Predictors of Adherence to Inhaled Medications Among Veterans with COPD

BACKGROUND

Factors contributing to medication nonadherence among patients with chronic obstructive pulmonary disease (COPD) are poorly understood.

OBJECTIVES

To identify patient characteristics that are predictive of adherence to inhaled medications for COPD and, for patients on multiple inhalers, to assess whether adherence to one medication class was associated with adherence to other medication classes.

DESIGN

Cohort study using data from Veteran Affairs (VA) electronic databases.

PARTICIPANTS

This study included 2,730 patients who underwent pulmonary function testing between 2003 and 2007 at VA facilities in the Northwestern United States, and who met criteria for COPD.

MAIN MEASURES

We used pharmacy records to estimate adherence to inhaled corticosteroids (ICS), ipratropium bromide (IP), and long-acting beta-agonists (LABA) over two consecutive six month periods. We defined patients as adherent if they had refilled medications to have 80?% of drug available over the time period. We also collected information on their demographics, behavioral habits, COPD severity, and comorbidities.

KEY RESULTS

Adherence to medications was poor, with 19.8?% adherent to ICS, 30.6?% adherent to LABA, and 25.6?% adherent to IP. Predictors of adherence to inhaled therapies were highly variable and dependent on the medication being examined. In adjusted analysis, being adherent to a medication at baseline was the strongest predictor of future adherence to that same medication [(Odds ratio, 95?% confidence interval) ICS: 4.79 (3.22?C7.12); LABA: 6.60 (3.92?C11.11); IP: 14.13 (10.00?C19.97)], but did not reliably predict adherence to other classes of medication.

CONCLUSIONS

Among patients with COPD, past adherence to one class of inhaled medication strongly predicted future adherence to the same class of medication, but only weakly predicted adherence to other classes of medication.     

Predictors of Preventive Health Care Use Among Middle-aged and Older Adults in Mexico: The Role of Religion

Research has shown that religion is associated with a wide range of health behaviors among adults of all ages. Although there is strong support for religion’s influence on behaviors such as drinking and smoking, less is known about the possible relationship between religion and the use of preventive health services. This relationship may be particularly important in Mexico, a country with high levels of religiousness and low levels of preventive service utilization. The current study uses a nationally representative sample of middle-aged and older adults in Mexico (n = 9,890) to test the association between three facets of religion and three preventive services aimed at detecting chronic conditions or underlying risk factors. The findings show that religious salience is significantly related to the use of blood pressure and cholesterol screenings, even after controlling for a variety of social, demographic, and health-related factors. In addition, attending religious services and participating in religious activities are both positively associated with blood pressure and diabetes screening. This type of research adds to our knowledge of the determinants of preventive service utilization, as well as to the burgeoning literature on religion and health. Furthermore, because the vast majority of research in this field takes place in more developed and Westernized countries, such as the US and Western Europe, analyzing this relationship in a sample of older Mexicans is critical for providing the field with a more comparative orientation.     

Substance Use Predictors of Poor Medication Adherence: The Role of Substance Use Coping Among HIV-Infected Patients in Opioid Dependence Treatment

Many HIV-infected injection drug users (IDUs) continue to use illicit substances despite being in substance use treatment. Substance use is associated with non-adherence to HIV medications; however underlying mechanisms regarding this relation are understudied. The current investigation examined the role of substance use coping in terms of the relation between substance use and HIV medication adherence. Participants were 121 HIV-infected IDUs (41 % female, M age = 47, SD = 7.1) in opioid dependence treatment. Participants completed self-report questionnaires, were administered clinical interviews and oral toxicology screens, and used a medication-event-monitoring-system cap to assess 2 week HIV medication adherence. The use of cocaine and multiple substances were significantly related to decreased medication adherence. Substance use coping mediated these associations. Findings highlight the importance of assessing, monitoring, and targeting ongoing substance use, and ways to increase positive coping for HIV-infected IDUs in substance use treatment to aid in HIV medication adherence.     

Ethnic and Racial Disparities in Resource Utilization and In-hospital Outcomes Among Those Admitted for Atrial Fibrillation: A National Analysis

Disparities in overall outcomes for atrial fibrillation (AF) across racial and ethnic groups have been demonstrated in prior studies. We aim to evaluate in-hospital outcomes and resource utilization across 3 racial/ethnic groups with AF using contemporary data. We identified patients admitted with AF in the National Inpatient Sample registry from 2015 to 2018. ICD-10-CM codes were used to identify variables of interest. The primary outcomes were in-hospital complications and resource utilization. There were 1,250,075 AF admissions. Our sample was made up of 85.49% White, 8.12% Black, and 6.38% Hispanic patients. Black patients were younger but had a higher burden of cardiovascular comorbidities including obesity, hypertension, and chronic kidney disease. Social determinants were also less favorable in Black patients, with a higher percentage of Medicaid insurance and a high proportion of patients being in the lowest percentile for household income. Total hospital charge was highest in Hispanic patients. Despite higher rates of gastrointestinal bleed, Black patients were least likely to undergo left atrial appendage occlusion device implantation. Black and Hispanic patients were less like to undergo catheter ablation therapy. Black race was an independent predictor of mortality, stroke, mechanical ventilation, acute kidney injury, hemodynamic shock, need for vasopressor, upper gastrointestinal bleed, need for blood transfusion, total hospital charges, and length of stay when compared to other groups. Disparities exist in the risk of AF, and its management among racial and ethnic groups. Health care costs and inpatient outcomes disproportionately impact minorities in the United States.     

COPD Exacerbation Frequency,Pharmacotherapy and Resource Use: An Observational Study in UK Primary Care

Chronic Obstructive Pulmonary Disease (COPD) management represents a significant health resource use burden. Understanding of current resource use, treatment strategies and outcomes can improve future COPD management, for patient benefit and to aid efficient service delivery. This study aimed to describe exacerbation frequency, pharmacotherapy and health resource use in COPD management in routine UK primary care. A retrospective, observational study using routine clinical records of 511 patients with COPD, was undertaken in 10 General Practices in England. Up to 3 years’ patient data were collected and analysed. 75% (234/314) patients with mild-moderate COPD (≥50% predicted FEV₁) received inhaled corticosteroids (ICS). 11% of patients (54/511) received ICS monotherapy. Mean (standard deviation) annual exacerbation frequency was 1.1 (1.2) in mild-moderate, 1.7 (1.6) in severe (30–49% predicted FEV₁) and 2.2 (2.0) in very severe (<30% predicted FEV₁) COPD. 14% patients (69/511) had a mean exacerbation frequency of ≥3/year (‘frequent-exacerbators’); 9% (27/314) of patients with mild-moderate, 19% (27/145) with severe and 29% (15/52) with very severe COPD. 14% (10/69) of frequent-exacerbators failed to receive inhaled long-acting beta agonists (LABA), 25% (17/69) inhaled long-acting muscarinic antagonists (LAMA), and 12% (`/69) ICS. Frequent-exacerbators had a median of 6.67 primary care contacts/year, 1.0 secondary care visits/year and 21% were hospitalised for COPD/year. Inhaled therapy was frequently inappropriate, with over-use of ICS in patients with mild-moderate COPD. COPD exacerbations were associated with high health resource use and occurred at all levels of disease severity. COPD management strategies should encompass risk-stratification for both exacerbation frequency and physiological impairment.     

National Trends of Tobacco,Alcohol, and Drug Use in Patients Admitted With Acute Myocardial Infarction

BackgroundAcute myocardial infarction (AMI) is a significant health and economic burden in the US. Tobacco, alcohol, and drug use are established risk factors. We sought to evaluate the national trend of use of each substance in patients admitted with AMI.MethodsWe used the National Inpatient Sample between 2005 and 2017. We included adult patients hospitalized with AMI. International Classification of Diseases, Ninth and Tenth Revisions codes were used to define tobacco, alcohol, cocaine, opioid, cannabis and other drug use. Trends of each substance use were assessed using multivariable Poisson regression, and were expressed as annual percent change (APC) with their 95% confidence intervals (CIs).ResultsA total of 10,796,844 hospitalizations with AMI were included. Among all substances used, tobacco was the most common (32.7%), followed by alcohol (3.2%). Between 2005 and 2017, the prevalence ratio of tobacco use increased from 21.5% to 44.5% with an APC +6.2% (95%CI 6.2%–6.2%). Tobacco users had more percutaneous coronary intervention (41%vs25%) and coronary artery bypass surgery (6.9%vs4.9%), p < 0.001. Further, there were positive trends in alcohol (APC +3.1%; 95%CI 3.0%–3.2%), opioid (APC +9.0%; 95%CI 8.7%–9.2%), cannabis (APC + 7.2; 95% CI 7%–7.4%), and combined all drug use (+7.1%; 95%CI 7%–7.2%). Meanwhile, there was a slight negative trend in cocaine use.ConclusionsThis analysis outlines the national trends of substance use in patients admitted with AMI and reveals an increasing prevalence of tobacco use, alcohol and drug use. More effective cessation measures are necessary to reduce the risk for AMI and its burden on the healthcare system and economy.     

Habit, Intention, and Drug Use as Interactive Predictors of Condom Use Among Drug Abusers

This three-wave study explored the prospective effects of habit (previous condom use), intentions to use condoms, past and proximal (before sex) drug use (alcohol, marijuana, cigarette, and hard drug use), and interactions among these variables on condom use among 211 men and women intravenous drug users. Several theoretical alternatives were evaluated. In one alternative, habit is thought to have preeminence over intentions and other variables in the prediction of behavior. In another alternative, drug use is thought to interact in its effects on condom use, by making individuals susceptible to not adhering to their previous intentions regarding safe sex practices. The results showed that condom use habit was a consistent and strong predictor of future condom use, whereas intention was a weak and inconsistent predictor. Neither past (long-term) nor proximal (before sex) drug use moderated (interacted with) the effects of either intention or habit on later condom use. The preeminence of habit in the prediction of condom use is similar to findings from other areas of health behavior, underscoring the need for more focused research on the underpinnings of health habit effects.Correspondence should be directed to Alan Stacy, Department of Psychology, UCLA, 1282A Franz Hall, Los Angeles, California 90095-1563.     

Risk Factors for Serious Alcohol and Drug Use: The Role of Psychosocial Variables in Predicting the Frequency of Substance Use Among Adolescents

Reviews of the psychosocial risk factors of adolescent alcohol and drug use suggest that the highest risks can be summarized as: 1) psychological functioning, 2) family environment, 3) peer relationships, and 4) stressful life events. The purpose of this study is to describe the relationships among the most common risk factors among a clinical sample (n = 214) and to determine the collective importance of these risk factors on problems with substance use. Collectively, these risk factors were most effective in explaining alcohol use and binge drinking and marijuana use, which were the most frequent types of substance use in this sample. Antisocial peers and delinquent behavior were the strongest predictors of substance use. Implications are that treatment programs target different psychosocial factors depending on the substance being used, and put extra effort on understanding and altering the relationship between an adolescent's choice of peers and their own attitudes toward delinquency and drug use.