Abstract：
OBJECTIVE:To examine medication adherence and persistence among COPD patients during their last year of life. DATA SOURCE:National VA databases were used to identify patients who had COPD and died between 1999 and 2003. STUDY DESIGN:We examined use of inhaled corticosteroids (ICS), long acting beta(2) agonists (LABA), methylxanthines (MTX), and anticholinergics (AC), alone and in combination. Medication possession ratios (MPR) were compared between regimens by quarterly periods using General Estimating Equations (GEE). Medication persistence was examined in monotherapy users with Kaplan-Meier survival analysis and extended Cox proportional hazard models. PRINCIPAL FINDINGS:Only half of the identified patients in the COPD cohort (5913 of 11,376) used any medications. Among 5913 patients, overall mean (SD) MPR was 0.44 (0.32) during the last year of life. A positive linear trend in MPR was observed across quarterly periods in AC users (beta=0.014, p<0.0001), and was highest for MTX users (beta=0.11, p<0.0001). Of 3436 on monotherapy only, 40% discontinued medication within 30 days, and 70% discontinued within 90 days. MTX users were less likely to discontinue (HR=0.714, p=0.012) than reference (AC) group. CONCLUSION:COPD patients in their last year of life tended to use respiratory medications sporadically. Further research is needed to qualify whether minor differences in MPR between regimens reflect behavioral differences related to regimen or reflect refill policy and MPR calculation technique.
journal_name
Respir Medjournal_title
Respiratory medicineauthors
Jung E,Pickard AS,Salmon JW,Bartle B,Lee TAdoi
10.1016/j.rmed.2008.11.004subject
Has Abstractpub_date
2009-04-01 00:00:00pages
525-34issue
4eissn
0954-6111issn
1532-3064pii
S0954-6111(08)00397-1journal_volume
103pub_type
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pub_type： 杂志文章
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更新日期：2005-08-01 00:00:00
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更新日期：2013-03-01 00:00:00
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pub_type： 杂志文章,随机对照试验
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更新日期：2014-08-01 00:00:00
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journal_title：Respiratory medicine
pub_type： 杂志文章
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更新日期：2006-06-01 00:00:00
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journal_title：Respiratory medicine
pub_type： 杂志文章
doi：10.1053/rmed.1999.0746
更新日期：2000-04-01 00:00:00
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pub_type： 临床试验,杂志文章
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更新日期：2003-04-01 00:00:00
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更新日期：2019-08-01 00:00:00
