BACKGROUND: COPD remains undiagnosed in a majority of patients until they progress towards the later stages of the disease where they are more likely to have exacerbations that may lead to hospitalizations. Appropriate treatment, including long-acting bronchodilators, following exacerbation may prevent future exacerbations. However, under-treatment is a major gap in COPD care. Evaluating rates of diagnosis and evaluating treatment patterns by healthcare setting may provide insight to the degree of under-diagnosis and under-treatment.
OBJECTIVE: To determine the healthcare setting of initial COPD diagnosis and descriptively assess COPD treatment patterns post-diagnosis.
METHODS: A retrospective observational analysis of administrative claims data was conducted. Managed care enrollees ≥40 years old with a COPD diagnosis (≥1 medical claim with a COPD ICD-9-CM diagnosis code) occurring between 1/1/2011 and 12/31/2012 were selected. The index date was defined as the earliest COPD diagnosis. Continuous health plan enrollment was required in the 12-month period prior to and following the index date, defined as pre- and post-diagnosis period respectively. Only ‘new’ COPD patients were included i.e., no COPD diagnosis was allowed in the pre-diagnosis period. Patients were placed into one of the two study groups depending upon the place of service of the index COPD diagnosis: 1) Inpatient or ED (IP/ED) and 2) physician office or other outpatient (PO/OP) setting. Treatment patterns were assessed in the post-diagnosis period based on the occurrence of ≥1 prescription claim for a COPD treatment. Proportions of patients receiving various COPD treatments were reported.
RESULTS: The study population consisted of 66,927 COPD patients. Of these, 14.5% were diagnosed in an I P/ED setting. About 40% of the study population did not receive a prescription for any type of COPD treatment. Only 25% received a prescription for a long-acting bronchodilator. A greater proportion of patients in the IP/ED group received a COPD treatment of any type compared to those in the PO/OP group (59.4% vs. 54.6%, respectively). There were no differences in the proportions of patients receiving a long-acting bronchodilator by healthcare setting of initial COPD diagnosis.
CONCLUSION: This study showed that a sizable proportion of patients are first diagnosed with COPD in an IP/ED setting. This study also highlights that under-treatment is prevalent in COPD, with most patients not receiving a long-acting bronchodilator therapy including those first diagnosed with COPD in an IP/ED setting.
