TY - JOUR
T1 - Adherence to long-acting inhaled therapies among patients with chronic obstructive pulmonary disease (COPD)
AU - Cecere, Laura M.
AU - Slatore, Christopher G.
AU - Uman, Jane E.
AU - Evans, Laura E.
AU - Udris, Edmunds M.
AU - Bryson, Chris L.
AU - Au, David H.
N1 - Funding Information:
This material is based upon work supported by a VA Advanced Fellowship Program in Health Services Research and Development [TPM 61-037] and a Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development grant [IIR 02-292]. Dr. Slatore is supported by a Veterans Affairs HSR&D Career Development Award and resources from the Portland VA Medical Center, Portland, OR. Additional support also comes from the Firland Foundation. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. Some of the results of this work were presented in abstract form at the American Thoracic Society International Conference, in Denver, Colorado on May 15, 2011.
PY - 2012/6
Y1 - 2012/6
N2 - Background: Long-acting inhaled medications are an important component of the treatment of patients with chronic obstructive pulmonary disease (COPD), yet few studies have examined the determinants of medication adherence among this patient population. Objective: We sought to identify factors associated with adherence to long-acting beta-agonists (LABA) and inhaled corticosteroids (ICS) among patients with COPD. Methods: We performed secondary analysis of baseline data collected in a randomized trial of 376 Veterans with spirometrically confirmed COPD. We used electronic pharmacy records to assess adherence, defined as a medication possession ratio of ≥0.80. We investigated the following exposures: patient characteristics, disease severity, medication regimen complexity, health behaviors, confidence in self-management, and perceptions of provider skill. We performed multivariable logistic regression, clustered by provider, to estimate associations. Results: Of the 167 patients prescribed LABA, 54% (n = 90) were adherent to therapy while only 40% (n = 74) of 184 the patients prescribed ICS were adherent. Higher adherence to LABA and ICS was associated with patient perception of their provider as being an "expert" in diagnosing and managing lung disease For LABA: OR = 21.70 (95% CI 6.79, 69.37); For ICS OR = 7.93 (95 CI 1.71, 36.67). Factors associated with adherence to LABA, but not ICS, included: age, education, race, COPD severity, smoking status, and confidence in self-management. Conclusions: Adherence to long-acting inhaled medications among patients with COPD is poor, and determinants of adherence likely differ by medication class. Patient perception of clinician expertise in lung disease was the factor most highly associated with adherence to long-acting therapies.
AB - Background: Long-acting inhaled medications are an important component of the treatment of patients with chronic obstructive pulmonary disease (COPD), yet few studies have examined the determinants of medication adherence among this patient population. Objective: We sought to identify factors associated with adherence to long-acting beta-agonists (LABA) and inhaled corticosteroids (ICS) among patients with COPD. Methods: We performed secondary analysis of baseline data collected in a randomized trial of 376 Veterans with spirometrically confirmed COPD. We used electronic pharmacy records to assess adherence, defined as a medication possession ratio of ≥0.80. We investigated the following exposures: patient characteristics, disease severity, medication regimen complexity, health behaviors, confidence in self-management, and perceptions of provider skill. We performed multivariable logistic regression, clustered by provider, to estimate associations. Results: Of the 167 patients prescribed LABA, 54% (n = 90) were adherent to therapy while only 40% (n = 74) of 184 the patients prescribed ICS were adherent. Higher adherence to LABA and ICS was associated with patient perception of their provider as being an "expert" in diagnosing and managing lung disease For LABA: OR = 21.70 (95% CI 6.79, 69.37); For ICS OR = 7.93 (95 CI 1.71, 36.67). Factors associated with adherence to LABA, but not ICS, included: age, education, race, COPD severity, smoking status, and confidence in self-management. Conclusions: Adherence to long-acting inhaled medications among patients with COPD is poor, and determinants of adherence likely differ by medication class. Patient perception of clinician expertise in lung disease was the factor most highly associated with adherence to long-acting therapies.
KW - Chronic disease
KW - Medication adherence
KW - Pharmacoepidemiology
KW - Pulmonary diseases
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U2 - 10.3109/15412555.2011.650241
DO - 10.3109/15412555.2011.650241
M3 - Article
C2 - 22497533
AN - SCOPUS:84862087720
SN - 1541-2555
VL - 9
SP - 251
EP - 258
JO - COPD: Journal of Chronic Obstructive Pulmonary Disease
JF - COPD: Journal of Chronic Obstructive Pulmonary Disease
IS - 3
ER -