Health care utilization history, GOLD guidelines, and respiratory medication prescriptions in patients with COPD.
BACKGROUND
The relationship between prior health care utilization and respiratory medication prescriptions in an unselected population of patients with COPD is not known.


METHODS
We determined the prescribed respiratory medications and respiratory and nonrespiratory health care encounters in 523 Veterans with COPD at the Cincinnati Veterans Affairs Medical Center between 2000 and 2005. Prescribed treatments were compared with the GOLD guidelines and each patient was classified as receiving less medications than recommended in the guidelines (<G), medications according to the guidelines (=G), or more medications than recommended (>G).


RESULTS
Respiratory medications were <G for 54%, =G in 33%, and >G for 14% of the patients studied. For GOLD stages 1 and 2, <G patients had the fewest and >G patients the most prior respiratory encounters during a 12 month period (0.31 +/- 0.073 (0.21, 0.47), 0.75 +/- 0.5 (0.37, 1.5), 1.1 +/- 0.27 (0.74, 1.6) visits/person/year, <G, =G, >G, respectively, mean + standard error of mean (SEM) (95% confidence limits) 2 degrees of freedom (df) ANOVA P < 0.001 for prescription effect). For GOLD stages 3 and 4, <G was associated with significantly fewer prior respiratory visits than was =G (0.78 +/- 0.11 (0.6, 1.0) and 2.4 +/- 0.47 (1.9, 3.1) visits/person/year, respectively, P < 0.001). There were no differences in nonrespiratory health care visits for GOLD stages 1 and 2 by prescription level (3.1 +/- 0.24 (2.6, 3.5), 3.1 +/- 0.46 (2.1, 4.6) and 4.1 +/- 0.55 (3.3, 5.1) visits/person/year, <G, =G, >G respectively, 2 df ANOVA P = 0.096) or for GOLD stages 3 and 4 (3.6 +/- 0.25 (3.2, 4.1) and 4.0 +/- 0.44 (3.3, 4.9) visits/person/year, <G and =G, respectively, P = 0.36).


CONCLUSIONS
Respiratory medications prescribed for an unselected population with a broad range of COPD severity complied poorly with the GOLD pharmacologic treatment guidelines but correlated with the number of prior respiratory health care visits.
Seaman
Joseph
J
Pulmonary, Critical Care, and Sleep Division, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA.
Leonard
Anthony C
AC
Panos
Ralph J
RJ
D000368:Aged; D019317:Evidence-Based Medicine; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D017408:Guidelines as Topic; D006296:Health Services / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009820:Ohio; D010818:Practice Patterns, Physicians' / Q000592:standards*; D055553:Prescription Drugs / Q000627:therapeutic use; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D014728:Veterans; D014797:Vital Capacity / Q000502:physiology
D055553:Prescription Drugs
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