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Yin, Yiwei

University of British Columbia

Background: Maintenance inhaled medications are essential for managing chronic obstructive pulmonary disease (COPD). Despite existing management strategies providing evidence-based recommendations, many patients don't receive guideline-concordant care, necessitating comprehensive population-based analysis of medication use patterns. Objectives: This thesis aimed to synthesize existing methods for evaluating guideline-concordance of COPD maintenance inhaled medication use and apply them to administrative health data. Methods: I performed a systematic review of definitions for guideline-concordant and guideline-discordant maintenance inhaled medication use in administrative health data and created a generalizable definition for claims data. This definition was then applied to British Columbia's (BC) general COPD patient population to analyze trends in guideline-concordant medication initiation and adherence, along with associated factors. Results: All the definitions I identified were based on Global Initiative for Chronic Obstructive Lung Disease (GOLD) management strategy recommendations. Eighty percent of studies applied the definition measuring guideline-discordant inhaled corticosteroid (ICS) use and 75% of studies applied the definition measuring guideline-concordant long-acting bronchodilator (LABDs) use in accordance with GOLD. Because acute exacerbation of COPD (AECOPD) risk was the most common criterion that aligned with past and current management strategy recommendations, I developed a guideline-concordance definition for claims data based on this approach. When applying an AECOPD risk-based definition to a cohort of 88,002 patients with newly-diagnosed COPD in BC, 31.91% ever initiated guideline-concordant treatment during follow-up. Among initiators, the mean proportion of days covered (PDC) by guideline-concordant therapy was 0.30. Patients with high risk of AECOPD received guideline-concordant therapy more often than those at low risk (66.21% vs. 13.21% per year) and had higher adherence (mean PDC 0.58 vs. 0.24 per year). Pulmonologist care and more frequent outpatient visits were associated with both increased initiation (OR 4.80, 95% CI: 4.58–5.03, and 1.25, 95% CI: 1.24–1.26, respectively) and adherence (PDC increase of 0.03, 95% CI: 0.02–0.03, and 0.004, 95% CI: 0.003–0.005, respectively) to guideline-concordant treatment. Conclusion: AECOPD risk-based definitions effectively assess guideline-concordant COPD medication use in administrative health data. When applied to BC's COPD population, results showed very low use of guideline-concordant maintenance inhaled medications. Improving access to care may enhance guideline-concordant care.

Text

2024-12-10

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/89823

Pharmaceutical Sciences

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/