An observation of prescription behaviors and adherence to guidelines in patients with COPD: real world data from October 2012 to September 2014

Abstract

Introduction: GOLD guideline recommendations are currently the “gold standard” for the treatment of COPD patients.

Objectives: The objective of this analysis was to evaluate compliance with GOLD guidelines in managing COPD patients’ treatment by general practitioners (GPs) and pulmonologists. Since inhaled corticosteroid (ICS) use is defined as inappropriate in mild and moderate COPD patients, special attention was paid to ICS therapy use in these classes.

Methods: The study was based on the Italian GP database IMS Health Longitudinal Patient Database (IMS Health LPD) and on the Patient Analyzer specialist IMS Health database. The observed cohort included all patients with a diagnosis of COPD, aged 40 years or more, with at least one ATC R03 class prescription, visited by GPs and pulmonologists during four timeframes: October 2012 – March 2013 (cohort 1), April 2013 – September 2013 (cohort 2), October 2013 – March 2014 (cohort 3); April 2014 – September 2014 (cohort 4). Patients were classified into disease severity groups following 2008 GOLD guidelines, based on FEV1 value.

Results: Cohorts were quite similar in size (about two thousand patients per cohort). Pulmonologists visited more severe patients than GPs. About 50% of GPs’ mild and moderate patients received treatments containing inhaled corticosteroids. Pulmonologists were more adherent to guidelines, with smaller percentages of mild patients treated with therapies containing ICS (ranging from 19.0% to 30.1%). An improvement in adherence was observed during the four time periods, with a decrease in the use of therapies containing ICS in mild and moderate patients. In absolute terms, it emerged that GPs more often prescribe ICS improperly to patients in the mild and moderate severity classes than pulmonologists.

Conclusion: Real world data indicate that adherence to GOLD guidelines is only partially met by GPs in their general practice and shows higher prescription appropriateness by pulmonologists.

Keywords:

• Adherence
• COPD
• GOLD guidelines
• Real world data

Transparency

Declaration of funding

This study was funded by Novartis Farma Spa.

Declaration of financial/other relationships

E.V. has disclosed that she was an employee of IMS Health Information Solutions Italy at the time this study was conducted. E.P. has disclosed that she is an employee of Novartis Farma Spa. P.P. has disclosed that he collaborated with AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Guidotti-Malesci, Menarini, Novartis, and TEVA. D.N. has disclosed that he collaborated with Menarini, Biofutura, Mundipharma as rapporteur for courses or conferences on COPD or asthma. He also collaborated with Boehringer Ingelheim and Sanofi as investigator in the clinical studies on idiopathic pulmonary fibrosis. B.V. has disclosed that she has no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no other relevant financial relationships to disclose.

Acknowledgments

All named authors take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.