COMPLIANCE WITH A QUALITY MEASURE AND INCORPORATION OF AN EVIDENCE-BASED PRACTICE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) affects more than 15 million Americans and is the third leading cause of mortality in the United States. The aims of this study were to describe rate of compliance with the quality measure that patients with COPD receive an inhaled corticosteroid and inhaled broncho dilator and to assess the effect of the evidence-based practice, extended course systemic macrolide therapy, on COPD exacerbation rate. METHODS: Patients ≥18 years-of-age with a hospitalization or emergency department (ED) visit for a COPD exacerbation were identified in IMS Lifelink Plus (2006-2015). The earliest COPD exacerbation date was the index-date. Patients had continuous enrollment for 6 months before and after index-date. Patients with ≥ 1 prescription for inhaled corticosteroid and bronchodilator within 30 days from index-date were defined as standard therapy. Patients with ≥30 day supply of macrolide within 90 days of index-date were denned as macrolide therapy. COPD exacerbation recurrence was denned as hospitalization or ED visit in the six month post-index period. Logistic regression analysis was performed using age, sex, geographic region, and comorbidities to assess the effect of exposure to macrolide on COPD exacerbation recurrence. RESULTS: Of 56,055 patients who met inclusion criteria, 4,512 (8.05%) received an inhaled corticosteroid and bronchodilator, 202 (0.36%) received systemic macrolide therapy, and 41 (0.07%) received both interventions. Within six months of index-date exacerbation, 7,987 (14.25%) patients experienced another exacerbation. In unadjusted analysis, receipt of macrolide therapy was associated with lower odds of experiencing another COPD exacerbation (odds ratio 0.473, 95% confidence interval 0.319-0.701); however, after adjusting for covariates, this association no longer existed (odds ratio 0.880, 95% confidence interval 0.415-1.867). CONCLUSIONS: There is a low rate of compliance with the quality measure that patients with COPD receive an inhaled corticosteroid and an inhaled bronchodilator and no effect on exacerbation rate with use of systemic macrolide therapy.