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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
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.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
primary care, pharmacotherapy, disease management, COPD, OBSTRUCTIVE PULMONARY-DISEASE, SMOKING-CESSATION INTERVENTION, HEALTH, FLOW, MEDICATION, ADHERENCE, PATTERNS, THERAPY
journal title
ANNALS OF PHARMACOTHERAPY
Ann. Pharmacother.
volume
44
issue
2
pages
257 - 266
Web of Science type
Article
Web of Science id
000274617100002
JCR category
PHARMACOLOGY & PHARMACY
JCR impact factor
2.166 (2010)
JCR rank
135/249 (2010)
JCR quartile
3 (2010)
ISSN
1060-0280
DOI
10.1345/aph.1M481
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
898760
handle
http://hdl.handle.net/1854/LU-898760
date created
2010-03-09 10:49:05
date last changed
2010-07-14 09:47:55
@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},
}

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, E., 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.