Use of medicines and health services for chronic obstructive pulmonary disease among a cohort of Australians over 50 years

Abstract

Background

It is not known if the medicines and services for COPD are used in Australia according to the COPD-X guideline. This study examined the use of medicines and health services for COPD among an Australian cohort to determine if they were consistent with recommendations.

Methods

The administrative claims data from the Australian Government Department of Veterans’ Affairs were used and included persons aged ≥50 years who were using medicines for COPD in April 2016. Use of medicines was identified using the Anatomical, Therapeutic and Chemical Classification and Pharmaceutical Benefits Scheme. Use of services was identified using the Medicare Benefits Schedule and Australian Government Department of Veterans’ Affairs Fee Schedule.

Results

Of the 143,261 persons aged ≥50 years, 12,623 (8.8%) were on medicines for COPD. Of the total COPD population, 42% were managed on monotherapy, 36% on dual therapy, 21% on triple therapy, and 1.5% on more than three COPD medicines. Monotherapy comprised tiotropium (80%) predominantly. Services to practitioners who may provide pulmonary rehabilitation service showed less than 10% of the cohort had a claim for a visit to an exercise physiologist and less than a third had a claim for a physiotherapist visit in the prior 12 months. Services to assist with care coordination in the form of general practitioner management plans were only claimed by half of the cohort, while services supporting appropriate medicine use were claimed by less than one in six cases, despite high levels of inhaler use and multiple inhaler use.

Conclusion

More than three-quarters of COPD persons aged 50 years and above were managed on either monotherapy or dual therapy, consistent with the guideline recommendations. Almost one-quarter was on three or more therapies, which will create challenges for multiple device management. Many services that may benefit persons with COPD appear to be underutilized.

Keywords:

• Australia
• chronic obstructive pulmonary disease
• health services administration
• medicine utilization

Acknowledgments

This work was funded by DVA as part of the Veterans’ Medicines Advice and Therapeutics Education Services (Veterans’ MATES) program. DVA reviewed this manuscript before submission but played no role in study design, execution, analysis or interpretation of data, writing of manuscript, or decision to submit the paper for publication.

Author contributions

RL participated in data analysis and drafted the manuscript. MK performed the data analysis and assisted in study design. EER conceived and designed the study, and critically revised the manuscript for important intellectual content. All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

EER is supported by the National Health and Medical Research Council (NHMRC) grant (GNT 1110139). The authors report no other conflicts of interest in this work.