Medication Discontinuation in Adults With COPD Discharged From the Hospital: A Population-Based Cohort Study

Andrea S Gershon; Rachel E McGihon; Deva Thiruchelvam; Teresa To; Robert Wu; Chaim M Bell; Shawn D Aaron; Canadian Respiratory Research Network

doi:10.1016/j.chest.2020.09.254

Medication Discontinuation in Adults With COPD Discharged From the Hospital: A Population-Based Cohort Study

Chest. 2021 Mar;159(3):975-984. doi: 10.1016/j.chest.2020.09.254. Epub 2020 Oct 2.

Authors

Andrea S Gershon¹, Rachel E McGihon², Deva Thiruchelvam³, Teresa To⁴, Robert Wu⁵, Chaim M Bell⁶, Shawn D Aaron⁷; Canadian Respiratory Research Network

Affiliations

¹ Department of Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. Electronic address: andrea.gershon@ices.on.ca.
² Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
³ ICES, Toronto, ON, Canada.
⁴ ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
⁵ Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of General Internal Medicine, University Health Network, Toronto, ON, Canada.
⁶ ICES, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Sinai Health System, Toronto, ON, Canada.
⁷ The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, ON, Canada.

PMID: 33011204
DOI: 10.1016/j.chest.2020.09.254

Abstract

Background: Patients admitted to the hospital with COPD are commonly managed with inhaled short-acting bronchodilators, sometimes in lieu of the long-acting bronchodilators they take as outpatients. If held on admission, these long-acting inhalers should be re-initiated upon discharge; however, health-care transitions sometimes result in unintentional discontinuation.

Research question: What is the risk of unintentional discontinuation of long-acting muscarinic antagonist (LAMA) and long-acting beta-agonist and inhaled corticosteroid (LABA-ICS) combination medications following hospital discharge in older adults with COPD?

Study design and methods: A retrospective cohort study was conducted by using health administrative data from 2004 to 2016 from Ontario, Canada. Adults with COPD aged ≥ 66 years who had filled prescriptions for a LAMA or LABA-ICS continuously for ≥ 1 year were included. Log-binomial regression models were used to determine risk of medication discontinuation following hospitalization in each medication cohort.

Results: Of the 27,613 hospitalization discharges included in this study, medications were discontinued 1,466 times. Among 78,953 patients with COPD continuously taking a LAMA or LABA-ICS, those hospitalized had a higher risk of having medications being discontinued than those who remained in the community (adjusted risk ratios of 1.50 [95% CI, 1.34-1.67; P < .001] and 1.62 [95% CI, 1.39, 1.90; P < .001] for LAMA and LABA-ICS, respectively). Crude rates of discontinuation for people taking LAMAs were 5.2% in the hospitalization group and 3.3% in the community group; for people taking LABA-ICS, these rates were 5.5% in the hospitalization group and 3.1% in the community group.

Interpretation: In an observational study of highly compliant patients with COPD, hospitalization was associated with an increased risk of long-acting inhaler discontinuation. These Results suggest a likely larger discontinuation problem among less adherent patients and should be confirmed and quantified in a prospective cohort of patients with COPD and average compliance. Quality improvement efforts should focus on safe transitions and patient medication reconciliation following discharge.

Keywords: COPD; bronchodilators; epidemiology; health-care utilization.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Administration, Inhalation
Adrenal Cortex Hormones / administration & dosage
Adrenal Cortex Hormones / pharmacokinetics
Adrenergic beta-Agonists / administration & dosage
Adrenergic beta-Agonists / pharmacokinetics
Aged
Bronchodilator Agents* / administration & dosage
Bronchodilator Agents* / pharmacokinetics
Canada / epidemiology
Continuity of Patient Care
Delayed-Action Preparations* / administration & dosage
Delayed-Action Preparations* / pharmacokinetics
Deprescriptions
Female
Humans
Male
Medication Therapy Management / standards*
Muscarinic Antagonists / administration & dosage
Muscarinic Antagonists / pharmacokinetics
Patient Discharge / standards*
Patient Transfer* / methods
Patient Transfer* / standards
Pulmonary Disease, Chronic Obstructive* / epidemiology
Pulmonary Disease, Chronic Obstructive* / therapy
Quality Improvement

Substances

Adrenal Cortex Hormones
Adrenergic beta-Agonists
Bronchodilator Agents
Delayed-Action Preparations
Muscarinic Antagonists