Changes in initial COPD treatment choice over time and factors influencing prescribing decisions in UK primary care: a real-world study

Kevin Gruffydd-Jones, Guy Brusselle, Rupert Jones, Marc Miravitlles, Michael Baldwin, Rebecca Stewart, Anna Rigazio, Emily Davis, Dorothy L. Keininger, David Price

Research output: Contribution to journalReview article

13 Citations (Scopus)
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Abstract

Prescribing patterns in chronic obstructive pulmonary disease (COPD) are often inconsistent with published guidelines. This retrospective, observational study utilised data from the Optimum Patient Care Research Database to examine the changes in COPD prescribing patterns over time and to identify predictors of physician treatment choice for patients newly diagnosed with COPD. Initial therapy was defined as the treatment(s) prescribed at or within 1 year before COPD diagnosis. Changes over time were assessed in three cohorts based on the date of diagnosis: (1) 1997-2001; (2) 2002-2006; and (3) 2007-2010. Factors affecting the odds of being prescribed any initial therapy or any initial maintenance therapy were identified by univariable and multivariable logistic regression. The analysis included 20,154 patients, 45% of whom were prescribed an initial regimen containing an inhaled corticosteroid (ICS), whereas 28% received no initial pharmacological treatment. Prescribing of ICS monotherapy decreased over time, as did the proportion of patients receiving no therapy at or within 1 year before diagnosis. Comorbid asthma, a high exacerbation rate, increased symptoms and poor lung function each increased the likelihood of being prescribed any initial therapy or initial maintenance therapy; comorbid asthma and an annual rate of ≥ 3 exacerbations were the strongest predictors. In conclusion, our analyses revealed major differences between actual prescribing behaviour and guideline recommendations for patients with newly diagnosed COPD, with many patients receiving no treatment and large numbers of patients receiving ICS-containing regimens. Predictors of initial therapy were identified.

Original languageEnglish
Article number16002
Journalnpj Primary Care Respiratory Medicine
Volume26
DOIs
Publication statusPublished - 2016

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Chronic Obstructive Pulmonary Disease
Primary Health Care
Therapeutics
Adrenal Cortex Hormones
Asthma
Guidelines
Observational Studies
Patient Care
Retrospective Studies
Logistic Models
Databases
Pharmacology
Physicians
Lung

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Public Health, Environmental and Occupational Health

Cite this

Changes in initial COPD treatment choice over time and factors influencing prescribing decisions in UK primary care : a real-world study. / Gruffydd-Jones, Kevin; Brusselle, Guy; Jones, Rupert; Miravitlles, Marc; Baldwin, Michael; Stewart, Rebecca; Rigazio, Anna; Davis, Emily; Keininger, Dorothy L.; Price, David.

In: npj Primary Care Respiratory Medicine, Vol. 26, 16002, 2016.

Research output: Contribution to journalReview article

Gruffydd-Jones, Kevin ; Brusselle, Guy ; Jones, Rupert ; Miravitlles, Marc ; Baldwin, Michael ; Stewart, Rebecca ; Rigazio, Anna ; Davis, Emily ; Keininger, Dorothy L. ; Price, David. / Changes in initial COPD treatment choice over time and factors influencing prescribing decisions in UK primary care : a real-world study. In: npj Primary Care Respiratory Medicine. 2016 ; Vol. 26.
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title = "Changes in initial COPD treatment choice over time and factors influencing prescribing decisions in UK primary care: a real-world study",
abstract = "Prescribing patterns in chronic obstructive pulmonary disease (COPD) are often inconsistent with published guidelines. This retrospective, observational study utilised data from the Optimum Patient Care Research Database to examine the changes in COPD prescribing patterns over time and to identify predictors of physician treatment choice for patients newly diagnosed with COPD. Initial therapy was defined as the treatment(s) prescribed at or within 1 year before COPD diagnosis. Changes over time were assessed in three cohorts based on the date of diagnosis: (1) 1997-2001; (2) 2002-2006; and (3) 2007-2010. Factors affecting the odds of being prescribed any initial therapy or any initial maintenance therapy were identified by univariable and multivariable logistic regression. The analysis included 20,154 patients, 45{\%} of whom were prescribed an initial regimen containing an inhaled corticosteroid (ICS), whereas 28{\%} received no initial pharmacological treatment. Prescribing of ICS monotherapy decreased over time, as did the proportion of patients receiving no therapy at or within 1 year before diagnosis. Comorbid asthma, a high exacerbation rate, increased symptoms and poor lung function each increased the likelihood of being prescribed any initial therapy or initial maintenance therapy; comorbid asthma and an annual rate of ≥ 3 exacerbations were the strongest predictors. In conclusion, our analyses revealed major differences between actual prescribing behaviour and guideline recommendations for patients with newly diagnosed COPD, with many patients receiving no treatment and large numbers of patients receiving ICS-containing regimens. Predictors of initial therapy were identified.",
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note = "Acknowledgements Samantha Holmes (CircleScience, an Ashfield Company, part of UDG Healthcare plc) and Paul Hutchin (contracted to CircleScience, an Ashfield Company, part of UDG Healthcare plc) provided medical writing assistance. Funding The study was funded by Novartis Pharma AG (Basel, Switzerland). Erratum published 08 June 2017 npj Primary Care Respiratory Medicine 27, Article number: 17004 (2017) doi:10.1038/npjpcrm.2017.4",
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AU - Keininger, Dorothy L.

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