Medication Discontinuation in Adults With COPD Discharged From the Hospital: A Population-Based Cohort Study (2023)

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Article preview Background Research Question Study Design and Methods Results Interpretation Section snippets Patients and Methods Study Population Discussion Interpretation Acknowledgments References (32) Chest Chest Lancet Respir Med Respir Med Synthesis, grading, and presentation of evidence in guidelines: article 7 in integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report Proc Am Thorac Soc Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2017 report). 2017 Adherence to inhaled therapy, mortality and hospital admission in COPD Thorax Medication errors: prescribing faults and prescription errors Br J Clin Pharmacol Prescribing errors and other problems reported by community pharmacists Ther Clin Risk Manag Inhaler use in hospitalized patients with chronic obstructive pulmonary disease or asthma: assessment of wasted doses Hosp Pharm An observational study of changes to long-term medication after admission to an intensive care unit Anaesthesia Association of ICU or hospital admission with unintentional discontinuation of medications for chronic diseases JAMA Discontinuity of chronic medications in patients discharged from the intensive care unit JGen Intern Med Unintentional discontinuation of chronic medications for seniors in nursing homes: evaluation of a national medication reconciliation accreditation requirement using a population-based cohort study Medicine (Baltimore) The Ontario Drug Benefit Program Copayment: Its Impact on Access for Ontario Seniors and Charges to the Program Cited by (1) Recommended articles (6)
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Chest

Volume 159, Issue 3,

March 2021

, Pages 975-984

Preliminary Results of this study were presented at the American Thoracic Society 2018 International Conference, May 18-23, 2018, San Diego, CA.

Author links open overlay panelThe Canadian Respiratory Research Network

Background

Patients admitted to the hospital with COPD are commonly managed with inhaled short-acting bronchodilators, sometimes in lieu of the long-acting bronchodilators they take as outpatients. If held on admission, these long-acting inhalers should be re-initiated upon discharge; however, health-care transitions sometimes result in unintentional discontinuation.

Research Question

What is the risk of unintentional discontinuation of long-acting muscarinic antagonist (LAMA) and long-acting beta-agonist and inhaled corticosteroid (LABA-ICS) combination medications following hospital discharge in older adults with COPD?

Study Design and Methods

A retrospective cohort study was conducted by using health administrative data from 2004 to 2016 from Ontario, Canada. Adults with COPD aged≥ 66 years who had filled prescriptions for a LAMA or LABA-ICS continuously for≥ 1 year were included. Log-binomial regression models were used to determine risk of medication discontinuation following hospitalization in each medication cohort.

Results

Of the 27,613 hospitalization discharges included in this study, medications were discontinued 1,466 times. Among 78,953 patients with COPD continuously taking a LAMA or LABA-ICS, those hospitalized had a higher risk of having medications being discontinued than those who remained in the community (adjusted risk ratios of 1.50 [95%CI, 1.34-1.67; P< .001] and 1.62 [95%CI, 1.39, 1.90; P< .001] for LAMA and LABA-ICS, respectively). Crude rates of discontinuation for people taking LAMAs were 5.2%in the hospitalization group and 3.3%in the community group; for people taking LABA-ICS, these rates were 5.5%in the hospitalization group and 3.1%in the community group.

Interpretation

In an observational study of highly compliant patients with COPD, hospitalization was associated with an increased risk of long-acting inhaler discontinuation. These Results suggest a likely larger discontinuation problem among less adherent patients and should be confirmed and quantified in a prospective cohort of patients with COPD and average compliance. Quality improvement efforts should focus on safe transitions and patient medication reconciliation following discharge.

Section snippets

Patients and Methods

This population-based, retrospective cohort study was conducted to examine medication discontinuation following hospitalization in adults with COPD who were long-term, regular users of long-acting bronchodilators. We used linked health administrative data from April 1, 2004, to March 31, 2016, from the province of Ontario, Canada. Research ethics approval was obtained from the Sunnybrook Health Sciences Centre in Toronto (project identification number: 439-2017).

Study Population

The study included 27,613 hospitalization episodes and 56,057 ED visit episodes in 78,953 highly compliant medication users with COPD. A total of 18,330 hospitalization episodes were found among 69,253 continuous users of LAMAs and 9,283 among 36,439 continuous users of LABA-ICS. Across both medication cohorts, most patients (about 51%) were between the ages of 66 and 75 years, about one-half were women, and the majority lived in urban areas. The proportion of people with COPD who had a

Discussion

We conducted this observational population-based study to examine the impact of hospitalization on the continuous use of long-acting bronchodilators in adults with COPD. Our Results show that, in patients who are highly compliant users of either LAMA or LABA-ICS medications, being hospitalized was associated with an increased risk of these medications being discontinued. This finding suggests that the discontinuation rate of a COPD patient with average compliance taking medication is likely

Interpretation

Transitions between health-care settings may exacerbate risks to patient safety. In a large observational population-based study, we found that highly adherent older adults with COPD have an elevated risk of having their long-acting bronchodilator medications unintentionally discontinued following hospitalization. Considering the adverse health outcomes that may be associated with gaps in drug continuity, these findings underscore a need for further prospective clinical study in average, less

Acknowledgments

Author contributions: A. S. G. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. A. S. G. and R. E. M. contributed to the literature search. A. S. G., R. E. M., and D.T. contributed to the acquisition and analysis of data. A. S. G. and R. E. M. drafted the manuscript. All authors contributed to the study concept and design, interpretation of data, and the critical revision of the final manuscript.

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    © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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