COMPARISON STUDY OF CURRENT GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE (GOLD) RECOMMENDATIONS WITH COPD EXACERBATION TREATMENTS IN MISSISSIPPI MEDICAID
Author(s)
Rong Y1, Bhattacharya K2, Pittman E3, Zhang Y4, Noble S5, Kirby T6, Banahan III B3
1University of Mississippi, Oxford, MS, USA, 2Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA, 3Center for Pharmaceutical Marketing and Management, University of Mississippi, University, MS, USA, 4Department of Pharmacy Administration, University of Mississippi School of Pharmacy, Oxford, MS, USA, 5Mississippi Division of Medicaid, Jackson, MS, USA, 6Office of the Governor, Mississippi Division of Medicaid, Jackson, MS, USA
OBJECTIVES : To evaluate how well current treatment patterns for chronic obstructive pulmonary disease (COPD) exacerbations complied with the recently updated Global Initiative for Chronic Obstructive Lung Disease (GOLD). Although minor changes in treatment recommendations were made in the 2018 GOLD guidelines, the vast majority of treatment recommendations evaluated in this study were included in the 2017 guidelines. METHODS : A retrospective cross-sectional study was conducted using Mississippi Medicaid claims data. ICD-10 codes in medical claims from January 2017 to July 2018 were used to identify beneficiaries age 18 or older with a COPD diagnosis. Acute COPD exacerbations, defined by any ED visit or hospitalization with primary diagnosis of COPD, occurring after a minimum 6 months therapy without an exacerbation were identified. Prescription claims for COPD therapies prior to and following each exacerbation were compared to 2018 GOLD recommended pharmacotherapies. RESULTS : A total of 22,171 beneficiaries were identified as having COPD with 2,458 exacerbation events meeting the inclusion criteria. Among the study subjects, 1,721 (7.8%) had one or more exacerbations during the study period with an average of 1.4 exacerbations. Only 517 (21.0%) of exacerbation events had a COPD-related physician visit within 6 months of the exacerbation with an average time interval of 68.0 days. Overall, 5,603 (25.3%) beneficiaries received GOLD recommended maintenance drugs during the study period. However, only 481 (19.6%) of post-exacerbation treatment regimens included a long-acting bronchodilator and only 198 (8.1%) had a GOLD recommended medication added-on. Following 51.5% of exacerbations there were no claims for any bronchodilators 45 days post discharge. CONCLUSIONS : Educational initiatives are needed to increase compliance with the GOLD guidelines that will result in better control of COPD and thus decrease the number of exacerbations leading to ED visits, hospitalizations, and death as well as an increase in productivity and quality of life.
Conference/Value in Health Info
2019-05, ISPOR 2019, New Orleans, LA, USA
Value in Health, Volume 22, Issue S1 (2019 May)
Code
PRS45
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care
Topic Subcategory
Prescribing Behavior, Safety & Pharmacoepidemiology
Disease
Drugs, Respiratory-Related Disorders
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