Relationship Between Changes in Inhalation Treatment Level and Exacerbation of Chronic Obstructive Pulmonary Disease: Nationwide the Health Insurance and Assessment Service Database

• Main Authors: Jo YS, Yoo KH, Park YB, Rhee CK, Jung KS, Jang SH, Park JY, Kim Y, Kim BY, Ahn SI, Jo YU, Hwang YI
• Format: Article
• Language: English
• Published: Dove Medical Press 2020-06-01
• Series: International Journal of COPD
• Subjects: copd; population-based; quality assessment; inhaler; health care utilization
• Online Access: https://www.dovepress.com/relationship-between-changes-in-inhalation-treatment-level-and-exacerb-peer-reviewed-article-COPD

Yong Suk Jo,1,2 Kwang Ha Yoo,3 Yong Bum Park,1,2 Chin Kook Rhee,4 Ki Suck Jung,2,5 Seung Hun Jang,2,5 Ji Young Park,2,5 Youlim Kim,2,6 Bo Yeon Kim,7 Sang In Ahn,7 Yon U Jo,7 Yong Il Hwang2,5 1Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea; 2Lung Research Institute of Hallym University College of Medicine, Chuncheon, South Korea; 3Department of Internal Medicine, Division of Pulmonary and Allergy Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea; 4Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; 5Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; 6Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon-Si, Gangwon-Do, Korea; 7Health Insurance Review & Assessment Service, Wonju, Republic of KoreaCorrespondence: Yong Il Hwang Tel [phone]Fax [phone]Email [e-mail] and Objective: Maintaining adequacy in chronic obstructive pulmonary disease (COPD) care is essential to sustain an adequate level of care. We aimed to assess the current status of COPD quality control and the influence of inhaler changes on disease-related health care utilization.Methods: The Health Insurance Review and Assessment Service (HIRA) nationwide database for reimbursed insurance claims from all medical institutions in South Korea from May 2014 to April 2017 was investigated. COPD care quality was assessed by the performance rate of spirometry, the percentage of persistent visit patients and patients prescribed a bronchodilator. The number of severe exacerbations was evaluated.Results: A total of 68,942 COPD patients were included for 3 years of longitudinal analyses. The overall spirometry enforcement rate was just over 50%, the percentage of regular follow-up patients was over 85%, and bronchodilators were prescribed to over 80% of the patients. COPD-related hospitalization or ER visit rates were 16.6%, 15.3%, and 17.8% for three consequent assessments, respectively. Inhaler changes were analyzed between the first and second assessments: 57.1% were maintained, 0.4% were changed to another class, 9% were escalated, and 5.2% were de-escalated. Only in the escalated group, especially those who changed from the mono to dual inhaler and dual to triple inhaler, had fewer hospitalizations or ER visits.Conclusion: Adequacy of COPD care status was not that high considering the low-enforcement rate of spirometry, but most patients were prescribed a bronchodilator and regularly followed up. Those who escalated inhaler treatment experienced less health care utilization.Keywords: COPD, population-based, quality assessment, inhaler, health care utilization