PURPOSE: The assessment of physician prescribing for patients with chronic obstructive pulmonary disease (COPD) vs. current guidelines is often difficult due to limited availability of spirometry data to determine disease severity. This study used a national electronic medical record (EMR) research database to access spirometry data obtained from pulmonary function tests (PFTs) to evaluate prescribing vs. guidelines.
METHODS: A national EMR database of patients receiving care in primary care settings was queried to evaluate physician prescribing for COPD patients. Patients with at least one ICD-9-CM code for COPD (491.xx, 492.x, 496) were identified. COPD patients with available spirometry data from PFTs (starting from year 2000) were stratified by the current Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity classifications. Patients with a history of asthma (ICD-9-CM code 493.xx) were excluded. Physician prescribing of respiratory medications was evaluated from 180 days prior to 210 days post the most recent PFT (identified as the study period).
RESULTS: 246 COPD patients met study criteria. Majority of these patients had moderate or severe COPD (76%). Approximately 80% of COPD patients were prescribed “any bronchodilator” during the study period. When short-acting beta-agonists alone were not included, this proportion decreased to 66% (mild 58.3%; moderate 63.5%; severe 72.6%; very severe 72.7%). Inhaled corticosteroid (ICS) use ranged from 39% in mild patients to 50% in very severe patients.
CONCLUSION: The use of maintenance bronchodilators among COPD patients in this study was low. Based on evidence-based guidelines, the use of ICS was higher than expected in mild patients. Less than 1% of COPD patients in this database had spirometry data available, indicating either a lack of PFT testing in primary care, lack of documentation, or limited transmission of spirometry data into the EMR.
CLINICAL IMPLICATIONS: The ability to evaluate pharmacologic treatment according to disease severity is critical to optimize a guideline-based approach to patient care. The utilization of a national EMR database can provide insight on physician prescribing among COPD patients with available spirometry data.
DISCLOSURE: Carl Asche, Grant monies (from industry related sources) Funded by Boehringer Ingelheim Pharmaceuticals, Inc.