Complexity of medication use in newly diagnosed chronic obstructive pulmonary disease patients

Caitlyn T. Solem; Todd A. Lee; Min J. Joo; Bruce L. Lambert; Surrey M. Walton; A. Simon Pickard

doi:10.1016/j.amjopharm.2011.12.003

Complexity of medication use in newly diagnosed chronic obstructive pulmonary disease patients

Caitlyn T. Solem, Todd A. Lee, Min J. Joo, Bruce L. Lambert, Surrey M. Walton, A. Simon Pickard^*

^*Corresponding author for this work

Communication Studies

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

Background: To better understand how medications have been used and the complexity of regimens used to treat patients, we characterized patterns of medication use and the degree to which patients used different classes of medications in combination and over time in a cohort of newly diagnosed chronic obstructive pulmonary disease (COPD) patients. Objective: The objectives of this study were to characterize patterns of medication use, including the degree to which patients used different classes of medications in combination and over time within a cohort of newly diagnosed COPD patients and to identify the proportion of patients who had gaps in filling their prescriptions. Methods: We identified a cohort of patients from the Veterans Affairs health care system with newly diagnosed COPD between 1999 and 2003. Using prescription fill information, we quantified the prevalence and incidence of exposure to short-acting β-agonists (SABAs), long-acting β-agonists (LABAs), short-acting anticholinergics (eg, ipratropium [IPRA]), and inhaled corticosteroids (ICSs) over 1 year. We additionally characterized the sequencing of medication addition and discontinuation and gaps between prescription fills. The prevalence of multiple respiratory medication use was summarized at 90, 180, and 365 days of follow-up. Results: Of 133,737 patients with newly diagnosed COPD, the majority (80.0%) used a SABA, followed by 40.0% using IPRA, 33.2% using an ICS and 16.0% using a LABA during the 1-year follow-up. Medication changes were frequent, with 57.7% of patients having a medication addition and 48.6% discontinuing medication. The sequence of medication changes varied greatly across patients. Multiple respiratory medication use was common, with 29% of patients dispensed 3 to 4 medication classes in 1 year. Conclusions: Many COPD patients who are started on medication management undergo changes in prescribed pharmacotherapy and are taking multiple medications. Despite clinical practice guidelines, there is an ad hoc nature of COPD medication management, and such heterogeneity challenges the ability to estimate relationships between drug exposure and outcomes using real-world data.

Original language	English (US)
Pages (from-to)	110-122.e1
Journal	American Journal Geriatric Pharmacotherapy
Volume	10
Issue number	2
DOIs	https://doi.org/10.1016/j.amjopharm.2011.12.003
State	Published - Apr 2012

Funding

Dr. Solem currently works as a consultant at Pharmerit International, which undertakes work for multiple pharmaceutical companies, but completed all data analysis before her employment by Pharmerit. This research and Drs. Lee, Lambert, Walton, and Pickard were financially supported by Novartis Pharmaceuticals Corporation through an investigator-initiated research program. The study sponsors were not involved in the study design, collection, analysis, or interpretation of data and did not place any limitations on submitting the manuscript. The authors have indicated that they have no other conflicts of interest regarding the content of this article. This research and Drs. Lee, Lambert, Walton, and Pickard were financially supported by Novartis Pharmaceuticals Corporation through an investigator initiated research program. Dr. Solem was a Dean's Scholar at the University of Illinois at Chicago and was also supported by a fellowship in Health Economics and Outcomes Research, sponsored by NovoNordisk and University of Illinois at Chicago, at the time that this research was undertaken.

Keywords

COPD
medication exposure
pharmacoepidemiology
pharmacotherapy

ASJC Scopus subject areas

Geriatrics and Gerontology
Pharmacology (medical)

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10.1016/j.amjopharm.2011.12.003

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title = "Complexity of medication use in newly diagnosed chronic obstructive pulmonary disease patients",

abstract = "Background: To better understand how medications have been used and the complexity of regimens used to treat patients, we characterized patterns of medication use and the degree to which patients used different classes of medications in combination and over time in a cohort of newly diagnosed chronic obstructive pulmonary disease (COPD) patients. Objective: The objectives of this study were to characterize patterns of medication use, including the degree to which patients used different classes of medications in combination and over time within a cohort of newly diagnosed COPD patients and to identify the proportion of patients who had gaps in filling their prescriptions. Methods: We identified a cohort of patients from the Veterans Affairs health care system with newly diagnosed COPD between 1999 and 2003. Using prescription fill information, we quantified the prevalence and incidence of exposure to short-acting β-agonists (SABAs), long-acting β-agonists (LABAs), short-acting anticholinergics (eg, ipratropium [IPRA]), and inhaled corticosteroids (ICSs) over 1 year. We additionally characterized the sequencing of medication addition and discontinuation and gaps between prescription fills. The prevalence of multiple respiratory medication use was summarized at 90, 180, and 365 days of follow-up. Results: Of 133,737 patients with newly diagnosed COPD, the majority (80.0%) used a SABA, followed by 40.0% using IPRA, 33.2% using an ICS and 16.0% using a LABA during the 1-year follow-up. Medication changes were frequent, with 57.7% of patients having a medication addition and 48.6% discontinuing medication. The sequence of medication changes varied greatly across patients. Multiple respiratory medication use was common, with 29% of patients dispensed 3 to 4 medication classes in 1 year. Conclusions: Many COPD patients who are started on medication management undergo changes in prescribed pharmacotherapy and are taking multiple medications. Despite clinical practice guidelines, there is an ad hoc nature of COPD medication management, and such heterogeneity challenges the ability to estimate relationships between drug exposure and outcomes using real-world data.",

keywords = "COPD, medication exposure, pharmacoepidemiology, pharmacotherapy",

author = "Solem, {Caitlyn T.} and Lee, {Todd A.} and Joo, {Min J.} and Lambert, {Bruce L.} and Walton, {Surrey M.} and Pickard, {A. Simon}",

note = "Funding Information: Dr. Solem currently works as a consultant at Pharmerit International, which undertakes work for multiple pharmaceutical companies, but completed all data analysis before her employment by Pharmerit. This research and Drs. Lee, Lambert, Walton, and Pickard were financially supported by Novartis Pharmaceuticals Corporation through an investigator-initiated research program. The study sponsors were not involved in the study design, collection, analysis, or interpretation of data and did not place any limitations on submitting the manuscript. The authors have indicated that they have no other conflicts of interest regarding the content of this article. Funding Information: This research and Drs. Lee, Lambert, Walton, and Pickard were financially supported by Novartis Pharmaceuticals Corporation through an investigator initiated research program. Dr. Solem was a Dean's Scholar at the University of Illinois at Chicago and was also supported by a fellowship in Health Economics and Outcomes Research, sponsored by NovoNordisk and University of Illinois at Chicago, at the time that this research was undertaken. ",

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AU - Solem, Caitlyn T.

AU - Lee, Todd A.

AU - Joo, Min J.

AU - Lambert, Bruce L.

AU - Walton, Surrey M.

AU - Pickard, A. Simon

N1 - Funding Information: Dr. Solem currently works as a consultant at Pharmerit International, which undertakes work for multiple pharmaceutical companies, but completed all data analysis before her employment by Pharmerit. This research and Drs. Lee, Lambert, Walton, and Pickard were financially supported by Novartis Pharmaceuticals Corporation through an investigator-initiated research program. The study sponsors were not involved in the study design, collection, analysis, or interpretation of data and did not place any limitations on submitting the manuscript. The authors have indicated that they have no other conflicts of interest regarding the content of this article. Funding Information: This research and Drs. Lee, Lambert, Walton, and Pickard were financially supported by Novartis Pharmaceuticals Corporation through an investigator initiated research program. Dr. Solem was a Dean's Scholar at the University of Illinois at Chicago and was also supported by a fellowship in Health Economics and Outcomes Research, sponsored by NovoNordisk and University of Illinois at Chicago, at the time that this research was undertaken.

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N2 - Background: To better understand how medications have been used and the complexity of regimens used to treat patients, we characterized patterns of medication use and the degree to which patients used different classes of medications in combination and over time in a cohort of newly diagnosed chronic obstructive pulmonary disease (COPD) patients. Objective: The objectives of this study were to characterize patterns of medication use, including the degree to which patients used different classes of medications in combination and over time within a cohort of newly diagnosed COPD patients and to identify the proportion of patients who had gaps in filling their prescriptions. Methods: We identified a cohort of patients from the Veterans Affairs health care system with newly diagnosed COPD between 1999 and 2003. Using prescription fill information, we quantified the prevalence and incidence of exposure to short-acting β-agonists (SABAs), long-acting β-agonists (LABAs), short-acting anticholinergics (eg, ipratropium [IPRA]), and inhaled corticosteroids (ICSs) over 1 year. We additionally characterized the sequencing of medication addition and discontinuation and gaps between prescription fills. The prevalence of multiple respiratory medication use was summarized at 90, 180, and 365 days of follow-up. Results: Of 133,737 patients with newly diagnosed COPD, the majority (80.0%) used a SABA, followed by 40.0% using IPRA, 33.2% using an ICS and 16.0% using a LABA during the 1-year follow-up. Medication changes were frequent, with 57.7% of patients having a medication addition and 48.6% discontinuing medication. The sequence of medication changes varied greatly across patients. Multiple respiratory medication use was common, with 29% of patients dispensed 3 to 4 medication classes in 1 year. Conclusions: Many COPD patients who are started on medication management undergo changes in prescribed pharmacotherapy and are taking multiple medications. Despite clinical practice guidelines, there is an ad hoc nature of COPD medication management, and such heterogeneity challenges the ability to estimate relationships between drug exposure and outcomes using real-world data.

AB - Background: To better understand how medications have been used and the complexity of regimens used to treat patients, we characterized patterns of medication use and the degree to which patients used different classes of medications in combination and over time in a cohort of newly diagnosed chronic obstructive pulmonary disease (COPD) patients. Objective: The objectives of this study were to characterize patterns of medication use, including the degree to which patients used different classes of medications in combination and over time within a cohort of newly diagnosed COPD patients and to identify the proportion of patients who had gaps in filling their prescriptions. Methods: We identified a cohort of patients from the Veterans Affairs health care system with newly diagnosed COPD between 1999 and 2003. Using prescription fill information, we quantified the prevalence and incidence of exposure to short-acting β-agonists (SABAs), long-acting β-agonists (LABAs), short-acting anticholinergics (eg, ipratropium [IPRA]), and inhaled corticosteroids (ICSs) over 1 year. We additionally characterized the sequencing of medication addition and discontinuation and gaps between prescription fills. The prevalence of multiple respiratory medication use was summarized at 90, 180, and 365 days of follow-up. Results: Of 133,737 patients with newly diagnosed COPD, the majority (80.0%) used a SABA, followed by 40.0% using IPRA, 33.2% using an ICS and 16.0% using a LABA during the 1-year follow-up. Medication changes were frequent, with 57.7% of patients having a medication addition and 48.6% discontinuing medication. The sequence of medication changes varied greatly across patients. Multiple respiratory medication use was common, with 29% of patients dispensed 3 to 4 medication classes in 1 year. Conclusions: Many COPD patients who are started on medication management undergo changes in prescribed pharmacotherapy and are taking multiple medications. Despite clinical practice guidelines, there is an ad hoc nature of COPD medication management, and such heterogeneity challenges the ability to estimate relationships between drug exposure and outcomes using real-world data.

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KW - pharmacoepidemiology

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Complexity of medication use in newly diagnosed chronic obstructive pulmonary disease patients

Abstract

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