Dhamane A, Candrilli S, Meyers J, Luthra R, Kaila S. Initial diagnosis and treatment patterns by healthcare setting among chronic obstructive pulmonary disease (COPD) patients in the United States. Poster presented at the 2016 AMCP Managed Care & Specialty Pharmacy Annual Meeting; April 2016. San Francisco, CA. [abstract] J Manag Care Pharm. 2016 Apr; 22(4-a):S90.

BACKGROUND: COPD remains undiagnosed in a majority of patients until they progress towards the later stages of the disease where they are more likely to have exacerbations that may lead to hospitalizations. Appropriate treatment, including long-acting bronchodilators, following exacerbation may prevent future exacerbations. However, under-treatment is a major gap in COPD care. Evaluating rates of diagnosis and evaluating treatment patterns by healthcare setting may provide insight to the degree of under-diagnosis and under-treatment.

OBJECTIVE: To determine the healthcare setting of initial COPD diagnosis and descriptively assess COPD treatment patterns post-diagnosis.

METHODS: A retrospective observational analysis of administrative claims data was conducted. Managed care enrollees ≥40 years old with a COPD diagnosis (≥1 medical claim with a COPD ICD-9-CM diagnosis code) occurring between 1/1/2011 and 12/31/2012 were selected. The index date was defined as the earliest COPD diagnosis. Continuous health plan enrollment was required in the 12-month period prior to and following the index date, defined as pre- and post-diagnosis period respectively. Only ‘new’ COPD patients were included i.e., no COPD diagnosis was allowed in the pre-diagnosis period. Patients were placed into one of the two study groups depending upon the place of service of the index COPD diagnosis: 1) Inpatient or ED (IP/ED) and 2) physician office or other outpatient (PO/OP) setting. Treatment patterns were assessed in the post-diagnosis period based on the occurrence of ≥1 prescription claim for a COPD treatment. Proportions of patients receiving various COPD treatments were reported.

RESULTS: The study population consisted of 66,927 COPD patients. Of these, 14.5% were diagnosed in an I P/ED setting. About 40% of the study population did not receive a prescription for any type of COPD treatment. Only 25% received a prescription for a long-acting bronchodilator. A greater proportion of patients in the IP/ED group received a COPD treatment of any type compared to those in the PO/OP group (59.4% vs. 54.6%, respectively). There were no differences in the proportions of patients receiving a long-acting bronchodilator by healthcare setting of initial COPD diagnosis.

CONCLUSION: This study showed that a sizable proportion of patients are first diagnosed with COPD in an IP/ED setting. This study also highlights that under-treatment is prevalent in COPD, with most patients not receiving a long-acting bronchodilator therapy including those first diagnosed with COPD in an IP/ED setting.

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