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Observational Study
. 2018 Jul 27:13:2279-2288.
doi: 10.2147/COPD.S160842. eCollection 2018.

Determinants of medical prescriptions for COPD care: an analysis of the EPOCONSUL clinical audit

Jose Luis Lopez-Campos  1   2 , Bernardino Alcázar Navarrete  3 , Joan B Soriano  4 , Juan J Soler-Cataluña  5 , José Miguel Rodríguez González-Moro  6 , Manuel E Fuentes Ferrer  7   8   9 , Myriam Calle Rubio  7   8   10
Affiliations
Observational Study

Determinants of medical prescriptions for COPD care: an analysis of the EPOCONSUL clinical audit

Jose Luis Lopez-Campos et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: Current COPD management recommendations indicate that pharmacological treatment can be stepped up or down, but there are no recommendations on how to make this adjustment. We aimed to describe pharmacological prescriptions during a routine clinical visit for COPD and study the determinants of changing therapy.

Methods: EPOCONSUL is a Spanish nationwide observational cross-sectional clinical audit with prospective case recruitment including 4,508 COPD patients from outpatient respiratory clinics for a period of 12 months (May 2014-May 2015). Prescription patterns were examined in 4,448 cases and changes analyzed in stepwise backward, binomial, multivariate, logistic regression models.

Results: Patterns of prescription of inhaled therapy groups were no treatment prescribed, 124 (2.8%) cases; one or two long-acting bronchodilators (LABDs) alone, 1,502 (34.6%) cases; LABD with inhaled corticosteroids (ICSs), 389 (8.6%) cases; and triple therapy cases, 2,428 (53.9%) cases. Incorrect prescriptions of inhaled therapies were observed in 261 (5.9%) cases. After the clinical visit was audited, 3,494 (77.5%) cases did not modify their therapeutic prescription, 307 (6.8%) cases had a step up, 238 (5.3%) cases had a change for a similar scheme, 182 (4.1%) cases had a step down, and 227 (5.1%) cases had other nonspecified change. Stepping-up strategies were associated with clinical presentation (chronic bronchitis, asthma-like symptoms, and exacerbations), a positive bronchodilator test, and specific inhaled medication groups. Stepping down was associated with lung function impairment, ICS containing regimens, and nonexacerbator phenotype.

Conclusion: The EPOCONSUL study shows a comprehensive evaluation of pharmacological treatments in COPD care, highlighting strengths and weaknesses, to help us understand how physicians use available drugs.

Keywords: COPD; clinical audit; pharmacological prescriptions; quality of care.

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Conflict of interest statement

Disclosure JLLC has received honoraria for lecturing, scientific advice, participation in clinical studies, and writing publications for (alphabetical order) Almirall, AstraZeneca, Bayer, Boehringer Ingelheim, Cantabria Pharma, Chiesi, Esteve, Faes, Ferrer, Gebro, GlaxoSmithKline, Grifols, Menarini, MSD, Novartis, Pfizer, Rovi, Teva, and Takeda. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Distribution of inhaled treatments in the EPOCONSUL cohort. Note: Percentages refer to the complete cohort. Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting beta 2 agonists; LABD, long-acting bronchodilator; LAMA, long-acting muscarinic antagonists.
Figure 2
Figure 2
Distribution of oral treatments in the EPOCONSUL cohort. Note: Percentages refer to the number of patients in each inhaled treatment group. Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting beta 2 agonists; LABD, long-acting bronchodilator; LAMA, long-acting muscarinic antagonists.
Figure 3
Figure 3
Distribution of inhaled treatments in the EPOCONSUL cohort according to GOLD 2017 patient types A–D. Note: Percentages refer to the complete cohort. Abbreviations: CAT, COPD Assessment Test; GOLD, Global Initiative for Obstructive Lung Disease; ICS, inhaled corticosteroid; LABA, long-acting beta 2 agonists; LABD, long-acting bronchodilator; LAMA, long-acting muscarinic antagonists; mMRC, modified Medical Research Council scale.
Figure 4
Figure 4
Distribution of oral therapies in the EPOCONSUL cohort according patient groups by GOLD 2017 patient types A–D. Note: Percentages refer to the number of patients in each treatment. Abbreviations: CAT, COPD Assessment Test; GOLD, Global Initiative for Obstructive Lung Disease; ICS, inhaled corticosteroid; LABA, long-acting beta 2 agonists; LABD, long-acting bronchodilator; LAMA, long-acting muscarinic antagonistsm; mMRC, modified Medical Research Council scale.
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