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Obstructive Lung Diseases |

Healthcare Resource Utilization Among COPD Patients With Nighttime and Early Morning Symptoms

Sean Sullivan, PhD; Michelle Mocarski, MPH; Qian Cai, MS; Judith Stephenson, MS; Hiangkiat Tan, MS; Jalpa Doshi, PhD
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University of Washington, Seattle, WA


Chest. 2013;144(4_MeetingAbstracts):695A. doi:10.1378/chest.1703238
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Abstract

SESSION TITLE: COPD Diagnosis & Evaluation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: To assess healthcare resource utilization among patients with chronic obstructive pulmonary disease (COPD) who experience nighttime (NT) and early morning (EM) symptoms.

METHODS: This study consisted of a cross-sectional patient survey linked with medical claims. Administrative claims from the HealthCore Integrated Research Database were utilized to identify a patient sample of commercially insured patients, aged ≥40 years, with ≥1 medical claim with an ICD-9-CM diagnosis code of COPD or ≥1 pharmacy claim for COPD maintenance medication between 09/01/2010-08/31/2011. Patients with potentially confounding diseases were excluded. Consenting respondents completed a 25-minute survey. Presence of NT/EM symptoms was defined as experiencing symptoms of COPD on 3 or more nights/mornings in the past week, respectively. Survey recruitment was stratified based on NT/EM symptoms to maximize balance across groups. Chi-square and ANOVA tests were used to evaluate between-group differences.

RESULTS: Of 752 respondents completing the survey, 42.3% reported NT and EM symptoms, 32.7% reported either, and 25.0% reported neither. Among respondents with NT symptoms, 48.7% reported that their symptoms were moderate/severe and 50.1% reported using rescue medication at night during the past week. Additionally, 77.7% of respondents with NT symptoms reported sleep disturbance due to symptoms, waking an average of 2.8 (±2.5) nights during the past week. Among respondents with EM symptoms, 55.5% reported that their symptoms were moderate/severe and 64.4% reported using rescue medication during the morning during the past week. Of respondents with EM symptoms, 60.4% reported morning activity limitation and 27.8% noted trouble concentrating during the morning. Compared with respondents with either or neither NT/EM symptoms, respondents with both symptoms reported significantly higher rates of COPD-related hospitalizations (both, 13.5% vs either, 8.1% vs neither, 5.3%; p=0.01) and emergency room (ER) visits (both, 14.2% vs either, 8.1% vs neither, 5.3%; p<0.01) during the past 12 months. Self-reported all-cause hospitalizations and ER visits showed a similar trend, though between-group differences were not statistically significant.

CONCLUSIONS: NT/EM symptoms negatively impact patients’ lives and are associated with increased COPD-related hospitalizations and ER visits.

CLINICAL IMPLICATIONS: Improved treatment of NT/EM symptoms may reduce hospitalizations and emergency room visits.

DISCLOSURE: Sean Sullivan: Consultant fee, speaker bureau, advisory committee, etc.: consultant fees from Forest Research Institute Michelle Mocarski: Employee: Forest Research Institute Qian Cai: Employee: of HealthCore, Inc., which received funding from Forest Research Institute, Inc., for study design, data collection, data analysis and interpretation Judith Stephenson: Employee: of HealthCore, Inc., which received funding from Forest Research Institute, Inc., for study design, data collection, data analysis and interpretation Hiangkiat Tan: Employee: of HealthCore, Inc., which received funding from Forest Research Institute, Inc., for study design, data collection, data analysis and interpretation Jalpa Doshi: Consultant fee, speaker bureau, advisory committee, etc.: Forest

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