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COPD management in primary care: an observational, community pharmacy-based study

Els Mehuys (UGent) , Koen Boussery (UGent) , Els Adriaens (UGent) , Lucas Van Bortel (UGent) , Leen De Bolle (UGent) , Inge Van Tongelen (UGent) , Jean Paul Remon (UGent) and Guy Brusselle (UGent)
(2010) ANNALS OF PHARMACOTHERAPY. 44(2). p.257-266
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Abstract
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a prevalent disease that is frequently treated in primary care. However, data regarding the primary care management of COPD are scarce. Such observational data are necessary to detect problem areas and to develop targeted interventions for improvement of COPD management. OBJECTIVE: To provide a detailed description of (1) drug therapy, (2) drug adherence, (3) inhalation technique, and (4) health status of patients with COPD recruited via community pharmacies. METHODS: A cross-sectional, observational study was conducted in 93 pharmacies in Belgium. Participants (N = 555) completed a questionnaire collecting information on personal characteristics, smoking history, influenza vaccination, COPD medication, and adverse effects. Adherence to COPD maintenance medication was analyzed 1 year retrospectively through prescription refill rates. Inhalation technique was scored using a checklist. Health status was evaluated with the St. George's Respiratory Questionnaire, the Clinical COPD Questionnaire, and the Modified Medical Research Council dyspnea scale. RESULTS: The mean age of the patients was 68.6 years; 73.7% were men and 37.2% were current smokers. The influenza vaccination status was significantly lower in patients aged less than 65 years (65.7%) than in patients aged 65 years or more (86.2%) (p < 0.001). Fixed combinations of inhaled corticosteroids and long-acting beta(2)-agonists were the most frequently used COPD medications (75.4%). About 48% of patients were underadherent (<80% adherence), 47% were adherent (80-120% adherence) and 5% were overadherent (>120% adherence). Predictors for underadherence were age and number of drugs. Twenty-one percent of patients made major inhalation technique errors with rescue medication; these were all errors in handling pressurized metered-dose inhalers (pMDIs). CONCLUSIONS: This observational study on COPD management in primary care highlights 4 main aspects that could be improved: (1) drug adherence, (2) inhalation technique with pMDIs, (3) influenza vaccination in COPD patients younger than 65 years, and (4) smoking cessation.
Keywords
primary care, pharmacotherapy, disease management, COPD, OBSTRUCTIVE PULMONARY-DISEASE, SMOKING-CESSATION INTERVENTION, HEALTH, FLOW, MEDICATION, ADHERENCE, PATTERNS, THERAPY

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Chicago
Mehuys, Els, Koen Boussery, Els Adriaens, Lucas Van Bortel, Leen De Bolle, Inge Van Tongelen, Jean Paul Remon, and Guy Brusselle. 2010. “COPD Management in Primary Care: An Observational, Community Pharmacy-based Study.” Annals of Pharmacotherapy 44 (2): 257–266.
APA
Mehuys, Els, Boussery, K., Adriaens, E., Van Bortel, L., De Bolle, L., Van Tongelen, I., Remon, J. P., et al. (2010). COPD management in primary care: an observational, community pharmacy-based study. ANNALS OF PHARMACOTHERAPY, 44(2), 257–266.
Vancouver
1.
Mehuys E, Boussery K, Adriaens E, Van Bortel L, De Bolle L, Van Tongelen I, et al. COPD management in primary care: an observational, community pharmacy-based study. ANNALS OF PHARMACOTHERAPY. 2010;44(2):257–66.
MLA
Mehuys, Els, Koen Boussery, Els Adriaens, et al. “COPD Management in Primary Care: An Observational, Community Pharmacy-based Study.” ANNALS OF PHARMACOTHERAPY 44.2 (2010): 257–266. Print.
@article{898760,
  abstract     = {BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a prevalent disease that is frequently treated in primary care. However, data regarding the primary care management of COPD are scarce. Such observational data are necessary to detect problem areas and to develop targeted interventions for improvement of COPD management.
OBJECTIVE: To provide a detailed description of (1) drug therapy, (2) drug adherence, (3) inhalation technique, and (4) health status of patients with COPD recruited via community pharmacies.
METHODS: A cross-sectional, observational study was conducted in 93 pharmacies in Belgium. Participants (N = 555) completed a questionnaire collecting information on personal characteristics, smoking history, influenza vaccination, COPD medication, and adverse effects. Adherence to COPD maintenance medication was analyzed 1 year retrospectively through prescription refill rates. Inhalation technique was scored using a checklist. Health status was evaluated with the St. George's Respiratory Questionnaire, the Clinical COPD Questionnaire, and the Modified Medical Research Council dyspnea scale.
RESULTS: The mean age of the patients was 68.6 years; 73.7\% were men and 37.2\% were current smokers. The influenza vaccination status was significantly lower in patients aged less than 65 years (65.7\%) than in patients aged 65 years or more (86.2\%) (p {\textlangle} 0.001). Fixed combinations of inhaled corticosteroids and long-acting beta(2)-agonists were the most frequently used COPD medications (75.4\%). About 48\% of patients were underadherent ({\textlangle}80\% adherence), 47\% were adherent (80-120\% adherence) and 5\% were overadherent ({\textrangle}120\% adherence). Predictors for underadherence were age and number of drugs. Twenty-one percent of patients made major inhalation technique errors with rescue medication; these were all errors in handling pressurized metered-dose inhalers (pMDIs).
CONCLUSIONS: This observational study on COPD management in primary care highlights 4 main aspects that could be improved: (1) drug adherence, (2) inhalation technique with pMDIs, (3) influenza vaccination in COPD patients younger than 65 years, and (4) smoking cessation.},
  author       = {Mehuys, Els and Boussery, Koen and Adriaens, Els and Van Bortel, Lucas and De Bolle, Leen and Van Tongelen, Inge and Remon, Jean Paul and Brusselle, Guy},
  issn         = {1060-0280},
  journal      = {ANNALS OF PHARMACOTHERAPY},
  keyword      = {primary care,pharmacotherapy,disease management,COPD,OBSTRUCTIVE PULMONARY-DISEASE,SMOKING-CESSATION INTERVENTION,HEALTH,FLOW,MEDICATION,ADHERENCE,PATTERNS,THERAPY},
  language     = {eng},
  number       = {2},
  pages        = {257--266},
  title        = {COPD management in primary care: an observational, community pharmacy-based study},
  url          = {http://dx.doi.org/10.1345/aph.1M481},
  volume       = {44},
  year         = {2010},
}

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