TY - JOUR
T1 - Predictors of adherence to inhaled medications among veterans with COPD
AU - Huetsch, John C.
AU - Uman, Jane E.
AU - Udris, Edmunds M.
AU - Au, David H.
N1 - Funding Information:
Acknowledgments: The authors thank all the research volunteers who participated in the study. This project was funded by the American Lung Association, grant # CI-51755N. Dr. Au was funded by HSR&D, VA Puget Sound Health Care System. The views expressed in this manuscript are those of the authors and do not necessarily represent the opinions of the Department of Veterans Affairs.
PY - 2012/11
Y1 - 2012/11
N2 - BACKGROUND: Factors contributing to medication nonadherence among patients with chronic obstructive pulmonary disease (COPD) are poorly understood. OBJECTIVES: To identify patient characteristics that are predictive of adherence to inhaled medications for COPD and, for patients on multiple inhalers, to assess whether adherence to one medication class was associated with adherence to other medication classes. DESIGN: Cohort study using data from Veteran Affairs (VA) electronic databases. PARTICIPANTS: This study included 2,730 patients who underwent pulmonary function testing between 2003 and 2007 at VA facilities in the Northwestern United States, and who met criteria for COPD. MAIN MEASURES: We used pharmacy records to estimate adherence to inhaled corticosteroids (ICS), ipratropium bromide (IP), and long-acting beta-agonists (LABA) over two consecutive six month periods. We defined patients as adherent if they had refilled medications to have 80 % of drug available over the time period. We also collected information on their demographics, behavioral habits, COPD severity, and comorbidities. KEY RESULTS: Adherence to medications was poor, with 19.8 % adherent to ICS, 30.6 % adherent to LABA, and 25.6 % adherent to IP. Predictors of adherence to inhaled therapies were highly variable and dependent on the medication being examined. In adjusted analysis, being adherent to a medication at baseline was the strongest predictor of future adherence to that same medication [(Odds ratio, 95 % confidence interval) ICS: 4.79 (3.22-7.12); LABA: 6.60 (3.92-11.11); IP: 14.13 (10.00-19.97)], but did not reliably predict adherence to other classes of medication. CONCLUSIONS: Among patients with COPD, past adherence to one class of inhaled medication strongly predicted future adherence to the same class of medication, but only weakly predicted adherence to other classes of medication.
AB - BACKGROUND: Factors contributing to medication nonadherence among patients with chronic obstructive pulmonary disease (COPD) are poorly understood. OBJECTIVES: To identify patient characteristics that are predictive of adherence to inhaled medications for COPD and, for patients on multiple inhalers, to assess whether adherence to one medication class was associated with adherence to other medication classes. DESIGN: Cohort study using data from Veteran Affairs (VA) electronic databases. PARTICIPANTS: This study included 2,730 patients who underwent pulmonary function testing between 2003 and 2007 at VA facilities in the Northwestern United States, and who met criteria for COPD. MAIN MEASURES: We used pharmacy records to estimate adherence to inhaled corticosteroids (ICS), ipratropium bromide (IP), and long-acting beta-agonists (LABA) over two consecutive six month periods. We defined patients as adherent if they had refilled medications to have 80 % of drug available over the time period. We also collected information on their demographics, behavioral habits, COPD severity, and comorbidities. KEY RESULTS: Adherence to medications was poor, with 19.8 % adherent to ICS, 30.6 % adherent to LABA, and 25.6 % adherent to IP. Predictors of adherence to inhaled therapies were highly variable and dependent on the medication being examined. In adjusted analysis, being adherent to a medication at baseline was the strongest predictor of future adherence to that same medication [(Odds ratio, 95 % confidence interval) ICS: 4.79 (3.22-7.12); LABA: 6.60 (3.92-11.11); IP: 14.13 (10.00-19.97)], but did not reliably predict adherence to other classes of medication. CONCLUSIONS: Among patients with COPD, past adherence to one class of inhaled medication strongly predicted future adherence to the same class of medication, but only weakly predicted adherence to other classes of medication.
KW - Health behavior
KW - Medication adherence
KW - Pulmonary diseases
KW - Veterans
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U2 - 10.1007/s11606-012-2130-5
DO - 10.1007/s11606-012-2130-5
M3 - Article
C2 - 22782274
AN - SCOPUS:84867885780
VL - 27
SP - 1506
EP - 1512
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
SN - 0884-8734
IS - 11
ER -