jurnal presentation

8/12/2019 jurnal presentation

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Introduction Chronic obstructive pulmonary disease (COPD) is

a debilitating disease that is asso-ciated with anincreased risk of death

COPD

The fifth leadingcause of death

worldwide in 2002

the

fourth leading

disease contributingto prematuremortality

Become the thirdleading cause of

death worldwide bythe

year 2030


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Chronic

cough

excessivesputum

production

wheeze. COPD

Therapy recommended ????

The 2014 Global initiative for chronicObstructive Lung Disease (GOLD)

guidelines recommmend

using inhaled long-acting bronchodi-lator (LABD) medications they areconvenient and are more effectivethan short-acting bronchodilator(SABD) medications


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Methods

Data were extracted from the Truven Health MarketScanCommercial and Medicare Supplemental Research Databases

This retrospective study ( 1 April 2008 31 Maret 2012)Data source

Patients who were at least 40 years old (commercial) or at least65 years old (Medicare supplemental),

Had a first hospitalization with COPD as the primary diagnosis

Enrolled 1 year before and 9 months after the index periodINCLUDED:

Diagnosed cystic fibrosis or tuberculosis at any time during thestudy period on a non-diagnostic claim

Transferred to another inpatient facility after hospital discharge

EXCLUDED:

For continuous variablesunivariate descriptive statistics

For independent sampleschi-square test

For correlated samples

McNemars

chi-square test

statistical

analyses


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RESULTS

Total patients met inclusion/exclusion criteria

All Patients with claims within the MarketScan

database during the index period


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Table1 Baseline patient characteristics and

resource utilization by 1180 days post-index

LABD prescription fills and overall


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Discussion Did not fill any LABD or SABD prescription in

the 90 days before or 180 days afterhospitalizationone quarter of theCOPD patients

Initiated an LABD following theirhospitalization

only approximately onequarter of the COPD

The pharmacological agents can reduce COPD exacerbation frequency and severity

It has also been shown that early treatment improves outcomes of COPD exacerbations and

leads to a faster recovery

Delay in medication initiation after an index hospitalization for COPD has been

associated with an increased risk of a subsequent COPD-related hospitalization or ED visit.


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The finding that patients in the no LABD group scored higher on thecomorbidity index than the LABD group

The finding that the no LABD group had fewer OP physician visits, EDvisits, and hospitalizations in the 1- to 90- and 1- to 180-day post-indexperiods than the LABD group

This finding might suggest that patients in the no LABD group had more

pressing health concerns that took precedence over control of COPDsymptoms

finding of this study worth noting was that patients who didnot fill an LABD prescription within the first 90 days afterhospitalization were not likely to fill an LABD prescription 91

180 days after hospitalization


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This research also had some limitations.

1. codes on the insurance claims might have beenrecorded incorrectly or not at all,

2. Disease severity, COPD stage, mortality rate, and otherclinical variables were unable to be recorded due to thenature of the database.


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Conclusion The observational study of claims dataa significant

proportion of COPD patients who were hospitalizedfor COPD were not receiving an LABD beforehospitalization, and, despite the negative impact ofhospitalization on long-term outcome


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