Retrospective Review of Medication Management for High-Risk COPD Patients in Primary Care

Abstract

Background: Patients with COPD have decreased lung function, higher incidence of lung infections, and increased ED visits and hospitalizations. Not all COPD patients are followed by a pulmonologist or specialty provider. Studies have shown that time allotted for PCP providers to evaluate patients in clinic is insufficient. UC Davis developed a care management program utilizing an RT to address gaps in care of COPD patients in the PCP setting. We aim to evaluate medication management interventions provided by the RT care manager.

Methods: Retrospective analysis of the High-risk COPD Registry and Acute Decline Workbenches at UC Davis were completed. The COPD High-risk Registry are those age ≥18 years with a risk factor of >60% and an ED visit or hospitalization in the previous 12-months were identified. Acute decline patients are defined as those who had a COPD exacerbation requiring prednisone use. Chart reviews were done on 191 patients managed between October 2022 and May 2023. Data on COPD characteristics, prescribed medications, and medication changes were evaluated. UC Davis IRB declared this review exempt (2060715-1). Statistical analysis was performed using student-t test and Chi-square.

Results: There were 50 patients enrolled in the COPD/Asthma Care Management Program between October 2022 and May 2023 with a mean age 73 years. More patients were female (n = 32, 64%). There was no difference in COPD stage (P = .29) or GOLD classification (P = .55). Inhaled medication changes were made on 32% (n = 16) patients, P < .001. These changes were driven by reported side effects, device complexity, cost, difficulty due to dexterity, poor symptoms, and GOLD guideline recommendations. Verbal and written medication education was provided to patients that explained medication purpose, dosage, frequency, and correct usage.

Conclusions: This small, single-center observation evaluating COPD patients in primary care demonstrated the need for inhaled medication changes in 32% of patients, which was statistically significant. Utilizing a respiratory therapist to extend services to COPD patients in the PCP setting to evaluate and recommend medication changes helps to address barriers and align treatments with GOLD recommendations.