Disease Management Opportunities for Chronic Obstructive Pulmonary Disease: Gaps Between Guidelines and Current Practice

Abstract

Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition with broad economic impacts. It presents a major opportunity for healthcare cost reduction and improved functional status. This study measures the gaps between current treatment practices and recently issued guidelines, and identifies the primary opportunities for COPD disease management. COPD patients (n 5 1,036) were initially identified using pharmacy claims data on outpatient respiratory medication use. Through a health assessment survey, they confirmed their diagnosis and reported on their medical resource use, vaccinations, smoking, and healthrelated quality of life (QOL). Drug utilization was measured using a 12-month retrospective review of prescription claims. Patients were stratified by severity level based on QOL scores. A large subset of patients (25.7%) did not use inhaled bronchodilators, the preferred first-line therapy in COPD guidelines; instead, these patients used oral bronchodilators (8.1%) or no bronchodilator at all (17.6%). Inhaled corticosteroids (ICSs) were used by 54.8% of patients. Many patients had not received an influenza vaccination during the previous year (20.7%) or a pneumococcal vaccination during their lifetime (28.3%). Some patients continue to smoke on a regular basis (11.8%). A majority of patients reported that they do not feel knowledgeable about their disease (52.2%) or therapy (53.2%). In summary, significant gaps exist between COPD treatment guidelines and clinical practice, including underuse of inhaled bronchodilators, extensive use of ICSs, and underuse of vaccinations. To reduce the condition's clinical and economic impacts, COPD disease management programs need to target four key areas: pharmacotherapy, vaccination rates, smoking cessation, and patient education. 143

Treatment patterns of chronic obstructive pulmonary disease in employed adults in the United States

“…Untreated rates from prior studies range from 12% to 71%. 7 , 8 , 12 The wide range is due to differences in the definition of treatment, with studies reporting low rates usually including reliever medications such as SABAs in their definitions. Make et al used a definition similar to our study, and they found that 66% of older patients and 59% of younger patients went untreated between 2004 and 2005.…”

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

“…In this study, 1 in 4 patients initiated maintenance therapy with AC, ICS+LABA, ICS monotherapy, or LABA monotherapy following a moderate COPD exacerbation. Most studies evaluating drug therapy rates in the COPD population have included use of SABAs across all severity levels, precluding a comparison with our study [ 12 , 13 ]. However, a recent study by Fitch et al evaluated drug therapy patterns by severity levels using a claims-based algorithm, and found that 26% of patients with moderate COPD in a commercially insured population were prescribed a long-acting bronchodilator [ 8 ].…”

The Quality of Obstructive Lung Disease Care for Adults in the United States as Measured by Adherence to Recommended Processes

“…Most studies have assessed a particular aspect of COPD or asthma care, [13][14][15] evaluated a small number of indicators of quality in a small geographic area, 16 -18 evaluated persons with a particular type of insurance coverage or relied on administrative data sets, 14,19 -26 relied on provider or patient self-report or survey, [27][28][29][30] or focused on quality improvement with a pre-post design. 29 -31 The studies 14,19,22,29,[32][33] that explored the process of health care delivered by providers mostly relied on administrative databases.…”