COPD Population in US Primary Care: Data From the Optimum Patient Care DARTNet Research Database and the Advancing the Patient Experience in COPD Registry

Abstract

Purpose: To describe demographic and clinical characteristics of chronic obstructive pulmonary disease patients managed in US primary care.

Methods: This was an observational registry study using data from the Chronic Obstructive Pulmonary Disease (COPD) Optimum Patient Care DARTNet Research Database from which the Advancing the Patient Experience COPD registry is derived. Registry patients were aged ≥35 years at diagnosis. Electronic health record data were collected from both registries, supplemented with patient-reported information/outcomes from the Advancing the Patient Experience registry from 5 primary care groups in Texas, Ohio, Colorado, New York, and North Carolina (June 2019 through November 2020).

Results: Of 17,192 patients included, 1,354 were also in the Advancing the Patient Experience registry. Patients were predominantly female (56%; 9,689/17,192), White (64%; 9,732/15,225), current/ex-smokers (80%; 13,784/17,192), and overweight/obese (69%; 11,628/16,849). The most commonly prescribed maintenance treatments were inhaled corticosteroid with a long-acting β₂-agonist (30%) and inhaled corticosteroid with a long-acting muscarinic antagonist (27%). Although 3% (565/17,192) of patitents were untreated, 9% (1,587/17,192) were on short-acting bronchodilator monotherapy, and 4% (756/17,192) were on inhaled corticosteroid monotherapy. Despite treatment, 38% (6,579/17,192) of patients experienced 1 or more exacerbations in the last 12 months. These findings were mirrored in the Advancing Patient Experience registry with many patients reporting high or very high impact of disease on their health (43%; 580/1,322), a breathlessness score 2 or more (45%; 588/1,315), and 1 or more exacerbation in the last 12 months (50%; 646/1,294).

Conclusions: Our findings highlight the high exacerbation, symptom, and treatment burdens experienced by COPD patients managed in US primary care, and the need for more real-life effectiveness trials to support decision making at the primary care level.

Keywords: APEX; characterization; electronic medical records; patient reported outcomes; primary care.

Figure 1.

Prevalence of comorbidities in COPD patients in the COPD-RD (n = 17,192) and the APEX-COPD registry (n = 1,354). APEX = Advancing the Patient Experience; COPD = chronic obstructive pulmonary disease; COPD-RD = COPD Optimum Patient Care DARTNet Research Database; CRS = chronic rhinosinusitis; GERD = gastresophageal reflux disease.

Figure 2.

Proportion of patients included in the COPD-RD (n = 17,192) and the APEX-COPD registry (n = 1,354) and who experienced exacerbations in the last year. APEX = Advancing the Patient Experience; COPD = chronic obstructive pulmonary disease; COPD-RD = COPD Optimum Patient Care DARTNet Research Database. Note: See Supplemental Table 6 for exacerbation algorithm.

Figure 3.

COPD treatment use among patients included in the COPD-RD (n = 17,192) and APEX-COPD registry (n = 1,354). APEX = Advancing the Patient Experience; COPD = chronic obstructive pulmonary disease; COPD-RD = COPD Optimum Patient Care DARTNet Research Database; ICS = inhaled corticosteroid; LABA = long-acting β₂-agonist; LAMA = long-acting muscarinic antagonist; LTRA = leukotriene receptor antagonist. ^a Prescribed with or without phopohodiesterase-4, macrolide, theophylline, or LTRA. ^b Prescribed with LTRA. ^c Prescribed with or without theophylline or LTRA.