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Health care utilization history, GOLD guidelines, and respiratory medication prescriptions in patients with COPD.

Seaman J, Leonard AC, Panos RJ - Int J Chron Obstruct Pulmon Dis (2010)

Bottom Line: Prescribed treatments were compared with the GOLD guidelines and each patient was classified as receiving less medications than recommended in the guidelines (<G), medications according to the guidelines (=G), or more medications than recommended (>G).For GOLD stages 1 and 2, <G patients had the fewest and >G patients the most prior respiratory encounters during a 12 month period (0.31 +/- 0.073 (0.21, 0.47), 0.75 +/- 0.5 (0.37, 1.5), 1.1 +/- 0.27 (0.74, 1.6) visits/person/year, <G, =G, >G, respectively, mean + standard error of mean (SEM) (95% confidence limits) 2 degrees of freedom (df) ANOVA P < 0.001 for prescription effect).For GOLD stages 3 and 4, <G was associated with significantly fewer prior respiratory visits than was =G (0.78 +/- 0.11 (0.6, 1.0) and 2.4 +/- 0.47 (1.9, 3.1) visits/person/year, respectively, P < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Pulmonary, Critical Care, and Sleep Division, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA.

ABSTRACT

Background: The relationship between prior health care utilization and respiratory medication prescriptions in an unselected population of patients with COPD is not known.

Methods: We determined the prescribed respiratory medications and respiratory and nonrespiratory health care encounters in 523 Veterans with COPD at the Cincinnati Veterans Affairs Medical Center between 2000 and 2005. Prescribed treatments were compared with the GOLD guidelines and each patient was classified as receiving less medications than recommended in the guidelines (G).

Results: Respiratory medications were G for 14% of the patients studied. For GOLD stages 1 and 2, G patients the most prior respiratory encounters during a 12 month period (0.31 +/- 0.073 (0.21, 0.47), 0.75 +/- 0.5 (0.37, 1.5), 1.1 +/- 0.27 (0.74, 1.6) visits/person/year, G, respectively, mean + standard error of mean (SEM) (95% confidence limits) 2 degrees of freedom (df) ANOVA P < 0.001 for prescription effect). For GOLD stages 3 and 4, G respectively, 2 df ANOVA P = 0.096) or for GOLD stages 3 and 4 (3.6 +/- 0.25 (3.2, 4.1) and 4.0 +/- 0.44 (3.3, 4.9) visits/person/year,

Conclusions: Respiratory medications prescribed for an unselected population with a broad range of COPD severity complied poorly with the GOLD pharmacologic treatment guidelines but correlated with the number of prior respiratory health care visits.

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Related in: MedlinePlus

Flow diagram for inclusion and exclusion of study patients.Note: The diagnosis of COPD was defined by ICD-9 codes, 491.XX (Chronic Bronchitis), 492.XX (Emphysema) and 496.XX (Chronic Obstructive Lung Disease).
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f1-copd-5-089: Flow diagram for inclusion and exclusion of study patients.Note: The diagnosis of COPD was defined by ICD-9 codes, 491.XX (Chronic Bronchitis), 492.XX (Emphysema) and 496.XX (Chronic Obstructive Lung Disease).

Mentions: We reviewed, retrospectively, the medical records of all patients at the Cincinnati Veterans Administration Medical Center (VAMC) with a diagnosis of COPD between June 1, 2000 and June 1, 2005 (Figure 1). To ensure that all participants were followed actively, individuals who did not have at least one health care encounter in the 12 months prior to the study were excluded (n = 189, Figure 1). Prescribed therapeutic regimens compared with GOLD treatment guidelines are presented in Figure 1. All spirometry was performed in the Cincinnati VAMC Pulmonary Function Laboratory according to American Thoracic Society (ATS) guidelines. For 131 patients, the forced expiratory volume in 1 second (FEV1) divided by the forced vital capacity (FVC), FEV1/FVC, was ≥0.70 and they were classified as clinical COPD (former GOLD stage 0).5 The remaining 392 patients were classified into 4 stages (modified GOLD 1, modified GOLD 2, modified GOLD 3, modified GOLD 4) defined by the GOLD guidelines based upon prebronchodilator spirometry.5


Health care utilization history, GOLD guidelines, and respiratory medication prescriptions in patients with COPD.

Seaman J, Leonard AC, Panos RJ - Int J Chron Obstruct Pulmon Dis (2010)

Flow diagram for inclusion and exclusion of study patients.Note: The diagnosis of COPD was defined by ICD-9 codes, 491.XX (Chronic Bronchitis), 492.XX (Emphysema) and 496.XX (Chronic Obstructive Lung Disease).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2865029&req=5

f1-copd-5-089: Flow diagram for inclusion and exclusion of study patients.Note: The diagnosis of COPD was defined by ICD-9 codes, 491.XX (Chronic Bronchitis), 492.XX (Emphysema) and 496.XX (Chronic Obstructive Lung Disease).
Mentions: We reviewed, retrospectively, the medical records of all patients at the Cincinnati Veterans Administration Medical Center (VAMC) with a diagnosis of COPD between June 1, 2000 and June 1, 2005 (Figure 1). To ensure that all participants were followed actively, individuals who did not have at least one health care encounter in the 12 months prior to the study were excluded (n = 189, Figure 1). Prescribed therapeutic regimens compared with GOLD treatment guidelines are presented in Figure 1. All spirometry was performed in the Cincinnati VAMC Pulmonary Function Laboratory according to American Thoracic Society (ATS) guidelines. For 131 patients, the forced expiratory volume in 1 second (FEV1) divided by the forced vital capacity (FVC), FEV1/FVC, was ≥0.70 and they were classified as clinical COPD (former GOLD stage 0).5 The remaining 392 patients were classified into 4 stages (modified GOLD 1, modified GOLD 2, modified GOLD 3, modified GOLD 4) defined by the GOLD guidelines based upon prebronchodilator spirometry.5

Bottom Line: Prescribed treatments were compared with the GOLD guidelines and each patient was classified as receiving less medications than recommended in the guidelines (<G), medications according to the guidelines (=G), or more medications than recommended (>G).For GOLD stages 1 and 2, <G patients had the fewest and >G patients the most prior respiratory encounters during a 12 month period (0.31 +/- 0.073 (0.21, 0.47), 0.75 +/- 0.5 (0.37, 1.5), 1.1 +/- 0.27 (0.74, 1.6) visits/person/year, <G, =G, >G, respectively, mean + standard error of mean (SEM) (95% confidence limits) 2 degrees of freedom (df) ANOVA P < 0.001 for prescription effect).For GOLD stages 3 and 4, <G was associated with significantly fewer prior respiratory visits than was =G (0.78 +/- 0.11 (0.6, 1.0) and 2.4 +/- 0.47 (1.9, 3.1) visits/person/year, respectively, P < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Pulmonary, Critical Care, and Sleep Division, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA.

ABSTRACT

Background: The relationship between prior health care utilization and respiratory medication prescriptions in an unselected population of patients with COPD is not known.

Methods: We determined the prescribed respiratory medications and respiratory and nonrespiratory health care encounters in 523 Veterans with COPD at the Cincinnati Veterans Affairs Medical Center between 2000 and 2005. Prescribed treatments were compared with the GOLD guidelines and each patient was classified as receiving less medications than recommended in the guidelines (G).

Results: Respiratory medications were G for 14% of the patients studied. For GOLD stages 1 and 2, G patients the most prior respiratory encounters during a 12 month period (0.31 +/- 0.073 (0.21, 0.47), 0.75 +/- 0.5 (0.37, 1.5), 1.1 +/- 0.27 (0.74, 1.6) visits/person/year, G, respectively, mean + standard error of mean (SEM) (95% confidence limits) 2 degrees of freedom (df) ANOVA P < 0.001 for prescription effect). For GOLD stages 3 and 4, G respectively, 2 df ANOVA P = 0.096) or for GOLD stages 3 and 4 (3.6 +/- 0.25 (3.2, 4.1) and 4.0 +/- 0.44 (3.3, 4.9) visits/person/year,

Conclusions: Respiratory medications prescribed for an unselected population with a broad range of COPD severity complied poorly with the GOLD pharmacologic treatment guidelines but correlated with the number of prior respiratory health care visits.

Show MeSH
Related in: MedlinePlus