: 11/20/2021] [Accepted: 04/11/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the impact of a multidisciplinary intervention on the clinical outcomes of patients with COPD. Methods This study retrospectively extracted the data of patients enrolled in the national pay-for-performance (P4P) program for COPD in four hospitals. Only COPD patients who received regular follow-up for at least one year in the P4P program between September 2018 and December 2020 were included. Results A total of 1081 patients were included in this study. Among them, 424 (39.2%), 287 (26.5%), 179 (16.6%), and 191 (17.7%) patients were classified as COPD Groups A, B, C, and D, respectively. Dual therapy with long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) was the most used inhaled bronchodilator at baseline (n = 477, 44.1%) patients, followed by LAMA monotherapy (n = 195, 18.0%), triple therapy with inhaled corticosteroid (ICS)/LABA/LAMA (n = 184, 17.0%), and ICS/LABA combination (n = 165, 15.3%). After one year of intervention, 374 (34.6%) and 323 (29.9%) patients had their pre- and post-bronchodilator-forced expiratory volume in one second (FEV1) increase of more than 100 mL. Both the COPD Assessment Test (CAT) and modified British Medical Research Council (mMRC) scores had a mean change of −2.2 ± 5.5 and −0.3 ± 0.9, respectively. The improvement in pulmonary function and symptom score were observed across four groups. The decreased number of exacerbations was only observed in Groups C and D, and not in Groups A and B. Conclusion This real-world study demonstrated that the intervention in the P4P program could help improve the clinical outcome of COPD patients. It also showed us a different view on the use of dual therapy, which has a lower cost in Taiwan.
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Affiliation(s)
- Kuo-Chen Cheng
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital Tainan Branch, Tainan, Taiwan
| | - Cheng-Yi Wang
- Department of Internal Medicine, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Ching-Min Wang
- Department of Internal Medicine, Chi Mei Medical Center, Liouying, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Cancer Center, Wan Fang Hospital, Taipei Medical University, Taipei, 11695, Taiwan.,Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Mei-I Sung
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Shu-Chen Hsing
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan
| | - Shian-Chin Ko
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
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Keller TL, Wright J, Donovan LM, Spece LJ, Duan K, Sulayman N, Dominitz A, Curtis JR, Au DH, Feemster LC. Association of Patient and Primary Care Provider Factors with Outpatient COPD Care Quality. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2022; 9:55-67. [PMID: 34915603 PMCID: PMC8893974 DOI: 10.15326/jcopdf.2021.0232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 06/14/2023]
Abstract
RATIONALE Large gaps exist between guideline-recommended outpatient chronic obstructive pulmonary disease (COPD) care and clinical practice. Seeking to design effective interventions, we identified patient and primary care provider (PCP) characteristics associated with receiving evidence-based COPD care. METHODS We performed an observational study of adults aged ≥ 40 years with clinically diagnosed COPD who received care at 2 University of Washington-affiliated primary care clinics between June 1, 2011, and June 1, 2013. Our primary outcome was the proportion of evidence-based outpatient COPD quality measures received through primary or pulmonary care. Among all patients, we assessed spirometry completion, respiratory symptom identification, smoking status ascertainment, oxygen saturation measurement, and guideline-concordant inhaled therapy prescription. We also determined confirmation of airflow obstruction, oxygen prescription, smoking cessation intervention, and pulmonary rehabilitation referral if eligible. We used multivariable mixed effects linear regression to estimate the association of patient and PCP characteristics with the primary outcome. RESULTS Among 641 patients, 382 were male (59.6%) with mean age 63.6 (standard deviation [SD] 10.6) years. Most patients currently smoked (N=386, 60.2%). Patients saw 150 unique PCPs during 5.3 (SD 3.2) PCP visits, with 107 completing pulmonary referrals (16.7%). Patients received 67.5% (SD 18.4%) of eligible (median 7 [interquartile range 6-7]) evidence-based quality measures. After adjustment, pulmonary referral was associated with a higher receipt of outpatient quality measures (ß117.7%, 95% confidence interval: 12.6%, 22.7%). Patient demographics, comorbidities, and PCP identity/characteristics were not associated with outpatient care quality. CONCLUSIONS The quality of outpatient COPD care was suboptimal. Future studies should investigate if engaging pulmonologists in COPD management improves care quality.
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Affiliation(s)
- Thomas L Keller
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States
| | - Jennifer Wright
- Department of Medicine, University of Washington, Seattle, Washington, United States
| | - Lucas M Donovan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington, United States
| | - Laura J Spece
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington, United States
| | - Kevin Duan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States
| | - Nadiyah Sulayman
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington, United States
| | - Alexandria Dominitz
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington, United States
| | - J Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, United States
| | - David H Au
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington, United States
| | - Laura C Feemster
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington, United States
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Clinical factors predictive of appropriate treatment in COPD: a community hospital setting. Drug Target Insights 2021; 15:21-25. [PMID: 34803374 PMCID: PMC8600449 DOI: 10.33393/dti.2021.2291] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a common respiratory disease. The appropriate treatment according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline was 19-60%. However, there are limited data on predictors of appropriate treatment in patients with COPD. This study aimed to evaluate risk factors of appropriate treatment in patients with COPD according to the GOLD guideline in a real-world community setting.
Methods: This is a retrospective study conducted at a community hospital. Inclusion criteria were adult patients diagnosed as COPD treated at a COPD clinic. The primary outcome was the appropriate treatment, defined by correct pharmacological treatment by the GOLD guideline according to the ABCD severity assessment. Clinical predictors of appropriate treatment were executed by stepwise multivariate logistic regression analysis.
Results: 136 patients with COPD met the study criteria. Of those, 100 patients had inappropriate treatment according to the GOLD guideline. Three factors were independently associated with the appropriate treatment including number of admissions, modified Medical Research Council (mMRC) score, and CAT score. These factors had adjusted odds ratio of 3.11, 2.86, and 1.26, respectively. Causes of inappropriate treatment were unavailability of long-acting muscarinic antagonist (LAMA) (51 patients; 79.69%), treated by inhaled corticosteroid (ICS) alone (12 patients; 18.75%), and treated with only bronchodilator (1 patient; 1.56%).
Conclusions: Appropriate COPD patients’ treatment according to the GOLD guideline was 26.47% in community setting. Factors associated with severity of COPD were associated with prescribing appropriate treatments.
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Fuoco MJ, Mularski RA, Wu B, Moretz C, McBurnie MA, Stanford RH, Crawford P, Gratie D, Salas B. Continuity of Care Assessment Within a Vertically Integrated Care Management Organization Before and After COPD-Related Exacerbations. Int J Chron Obstruct Pulmon Dis 2021; 16:2755-2767. [PMID: 34675501 PMCID: PMC8504477 DOI: 10.2147/copd.s290714] [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: 11/06/2020] [Accepted: 08/23/2021] [Indexed: 11/28/2022] Open
Abstract
Background There is currently little research describing patient experience and continuity of care immediately prior, during, and following an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This analysis examined clinical characteristics, chronic obstructive pulmonary disease (COPD)‑related medication patterns and outpatient visits before and after an AECOPD. Methods This retrospective analysis used electronic health records, medical claims, and pharmacy dispensing data for patients within the Kaiser Permanente Northwest Health System. Patients with ≥1 AECOPD between January 1, 2015 and December 31, 2017 were identified. The most recent AECOPD was considered the index date. An AECOPD was defined as an inpatient hospitalization with a primary diagnosis of COPD, or respiratory failure with a secondary diagnosis of COPD, or an outpatient visit with a primary diagnosis of COPD and dispensing of respiratory-related antibiotics and/or oral corticosteroids ±5 days of the visit. Eligible patients were: ≥40 years old; ≥2 encounters within 12 months of each other or ≥1 hospitalization with primary or secondary COPD diagnosis, chronic bronchitis, or emphysema prior to index; and continuously enrolled ±90 days relative to index. COPD-related inhaled maintenance medication, rescue inhalers, oral corticosteroid use, and ambulatory visits were assessed 90-days pre- and post-index. Results There were 2829 patients included (mean [standard deviation] age: 69.0 [10.5] years) who had an AECOPD (7% severe; 93% moderate). The percentage of patients on inhaled maintenance therapy increased from 60.6% pre-AECOPD to 68.8% post-AECOPD and increased from 60.0% to 87.4% among patients who experienced a severe AECOPD. COPD-related ambulatory visits increased more than four-fold for primary care and more than doubled for pulmonologist visits in the post-AECOPD period. Conclusion The low proportion of patients observed with changes to controller and rescue medication (particularly following a moderate AECOPD), yet higher utilization of COPD-related ambulatory visits before and after an AECOPD suggests that there is opportunity to improve pharmacotherapy management.
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Affiliation(s)
- Morgan Justice Fuoco
- Kaiser Permanente Center for Health Research, Science Programs Department, Portland, OR, USA
| | - Richard A Mularski
- Kaiser Permanente Center for Health Research, Science Programs Department, Portland, OR, USA
| | - Benjamin Wu
- GlaxoSmithKline, US Value Evidence and Outcomes, Research Triangle Park, Durham, NC, USA
| | - Chad Moretz
- GlaxoSmithKline, US Value Evidence and Outcomes, Research Triangle Park, Durham, NC, USA
| | - Mary Ann McBurnie
- Kaiser Permanente Center for Health Research, Science Programs Department, Portland, OR, USA
| | - Richard H Stanford
- GlaxoSmithKline, US Value Evidence and Outcomes, Research Triangle Park, Durham, NC, USA
| | - Phillip Crawford
- Kaiser Permanente Center for Health Research, Science Programs Department, Portland, OR, USA
| | - Daniel Gratie
- GlaxoSmithKline, US Value Evidence and Outcomes, Research Triangle Park, Durham, NC, USA
| | - Bianca Salas
- Kaiser Permanente Center for Health Research, Science Programs Department, Portland, OR, USA
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Savran O, Godtfredsen N, Sørensen T, Jensen C, Ulrik CS. Characteristics of COPD Patients Prescribed ICS Managed in General Practice vs. Secondary Care. COPD 2021; 18:493-500. [PMID: 34470537 DOI: 10.1080/15412555.2021.1970737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Inhaled corticosteroids (ICS) for COPD have been much debated. Our aim was to investigate characteristics of ICS prescribed COPD patients managed only in general practice compared to those also managed in secondary care. Participating general practitioners recruited patients with COPD (ICPC 2nd ed. code R95) currently prescribed ICS (ACT code R03AK and R03BA). Data on demographics, comorbidities, smoking habits, spirometry, dyspnea score and exacerbation history were retrieved from medical records. Logistic regression analysis was applied to detect predictors associated with management in secondary care. 2,279 COPD patients (45% males and mean age 71 years) were recruited in primary care. Compared to patients managed in primary care only (n = 1,179), patients also managed in secondary care (n = 560) were younger (p = 0.013), had lower BMI, more life-time tobacco exposure (p = 0.03), more exacerbations (p < 0.001) and hospitalizations (p < 0.001) and lower FEV1/FVC-ratio (0.59 versus 0.52, respectively). Compared to patients managed in only primary care, logistic regression analysis revealed that management also in secondary care was associated to MRC-score ≥3 (OR 2.70; 95% CI 1.50-4.86; p = 0.001), FEV1%pred (OR 0.98; 95% CI 0.95 to 0.99; p = 0.036), and systemic corticosteroids for COPD exacerbation (OR 1.44; 95% CI 1.10-1.89; p = 0.008). In COPD patients prescribed ICS recruited in primary care, patients also managed in secondary care had more respiratory symptoms, lower lung function and exacerbations treated with systemic corticosteroids indicating that the most severe COPD patients, in general, are referred for specialist care.
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Affiliation(s)
- Osman Savran
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Nina Godtfredsen
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Hvidovre, Denmark
| | | | | | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Hvidovre, Denmark
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Chen XRC, Fu SN, Leung WK, Ng SWC, Kwan WYW, Wong TK, Chan PF, Wong MYM, Ko WKW, Liang J, Hui MTE, Li YC, Luk W, Chao VKD. Clinical Audit on Chronic Obstructive Pulmonary Disease (COPD) Management in Primary Care: A Quality Improvement Project from Hong Kong. Int J Chron Obstruct Pulmon Dis 2021; 16:1901-1911. [PMID: 34188466 PMCID: PMC8236252 DOI: 10.2147/copd.s304527] [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: 01/29/2021] [Accepted: 04/21/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To enhance the quality of COPD management in primary care via a two-phase clinical audit in Hong Kong. Methods COPD patients aged 40 or above and had attended any of the 73 public primary care clinics under the Hospital Authority of Hong Kong (HAHK) for follow up (FU) during the audit period were included. Performance of six evidence-based audit criteria on COPD care was reviewed in phase 1 from 1st April 2017 to 31st March 2018. Service gaps were identified and a series of quality improvement strategies were executed in the one-year implementation phase. The outcome of the service enhancement was assessed in phase 2 from 1st April 2019 to 31st March 2020. Student’s t-test and the chi-square test were used to examine the statistically significant differences between the two phases. Results Totally 10,385 COPD cases were identified in phase 1, the majority were male (87.7%) and the mean age was 75.3±9.9 years. Among the 3102 active smokers, 1788 (57.6%) were referred to receive the smoking cessation counselling and 1578 (50.9%) actually attended it. A total of 4866 cases (46.9%) received seasonal influenza vaccine (SIV) and 4227 cases (40.7%) received pneumococcal vaccine (PCV). A total of 1983 patients (19.1%) had spirometry test done before and 1327 patients (12.8%) had history of hospital admission due to acute exacerbation of COPD (AECOPD). After the proactive implementation phase, performance on all criteria was significantly improved in phase 2, with a marked increase in the SIV and PCV uptake rate and spirometry performance rate. Most importantly, a significant reduction in AECOPD rate leading to hospital admission had been achieved (9.6%, P<0.00001). Conclusion COPD care at all public primary care clinics of HAHK had been significantly improved for all audit criteria via the systematic team approach, which, in turn, reduced the hospital admission rate and helped relieve the burden of the health care system.
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Affiliation(s)
- Xiao Rui Catherine Chen
- Department of Family Medicine and General Out Patient Clinics, Kowloon Central Cluster, Hospital Authority, Hong Kong
| | - Sau Nga Fu
- Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority, Hong Kong
| | - Wing Kit Leung
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong
| | - Sze Wing Catherine Ng
- Department of Family Medicine and Primary Health Care, Hong Kong West Cluster, Hospital Authority, Hong Kong
| | - Wing Yan Wendy Kwan
- Department of Family Medicine and Primary Health Care, Hong Kong East Cluster, Hospital Authority, Hong Kong
| | - Tseng Kwong Wong
- Department of Family Medicine and Primary Health Care, Kowloon East Cluster, Hospital Authority, Hong Kong
| | - Pang Fai Chan
- Department of Family Medicine and Primary Health Care, Kowloon East Cluster, Hospital Authority, Hong Kong
| | - Man Ying Michelle Wong
- Department of Family Medicine and Primary Health Care, Hong Kong East Cluster, Hospital Authority, Hong Kong
| | - Wai Kit Welchie Ko
- Department of Family Medicine and Primary Health Care, Hong Kong West Cluster, Hospital Authority, Hong Kong
| | - Jun Liang
- Department of Family Medicine and Primary Health Care, New Territories West Cluster, Hospital Authority, Hong Kong
| | - Ming Tung Eric Hui
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong
| | - Yim Chu Li
- Department of Family Medicine and General Out Patient Clinics, Kowloon Central Cluster, Hospital Authority, Hong Kong
| | - Wan Luk
- Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority, Hong Kong
| | - V K David Chao
- Department of Family Medicine and Primary Health Care, Kowloon East Cluster, Hospital Authority, Hong Kong
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Martinez FJ, Thomashow B, Sapir T, Simone L, Carter J, Han M. Does Evaluation and Management of COPD Follow Therapeutic Strategy Recommendations? CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2021; 8:230-242. [PMID: 33610138 DOI: 10.15326/jcopdf.2020.0175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction Recommendations for chronic obstructive pulmonary disease (COPD) diagnosis and management requires symptom and exacerbation risk assessment. Adherence to these recommendations appears to be limited. We examined the impact of a COPD quality improvement (QI) program in the Southeastern United States. Methods From 2017 to 2018, nine pulmonary and 15 primary care physicians were included in our study and asked to identify 6 to 7 of their COPD patients using maintenance COPD medications with at least 2 office visits in the past year. A separate group of COPD patients (n=135 pulmonary and 165 primary care) from the same practices were evaluated. Physicians underwent focused, educational, peer-to-peer small group webinars. Data were collected from physicians and their patients using a systematic survey. Chart audits occurred at baseline and 6 months after the webinars. Results The majority of physicians (67%) saw ≥ 20 COPD patients/week. There were important discrepancies between the care clinicians thought they provided, and the care recalled by their patients. Clinicians felt that 33% of their patients experienced at least 2 exacerbations in the past year; 56% of their patients reported this frequency. There was discrepancy in the clinicians' interpretations and the patients' reasons for discontinuing their medications and in the use of referrals. Self-reported changes were noted by clinicians after educational webinars and improvements in patient care were noted in the year following intervention. Conclusion We identified notable discrepancies between the clinicians' impression of care provided and the components actually recalled by their patients. We also identified improvements in processes of care and outcomes following an educational intervention based on the principles of audit and feedback.
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Affiliation(s)
- Fernando J Martinez
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, United States
| | - Byron Thomashow
- Columbia University, New York Presbyterian Hospital, New York, New York, United States
| | - Tamar Sapir
- PRIME Education, LLC, Fort Lauderdale, Florida, United States
| | - Laura Simone
- PRIME Education, LLC, Fort Lauderdale, Florida, United States
| | - Jeffrey Carter
- PRIME Education, LLC, Fort Lauderdale, Florida, United States
| | - MeiLan Han
- University of Michigan Health System, Ann Arbor, Michigan, United States
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12
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Turan PA, Turan O, Güldaval F, Anar C, Polat G, Büyükşirin M. Transitions between COPD groups: A cross-sectional study in Turkey. Respir Med 2021; 178:106310. [PMID: 33529994 DOI: 10.1016/j.rmed.2021.106310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/21/2020] [Accepted: 01/17/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Since GOLD 2017 separates spirometry results from 'ABCD' groups, there have been some changes to the stages of COPD patients. Our aim was to investigate the shifts in COPD groups after GOLD 2017. METHODS COPD patients from outpatient clinics of 3 hospitals in Turkey were stratified into old and new ABCD groups according to exacerbation history, mMRC evaluation and spirometry results for both GOLD 2011 and 2017 assessments. Treatment protocols were also evaluated if they were suitable for both classifications. RESULTS There were 578 patients (334 men, 244 women) with a mean age of 65.21±10.42. The distribution of patients from group A to D was 28%, 15%, 15%, 42% (GOLD 2011) and 36%, 22%, 7% and 35% (GOLD 2017) respectively. There were shifts from group C to A (53.4%) and D to B (18.4%). The treatment suitability was 66.3% in GOLD 2011 and 60.9% in GOLD 2017. The most common inappropriate treatment protocol was triple therapy. Presence of exacerbations in last year, mMRC score, FEV1 level (p < 0.01 for three parameters) and proportion of males (p = 0.029) were statistically significantly higher in groups C and D of GOLD 2017 compared with new patients in group A and B of GOLD 2017 (shifted from GOLD 2011's C-D groups). CONCLUSION There were shifts from group C to A and D to B with GOLD 2017, which means some high-risk COPD patients were reclassified into low-risk groups. Despite guideline updates, there are still many COPD patients with overtreatment. To our knowledge, this is the first study examining transitions between COPD groups after GOLD 2017 in Turkey.
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Affiliation(s)
- P A Turan
- Department of Pulmonary Medicine. Menemen State Hospital, Izmir, Turkey(1).
| | - O Turan
- Department of Pulmonary Medicine, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey(2)
| | - F Güldaval
- Department of Pulmonary Medicine, Dr. Suat Seren Chest Diseases and Surgery Training Hospital, Izmir, Turkey(3)
| | - C Anar
- Department of Pulmonary Medicine, Dr. Suat Seren Chest Diseases and Surgery Training Hospital, Izmir, Turkey(3)
| | - G Polat
- Department of Pulmonary Medicine, Dr. Suat Seren Chest Diseases and Surgery Training Hospital, Izmir, Turkey(3)
| | - M Büyükşirin
- Department of Pulmonary Medicine, Dr. Suat Seren Chest Diseases and Surgery Training Hospital, Izmir, Turkey(3)
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13
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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.
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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
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14
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Ierodiakonou D, Sifaki-Pistolla D, Kampouraki M, Poulorinakis I, Papadokostakis P, Gialamas I, Athanasiou P, Bempi V, Lampraki I, Tsiligianni I. Adherence to inhalers and comorbidities in COPD patients. A cross-sectional primary care study from Greece. BMC Pulm Med 2020; 20:253. [PMID: 32977779 PMCID: PMC7519509 DOI: 10.1186/s12890-020-01296-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/17/2020] [Indexed: 12/17/2022] Open
Abstract
Background Comorbidities and adherence to inhaled therapy appears to have a major impact on treatment goals, health status and disease control in chronic obstructive pulmonary disease (COPD). Aim of the study was to assess levels of adherence to inhalers, comorbidities and associations with COPD outcomes in patients residing in rural and semi-urban areas of Greece. Methods Two hundred fifty-seven COPD patients were enrolled from primary health care in 2015–2016. Physicians used structured interviews and questionnaires to assess quality of life and disease status. Patients were classified into groups according to GOLD 2019 guidelines (based on CAT and mMRC). Adherence to inhalers was measured with the Test of Adherence to Inhalers (TAI). Multivariate linear and logistics regression models were used to assess associations between comorbidities and adherence to inhalers with COPD outcomes, including CAT and mMRC scores, exacerbations and GOLD A-D status. Results 74.1% of COPD patients reported poor adherence, while most of them were characterized as deliberate non-compliers (69.5%). 77.1% had ≥2 comorbidities, with overweight/obese (82.2%), hypertension (72.9%) and diabetes mellitus (58%) being the most prevalent. In multivariate analysis, COPD outcomes having significant associations with poor adherence included worse health status [OR (95% CI) 4.86 (1.61–14.69) and 2.93 (1.51–5.71) based on CAT and mMRC, respectively], having ≥2 exacerbations in the past year [4.68 (1.51–4.44)], and disease status e.g., be in groups C or D [3.13 (1.49–8.53) and 3.35 (1.24–9.09) based on CAT and mMRC, respectively). Subjects with gastroesophageal reflux showed better inhaler adherence [OR (95% CI) 0.17 (0.6–0.45)], but none of the comorbid conditions was associated with COPD outcomes after adjustments. Conclusions Poor adherence to inhalers and comorbidities are both prevalent in COPD patients of primary care residing in rural/semi-urban areas of Greece, with adherence influencing COPD outcomes. Raising awareness of patients and physicians on the importance of comorbidities control and inhaler adherence may lead to interventions and improve outcomes.
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Affiliation(s)
- Despo Ierodiakonou
- Health Planning Unit. Department of Social Medicine, Faculty of Medicine, University of Crete, Voutes Campus, Heraklion, GR-71003, Crete, Greece.,Department of Public Health, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Dimitra Sifaki-Pistolla
- Health Planning Unit. Department of Social Medicine, Faculty of Medicine, University of Crete, Voutes Campus, Heraklion, GR-71003, Crete, Greece.,Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | - Maria Kampouraki
- Primary Care Practice, Health Center of Moires, Heraklion, Crete, Greece
| | | | | | - Ioannis Gialamas
- Primary Care Practice, Health Center of Sitia, Sitia General Hospital, Lasithi, Crete, Greece
| | - Polyxeni Athanasiou
- Department of Public Health, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Vasiliki Bempi
- Department of Public Health, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Irene Lampraki
- Department of Public Health, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Ioanna Tsiligianni
- Health Planning Unit. Department of Social Medicine, Faculty of Medicine, University of Crete, Voutes Campus, Heraklion, GR-71003, Crete, Greece.
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15
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Chen XRC, Leung SH, Li YC. Chronic Obstructive Pulmonary Disease (COPD) management in the community: how could primary care team contribute? BMC FAMILY PRACTICE 2020; 21:184. [PMID: 32900370 PMCID: PMC7487990 DOI: 10.1186/s12875-020-01256-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/31/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a progressive lung disease commonly encountered in primary care. This study aimed to audit COPD care at primary care clinics of Hong Kong and to work out improvement strategies. METHOD All COPD patients aged 40 or above who had been followed up at 13 public primary care clinics of Kowloon Central Cluster (KCC) under the Hospital Authority of Hong Kong (HAHK) were included in this clinic audit. Evidence-based audit criteria and performance standards were established after thorough literature review. Phase 1 was from 1st April 2016 to 31st March 2017, with deficiencies of care identified. It was followed by a one-year implementation phase through which a series of improvement strategies were executed. Outcome of the enhancement was reviewed during Phase 2 from 1st April 2018 to 31st March 2019. Chi-square test and student's t test were used to detect statistically significant changes between Phase 1 and Phase 2. RESULTS A total of 2358 COPD cases were identified in Phase 1 where 658 of them were smokers. Of those smokers, 332 (50.5%) had been referred to Smoking Counselling and Cessation Service (SCCS) and 289 (43.9%) actually attended it. 991 cases (42%) received Seasonal Influenza Vaccine (SIV) and 938 cases (39.8%) received Pneumococcal Vaccine (PCV). 698 patients (29.6%) had spirometry done before and 423 patients (17.9%) had been admitted to hospital due to acute exacerbation of COPD (AECOPD). With the concerted effort taken during the implementation phase, Phase 2 data showed significant improvement in nearly all criteria. There was a marked increase in the SIV and PCV uptake rate, spirometry performance rate and most importantly, a significant reduction in AECOPD rate leading to hospital admission (13.5%, P = 0.000043). However, the referral rate and attendance rate of SCCS among smokers remained stagnant (P > 0.05). CONCLUSION Via a systematic team approach, COPD care at primary care clinics of KCC under HAHK had been significantly improved for most of the audit criteria, which in turn reduced the burden of the healthcare system.
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Affiliation(s)
- X R Catherine Chen
- Department of Family Medicine and General Outpatient Clinics (GOPCs), Kowloon Central Cluster (KCC), Hospital Authority (HA), Kowloon, Hong Kong.
| | - S H Leung
- Department of Family Medicine and General Outpatient Clinics (GOPCs), Kowloon Central Cluster (KCC), Hospital Authority (HA), Kowloon, Hong Kong
| | - Y C Li
- Department of Family Medicine and General Outpatient Clinics (GOPCs), Kowloon Central Cluster (KCC), Hospital Authority (HA), Kowloon, Hong Kong
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16
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Pulmonologists Adherence to the Chronic Obstructive Pulmonary Disease GOLD Guidelines: A Goal to Improve. ACTA ACUST UNITED AC 2020; 56:medicina56090422. [PMID: 32825456 PMCID: PMC7558424 DOI: 10.3390/medicina56090422] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/05/2020] [Accepted: 08/19/2020] [Indexed: 01/09/2023]
Abstract
Background and objectives: Data about pulmonologist adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines showed a great variability and cannot be extrapolated. The present study investigates the current pharmacological prescribing practices in the treatment of chronic obstructive pulmonary disease (COPD) according to the 2017 GOLD guidelines, to determine the level of pulmonologist adherence and to identify possible factors that influence physician adherence. Materials and methods: This retrospective study took place between 1 February and 30 April 2018 in Pneumophtysiology Clinical Hospital Cluj-Napoca. We included 348 stable COPD outpatients classified according to the 2017 GOLD strategy in the ABCD risk groups. Pulmonologist adherence was defined as appropriate if the recommended pharmacological therapy was the first- or alternative-choice drug according to the guidelines, and inappropriate (overtreatment, undertreatment) if it was not in line with these recommendations. Results: The most prescribed treatment was the combination long-acting beta agonist (LABA) + long-acting antimuscarinic agent (LAMA) (34.77%), followed by LAMA + LABA + inhaled corticosteroid (ICS). Overall, pneumologist adherence was 79.02%. The most inappropriate therapies were in Group B (33.57%), followed by 33.33% in Group A. Compared to Groups C and D (analyzed together), Groups A and B had a 4.65 times higher chance (p = 0.0000001) of receiving an inappropriate therapy. Patients with cardiovascular comorbidities had a 1.89 times higher risk of receiving an inappropriate therapy (p = 0.021). ICS overprescription was the most common type of inappropriateness (17.81%). Groups C and D had a 3.12 times higher chance of being prescribed ICS compared to Groups A and B (p = 0.0000004). Conclusions: Pulmonologist adherence to the GOLD guidelines is not optimal and needs to be improved. Among the factors that influence the inappropriateness of COPD treatments, cardiovascular comorbidities and low-risk Groups A and B are important. ICS represent the most prescribed overtreatment. Further multicentric studies are needed to evaluate all factors that might influence the adherence rate.
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17
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Grewe FA, Sievi NA, Bradicich M, Roeder M, Brack T, Brutsche MH, Frey M, Irani S, Leuppi JD, Thurnheer R, Clarenbach CF, Kohler M. Compliance of Pharmacotherapy with GOLD Guidelines: A Longitudinal Study in Patients with COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:627-635. [PMID: 32273691 PMCID: PMC7105357 DOI: 10.2147/copd.s240444] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/10/2020] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate the clinical implementation of pharmacotherapy recommendations for chronic obstructive pulmonary disease (COPD) based on the Global Initiative for chronic obstructive lung disease (GOLD) guidelines, in a longitudinal setting. Methods This is a sub-analysis of a prospective, non-interventional cohort study including patients with confirmed mild-to-very-severe COPD from seven pulmonary outpatient clinics in Switzerland. Follow-up visits took place annually for up to 7 years, from October 2010 until December 2016. For each visit, we evaluated the compliance of the prescribed pharmacotherapy with the concurrently valid GOLD guideline. We investigated whether step-ups or step-downs in GOLD stage or risk-group were accompanied by concordant changes in prescribed medication. Groups were compared via ANOVA. Results Data of 305 patients (62±7 years, 66% men) were analysed. In 59.1% of visits, the prescribed medication conformed to the respective valid GOLD-guideline. Patients with very severe COPD were most likely to receive pharmacotherapy in compliance with guidelines. Step-ups and step-downs in risk group, requiring escalation, or de-escalation of pharmacotherapy, were noticed in 24 and 43 follow-up visits, respectively. Step-ups were adequately implemented in 4 (16.7%) and step-downs in six cases (14.0%). Conclusion The compliance of COPD-pharmacotherapy with GOLD-guidelines is suboptimal, especially in lower risk groups. The high rates of missed out treatment-adjustments suggest that the familiarity of physicians with guidelines leaves room for improvement.
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Affiliation(s)
- Fabian A Grewe
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
| | - Matteo Bradicich
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
| | - Maurice Roeder
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Brack
- Pulmonary Division, Cantonal Hospital of Glarus, Glarus, Switzerland
| | - Martin H Brutsche
- Pulmonary Division, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Martin Frey
- Pulmonary Division, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Sarosh Irani
- Pulmonary Division, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Jörg D Leuppi
- University Department of Medicine, Cantonal Hospital Baselland and University of Basel, Basel, Switzerland
| | - Robert Thurnheer
- Pulmonary Division, Cantonal Hospital of Münsterlingen, Münsterlingen, Switzerland
| | | | - Malcolm Kohler
- Pulmonary Division, University Hospital Zurich, Zurich, Switzerland.,Zurich Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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Duarte-de-Araújo A, Teixeira P, Hespanhol V, Correia-de-Sousa J. COPD: Analysing factors associated with a successful treatment. Pulmonology 2020; 26:66-72. [DOI: 10.1016/j.pulmoe.2019.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/15/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022] Open
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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.
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Ragaišienė G, Kibarskytė R, Gauronskaitė R, Giedraitytė M, Dapšauskaitė A, Kasiulevičius V, Danila E. Diagnosing COPD in primary care: what has real life practice got to do with guidelines? Multidiscip Respir Med 2019; 14:28. [PMID: 31516702 PMCID: PMC6732826 DOI: 10.1186/s40248-019-0191-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/25/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The role of primary care physician in COPD management varies in different health care systems. According to the researches in various countries, extent of spirometry use in diagnosing and grading COPD frequently remains insufficient. Inaccurate diagnosis results in mistreatment and disease progression.The aims of our study were to investigate the accuracy of COPD diagnosis, grading, and treatment according to guidelines in daily practice of primary care. METHODS A retrospective analysis of ambulatory records in a large primary care center was conducted. Digital medical records of current patients were screened for ICD-10-AM codes J44.0, J44.1, J44.8 and J44.9. All medical records starting from the first visit in this primary care center were reviewed. RESULTS Two hundred twenty-eight patients diagnosed with COPD were included in the study, 118 male, mean age 67 yrs. (SD 14). A spirometry report was available to 58% of the patients, 75% of them met the guidelines for COPD diagnosis. The grade was correct for 56.8% of the patients. 54% were consulted by the pulmonologist at least once. After re-analyzing spirometry, correcting the diagnosis, and grading, it was determined that only 70% of the patients were receiving appropriate treatments. Sixteen per cent of patients were undertreated and 14% were overtreated. CONCLUSIONS COPD care in primary practice remains suboptimal. Incorrect approach often leads to incorrect grading and mistreatment. Points for improvement should be identified in further studies.
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Affiliation(s)
- Greta Ragaišienė
- Clinic of Internal Diseases, Family Medicine and Oncology of Vilnius University, Santariškių st. 2, Vilnius, Lithuania
- Center of Family Medicine of Vilnius University Hospital Santaros Klinikos, Taikos st, 104-52, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21/27, Vilnius, Lithuania
| | - Rūta Kibarskytė
- Clinic of Chest Diseases and Allergology of Vilnius University, Vilnius, Lithuania
- Center of Pulmonology and Allergology of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21/27, Vilnius, Lithuania
| | - Rasa Gauronskaitė
- Clinic of Chest Diseases and Allergology of Vilnius University, Vilnius, Lithuania
- Center of Pulmonology and Allergology of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21/27, Vilnius, Lithuania
| | - Monika Giedraitytė
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21/27, Vilnius, Lithuania
| | - Agnė Dapšauskaitė
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21/27, Vilnius, Lithuania
| | - Vytautas Kasiulevičius
- Clinic of Internal Diseases, Family Medicine and Oncology of Vilnius University, Santariškių st. 2, Vilnius, Lithuania
- Center of Family Medicine of Vilnius University Hospital Santaros Klinikos, Taikos st, 104-52, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21/27, Vilnius, Lithuania
| | - Edvardas Danila
- Clinic of Chest Diseases and Allergology of Vilnius University, Vilnius, Lithuania
- Center of Pulmonology and Allergology of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio st. 21/27, Vilnius, Lithuania
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21
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Epstein D, Barak-Corren Y, Isenberg Y, Berger G. Clinical Decision Support System: A Pragmatic Tool to Improve Acute Exacerbation of COPD Discharge Recommendations. COPD 2019; 16:18-24. [DOI: 10.1080/15412555.2019.1593342] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Danny Epstein
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel
| | - Yuval Barak-Corren
- Predictive Medicine Group, Boston Children’s Hospital, Boston, MA, USA
- Shaare Tzedek Medical Center, Jerusalem, Israel
| | - Yoni Isenberg
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel
| | - Gidon Berger
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel
- Division of Pulmonary Medicine, Rambam Health Care Campus, Haifa, Israel
- The Rappaport's Faculty of Medicine, The Technion Institute, Haifa, Israel
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22
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Ghosh S, Anderson WH, Putcha N, Han MK, Curtis JL, Criner GJ, Dransfield MT, Barr RG, Krishnan JA, Lazarus SC, Cooper CB, Paine R, Peters SP, Hansel NN, Martinez FJ, Drummond MB. Alignment of Inhaled Chronic Obstructive Pulmonary Disease Therapies with Published Strategies. Analysis of the Global Initiative for Chronic Obstructive Lung Disease Recommendations in SPIROMICS. Ann Am Thorac Soc 2019; 16:200-208. [PMID: 30216731 PMCID: PMC6376942 DOI: 10.1513/annalsats.201804-283oc] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 09/12/2018] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Despite awareness of chronic obstructive pulmonary disease (COPD) treatment recommendations, uptake is poor. The Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) spans 2010-2016, providing an opportunity to assess integration of 2011 Global Initiative for Obstructive Lung Disease (GOLD) treatment strategies over time in a large observational cohort study. OBJECTIVES To evaluate how COPD treatment aligns with 2011 GOLD strategies and determine factors associated with failure to align with recommendations. METHODS Information on inhaled medication use collected via questionnaire annually for 4 years was compiled into therapeutic classes (long-acting antimuscarinic agent, long-acting β-agonist, inhaled corticosteroids [ICS], and combinations thereof). Medications were not modified by SPIROMICS investigators. 2011 GOLD COPD categories A, B, C, and D were assigned. Alignment of inhaler regimen with first-/second-line GOLD recommendations was determined, stratifying into recommendation aligned or nonaligned. Recommendation-nonaligned participants were further stratified into overuse and underuse categories. RESULTS Of 1,721 participants with COPD, at baseline, 52% of regimens aligned with GOLD recommendations. Among participants with nonaligned regimens, 46% reported underuse, predominately owing to lack of long-acting inhalers in GOLD category D. Of the 54% reporting overuse, 95% were treated with nonindicated ICS-containing regimens. Among 431 participants with 4 years of follow-up data, recommendation alignment did not change over time. When we compared 2011 and 2017 recommendations, we found that 47% did not align with either set of recommendations, whereas 35% were in alignment with both recommendations. CONCLUSIONS Among SPIROMICS participants with COPD, nearly 50% reported inhaler regimens that did not align with GOLD recommendations. Nonalignment was driven largely by overuse of ICS regimens in milder disease and lack of long-acting inhalers in severe disease.
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Affiliation(s)
- Sohini Ghosh
- 1 Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, and
| | - Wayne H Anderson
- 2 Marsico Lung Institute/Cystic Fibrosis Research Center, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nirupama Putcha
- 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Meilan K Han
- 4 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Jeffrey L Curtis
- 4 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Gerard J Criner
- 5 Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Mark T Dransfield
- 6 Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - R Graham Barr
- 7 Department of Medicine, Columbia University Medical Center, New York, New York
| | - Jerry A Krishnan
- 8 Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois, Chicago, Illinois
| | - Stephen C Lazarus
- 9 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Christopher B Cooper
- 10 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Robert Paine
- 11 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Stephen P Peters
- 12 Department of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest Baptist Health, Winston Salem, North Carolina; and
| | - Nadia N Hansel
- 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Fernando J Martinez
- 13 Department of Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - M Bradley Drummond
- 1 Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, and
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23
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Kim TO, Shin HJ, Kim YI, Rhee CK, Lee WY, Lim SY, Ra SW, Jung KS, Yoo KH, Park SJ, Lim SC. Adherence to the GOLD Guideline in COPD Management of South Korea: Findings from KOCOSS Study 2011-2018. Chonnam Med J 2019; 55:47-53. [PMID: 30740340 PMCID: PMC6351324 DOI: 10.4068/cmj.2019.55.1.47] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 01/28/2023] Open
Abstract
The guidelines for chronic obstructive pulmonary disease (COPD) treatment are important for the management of the disease. However, studies regarding the treatment adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines have been scarce in Korea. Therefore, to examine the adherence to the GOLD guidelines, we examined the patterns of prescribed medication in COPD patients from 2011 to 2018. Patients were classified as having been appropriately and inappropriately treated (overtreatment or undertreatment) for the GOLD group. Appropriate medical therapy was defined as using the first choice or alternative choice drug recommended in the GOLD guidelines. Inappropriate therapy was classified as overtreatment or undertreatment in accordance with the categorization in the GOLD guidelines. According to treatment of 2011 GOLD guidelines, there was inappropriate treatment in 52.3% in group A, 47.3% in group B, 56.3% in group C, and 17.8% in group D. According to treatment of 2017 GOLD guidelines, there was inappropriate treatment in 66.7% in group A, 45.3% in group B, 14.3% in group C, and 24.0% in group D. The common type of inappropriate COPD treatment is overtreatment, with inhaled corticosteroid (ICS) containing regimens. In conclusions, adherence to the GOLD guideline by the pulmonologist in clinical practice is still low in Korea. Therefore, we need better strategies to both optimize the use of the guidelines and adhere to the guidelines as well.
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Affiliation(s)
- Tae-Ok Kim
- Division of Pulmonary Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hong-Joon Shin
- Division of Pulmonary Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Yu-Il Kim
- Division of Pulmonary Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Chin-Kook Rhee
- Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Won-Yeon Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seong-Yong Lim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Won Ra
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and the Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Suck Jung
- Division of Pulmonary Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical School, Anyang, Korea
| | - Kwang-Ha Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Seoung-Ju Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Sung-Chul Lim
- Division of Pulmonary Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
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24
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Palmiotti GA, Lacedonia D, Liotino V, Schino P, Satriano F, Di Napoli PL, Sabato E, Mastrosimone V, Scoditti A, Carone M, Costantino E, Resta E, Attolini E, Foschino Barbaro MP. Adherence to GOLD guidelines in real-life COPD management in the Puglia region of Italy. Int J Chron Obstruct Pulmon Dis 2018; 13:2455-2462. [PMID: 30147311 PMCID: PMC6101739 DOI: 10.2147/copd.s157779] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background COPD is a disease associated with significant economic burden. It was reported that Global initiative for chronic Obstructive Lung Disease (GOLD) guideline-oriented pharmacotherapy improves airflow limitation and reduces health care costs. However, several studies showed a significant dissociation between international recommendations and clinicians’ practices. The consequent reduced diagnostic and therapeutic inappropriateness has proved to be associated with an increase in costs and a waste of economic resources in the health sector. The aim of the study was to evaluate COPD management in the Puglia region. The study was performed in collaboration with the pulmonology centers and the Regional Health Agency (AReS Puglia). Methods An IT platform allowed the pulmonologists to enter data via the Internet. All COPD patients who visited a pneumological outpatient clinic for the first time or for regular follow-ups or were admitted to a pneumological department for an exacerbation were considered eligible for the study. COPD’s diagnosis was confirmed by a pulmonologist at the moment of the visit. The project lasted 18 months and involved 17 centers located in the Puglia region. Results Six hundred ninety-three patients were enrolled, evenly distributed throughout the region. The mean age was 71±9 years, and 85% of them were males. Approximately 23% were current smokers, 63% former smokers and 13.5% never smokers. The mean post-bronchodilator forced expiratory volume in 1 second was 59%±20% predicted. The platform allowed the classification of patients according to the GOLD guidelines (Group A: 20.6%, Group B: 32.3%, Group C: 5.9% and Group D: 39.2%), assessed the presence and severity of exacerbations (20% of the patients had an exacerbation defined as mild [13%], moderate [37%] and severe [49%]) and evaluated the appropriateness of inhalation therapy at the time of the visit. Forty-nine percent of Group A patients were following inappropriate therapy; in Group B, 45.8% were following a therapy in contrast with the guidelines. Among Group C patients, 41.46% resulted in triple combination therapy, whilê14% of Group D patients did not have a therapy or were following an inappropriate therapy. In conclusion, 30% of all patients evaluated had been following an inadequate therapy. Subsequently, an online survey was developed to inquire about the reasons for the results obtained. In particular, we investigated the reasons why 30% of our population did not follow the therapy suggested by the GOLD guidelines: 1) why was there an excessive use of inhaled corticosteroids, 2) why a significantly high percentage was inappropriately treated with triple therapy and 3) why a consistent percentage (11%) of Group D patients were not treated at all. Conclusion The data provides an overview on the management of COPD in the region of Puglia (Italy) and represents a resource in order to improve appropriateness and reduce the waste of health resources.
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Affiliation(s)
- Giuseppe Antonio Palmiotti
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy,
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy,
| | - Vito Liotino
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Diseases, School of Medicine, University of Bari, Bari, Italy
| | - Pietro Schino
- Physiopathology Respiratory Unit, F Miulli General Hospital, Acquaviva delle Fonti, Bari, Italy
| | | | - Pier Luigi Di Napoli
- Physiopathology Respiratory Unit, F Miulli General Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Eugenio Sabato
- UOC of Pneumology, "N Melli" Hospital, San Pietro Vernotico, Italy
| | - Vincenzo Mastrosimone
- Division of Pulmonary Disease, Medical Center of Rehabilitation, Foundation Salvatore Maugeri, IRCCS, Marina di Ginosa, Italy
| | - Alfredo Scoditti
- Department of Respiratory Diseases, San Camillo Clinic, Taranto, Italy
| | - Mauro Carone
- Division of Pulmonary Disease, Medical Center of Rehabilitation, Foundation Salvatore Maugeri, IRCCS, Cassano delle Murge, Italy
| | - Elio Costantino
- UOC of Pneumology, Hospital "Madonna delle Grazie", Matera, Italy
| | - Emanuela Resta
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Diseases, School of Medicine, University of Bari, Bari, Italy
| | | | - Maria Pia Foschino Barbaro
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy,
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Chan HS, Ko FWS, Chan JWM, So LKY, Lam DCL, Chan VL, Tam CY, Yu WC. Comorbidities, mortality, and management of chronic obstructive pulmonary disease patients who required admissions to public hospitals in Hong Kong - computerized data collection and analysis. Int J Chron Obstruct Pulmon Dis 2018; 13:1913-1925. [PMID: 29942124 PMCID: PMC6005303 DOI: 10.2147/copd.s163659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background COPD is a common cause for hospital admission. Conventional studies of the epidemiology of COPD involved large patient number and immense resources and were difficult to be repeated. The present study aimed at assessing the utilization of a computerized data management system in the collection and analysis of the epidemiological and clinical data of a large COPD cohort in Hong Kong (HK). Patients and methods It was a computerized, multicenter, retrospective review of the characteristics of patients discharged from medical departments of the 16 participating hospitals with the primary discharge diagnosis of COPD in 1 year (2012). Comparison was made between the different subgroups in the use of medications, ventilatory support, and other health care resources. The mortality of the subjects in different subgroups was traced up to December 31, 2014. The top 10 causes of death were analyzed. Results In total, 9,776 subjects (82.6% men, mean age = 78 years) were identified. Of the 1,918 subjects with lung function coding, 85 (4.4%), 488 (25.5%), 808 (42.1%), and 537 (28.0%) subjects had the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1, 2, 3, and 4 classes, respectively. Patients with higher GOLD classes had higher number of hospital admissions, longer hospital stay, increased usage of noninvasive mechanical ventilation (NIV), combinations of long-acting bronchodilators, and higher mortality. Of the 9,776 subjects, 2,278 (23.3%) received NIV, but invasive mechanical ventilation was uncommon (134 of 9,776 subjects [1.4%]); 4,427 (45.3%) subjects had died by the end of 2014. The top causes of death were COPD, pneumonia, lung cancer, and other malignancies. Conclusion Patients admitted to hospitals for COPD in HK had significant comorbidities, mortality, and imposed heavy burden on health care resources. It is possible to collect and analyze data of a large COPD cohort through a computerized system. Suboptimal coding of lung function results was observed, and underutilization of long-acting bronchodilators was common.
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Affiliation(s)
- Hok Sum Chan
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital
| | - Fanny Wai San Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | | | | | | | | | - Cheuk Yin Tam
- Department of Medicine and Geriatrics, Tuen Mun Hospital
| | - Wai Cho Yu
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
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