Factors associated with inhaled corticosteroids prescription in primary care patients with COPD: A cross-sectional study in the Balearic Islands (Spain)

Román-Rodríguez, Miguel; van Boven, Job F. M.; Vargas, Freya; Contreras, Cecilia C.; Lamelas, Gema; Gestoso, Salvador; Gongora, Miguel; Corredor Ibáñez, María Teresa; Esteva Cantó, Magdalena

Factors associated with inhaled corticosteroids prescription in primary care patients with COPD: A cross-sectional study in the Balearic Islands (Spain)

Background: There is a worldwide over-prescription of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD), off-label prescribing, and unnecessary prescription of high doses. Objectives: Our aim was to assess the prescription rate of ICS and to identify sociode...

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Autores:	Román-Rodríguez, Miguel, van Boven, Job F. M., Vargas, Freya, Contreras, Cecilia C., Lamelas, Gema, Gestoso, Salvador, Gongora, Miguel, Corredor Ibáñez, María Teresa, Esteva Cantó, Magdalena
Tipo de recurso:	artículo
Fecha de publicación:	2016
País:	España
Institución:	Conselleria de Salut i Consum del Govern de les Illes Balears
Repositorio:	Docusalut
Idioma:	inglés
OAI Identifier:	oai:docusalut.com:20.500.13003/10515
Acceso en línea:	https://hdl.handle.net/20.500.13003/10515
Access Level:	acceso abierto
Palabra clave:	Administration, Inhalation Male Aged, 80 and over Asthma Aged Dose-Response Relationship, Drug Spain Adrenal Cortex Hormones Pulmonary Disease, Chronic Obstructive Humans Smoking Middle Aged Cross-Sectional Studies Spirometry Primary Health Care Regression Analysis Female Multivariate Analysis Femenino Análisis Multivariante Administración por Inhalación Masculino Fumar Estudios Transversales Enfermedad Pulmonar Obstructiva Crónica Relación Dosis-Respuesta a Droga Humanos Persona de Mediana Edad Anciano Asma Anciano de 80 o más Años Corticoesteroides Atención Primaria de Salud Análisis de Regresión Espirometría España Chronic obstructive pulmonary disease treatment inhaled corticosteroids primary care quality of healthcare

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spelling	Factors associated with inhaled corticosteroids prescription in primary care patients with COPD: A cross-sectional study in the Balearic Islands (Spain)Román-Rodríguez, Miguelvan Boven, Job F. M.Vargas, FreyaContreras, Cecilia C.Lamelas, GemaGestoso, SalvadorGongora, MiguelCorredor Ibáñez, María TeresaEsteva Cantó, MagdalenaAdministration, InhalationMaleAged, 80 and overAsthmaAgedDose-Response Relationship, DrugSpainAdrenal Cortex HormonesPulmonary Disease, Chronic ObstructiveHumansSmokingMiddle AgedCross-Sectional StudiesSpirometryPrimary Health CareRegression AnalysisFemaleMultivariate AnalysisAged, 80 and overFemeninoAnálisis MultivarianteAdministración por InhalaciónMasculinoFumarEstudios TransversalesEnfermedad Pulmonar Obstructiva CrónicaRelación Dosis-Respuesta a DrogaHumanosPersona de Mediana EdadAncianoAsmaAnciano de 80 o más AñosCorticoesteroidesAtención Primaria de SaludAnálisis de RegresiónEspirometríaEspañaChronic obstructive pulmonary diseasetreatmentinhaled corticosteroidsprimary carequality of healthcareBackground: There is a worldwide over-prescription of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD), off-label prescribing, and unnecessary prescription of high doses. Objectives: Our aim was to assess the prescription rate of ICS and to identify sociodemographic and clinical factors associated with ICS prescription among patients with COPD, treated in Balearic primary healthcare. Methods: This cross-sectional study included all patients with a clinical COPD diagnosis, who attended a primary care centre of the Balearic Islands (Spain) during 2012. Also, a sub-population with spirometry-confirmed COPD was defined. Data were obtained on patient demographics, smoking status, spirometry, ICS prescriptions, other respiratory medication, exacerbations and comorbidities. Associations with ICS and high-dose ICS prescription were assessed using multivariate regression analyses. Results: In total, 15,440 patients were included (70% men, mean age 68.6 years), and 44.6% were prescribed ICS. The largest association with ICS prescription was asthma comorbidity (OR: 3.50; 95%CI: 3.12-3.92), followed by exacerbation history (OR: 2.23; 95%CI: 2.07-2.47). In addition, smoking status, spirometry, atopic dermatitis, allergic rhinitis and mean age were significantly (P<0.001) associated with ICS treatment. In the spirometry-confirmed population, asthma (OR: 2.89; 95%CI: 2.29-3.64) and exacerbations were also the major factors (OR: 2.85; 95%CI: 2.45-3.32) followed by severe bronchial-obstruction (OR: 2.63; 95%CI: 2.24-3.08). High-dose ICS prescription was mainly associated with severe obstruction (OR: 2.27; 95%CI: 1.93-2.68). Conclusion: The percentage of COPD patients prescribed ICS in Balearic primary care is relatively low. Asthma comorbidity, exacerbation history, severe bronchial-obstruction, smoking status and a spirometry-confirmed COPD diagnosis were significantly associated with ICS prescription.Taylor & Francis Ltd20162016-01-0120162016-01-01research articlehttp://purl.org/coar/resource_type/c_2df8fbb1info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/20.500.13003/10515reponame:Docusalutinstname:Conselleria de Salut i Consum del Govern de les Illes BalearsInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:docusalut.com:20.500.13003/105152026-06-22T12:44:07Z
dc.title.none.fl_str_mv	Factors associated with inhaled corticosteroids prescription in primary care patients with COPD: A cross-sectional study in the Balearic Islands (Spain)
title	Factors associated with inhaled corticosteroids prescription in primary care patients with COPD: A cross-sectional study in the Balearic Islands (Spain)
spellingShingle	Factors associated with inhaled corticosteroids prescription in primary care patients with COPD: A cross-sectional study in the Balearic Islands (Spain) Román-Rodríguez, Miguel Administration, Inhalation Male Aged, 80 and over Asthma Aged Dose-Response Relationship, Drug Spain Adrenal Cortex Hormones Pulmonary Disease, Chronic Obstructive Humans Smoking Middle Aged Cross-Sectional Studies Spirometry Primary Health Care Regression Analysis Female Multivariate Analysis Aged, 80 and over Femenino Análisis Multivariante Administración por Inhalación Masculino Fumar Estudios Transversales Enfermedad Pulmonar Obstructiva Crónica Relación Dosis-Respuesta a Droga Humanos Persona de Mediana Edad Anciano Asma Anciano de 80 o más Años Corticoesteroides Atención Primaria de Salud Análisis de Regresión Espirometría España Chronic obstructive pulmonary disease treatment inhaled corticosteroids primary care quality of healthcare
title_short	Factors associated with inhaled corticosteroids prescription in primary care patients with COPD: A cross-sectional study in the Balearic Islands (Spain)
title_full	Factors associated with inhaled corticosteroids prescription in primary care patients with COPD: A cross-sectional study in the Balearic Islands (Spain)
title_fullStr	Factors associated with inhaled corticosteroids prescription in primary care patients with COPD: A cross-sectional study in the Balearic Islands (Spain)
title_full_unstemmed	Factors associated with inhaled corticosteroids prescription in primary care patients with COPD: A cross-sectional study in the Balearic Islands (Spain)
title_sort	Factors associated with inhaled corticosteroids prescription in primary care patients with COPD: A cross-sectional study in the Balearic Islands (Spain)
dc.creator.none.fl_str_mv	Román-Rodríguez, Miguel van Boven, Job F. M. Vargas, Freya Contreras, Cecilia C. Lamelas, Gema Gestoso, Salvador Gongora, Miguel Corredor Ibáñez, María Teresa Esteva Cantó, Magdalena
author	Román-Rodríguez, Miguel
author_facet	Román-Rodríguez, Miguel van Boven, Job F. M. Vargas, Freya Contreras, Cecilia C. Lamelas, Gema Gestoso, Salvador Gongora, Miguel Corredor Ibáñez, María Teresa Esteva Cantó, Magdalena
author_role	author
author2	van Boven, Job F. M. Vargas, Freya Contreras, Cecilia C. Lamelas, Gema Gestoso, Salvador Gongora, Miguel Corredor Ibáñez, María Teresa Esteva Cantó, Magdalena
author2_role	author author author author author author author author
dc.contributor.none.fl_str_mv
dc.subject.none.fl_str_mv	Administration, Inhalation Male Aged, 80 and over Asthma Aged Dose-Response Relationship, Drug Spain Adrenal Cortex Hormones Pulmonary Disease, Chronic Obstructive Humans Smoking Middle Aged Cross-Sectional Studies Spirometry Primary Health Care Regression Analysis Female Multivariate Analysis Aged, 80 and over Femenino Análisis Multivariante Administración por Inhalación Masculino Fumar Estudios Transversales Enfermedad Pulmonar Obstructiva Crónica Relación Dosis-Respuesta a Droga Humanos Persona de Mediana Edad Anciano Asma Anciano de 80 o más Años Corticoesteroides Atención Primaria de Salud Análisis de Regresión Espirometría España Chronic obstructive pulmonary disease treatment inhaled corticosteroids primary care quality of healthcare
topic	Administration, Inhalation Male Aged, 80 and over Asthma Aged Dose-Response Relationship, Drug Spain Adrenal Cortex Hormones Pulmonary Disease, Chronic Obstructive Humans Smoking Middle Aged Cross-Sectional Studies Spirometry Primary Health Care Regression Analysis Female Multivariate Analysis Aged, 80 and over Femenino Análisis Multivariante Administración por Inhalación Masculino Fumar Estudios Transversales Enfermedad Pulmonar Obstructiva Crónica Relación Dosis-Respuesta a Droga Humanos Persona de Mediana Edad Anciano Asma Anciano de 80 o más Años Corticoesteroides Atención Primaria de Salud Análisis de Regresión Espirometría España Chronic obstructive pulmonary disease treatment inhaled corticosteroids primary care quality of healthcare
description	Background: There is a worldwide over-prescription of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD), off-label prescribing, and unnecessary prescription of high doses. Objectives: Our aim was to assess the prescription rate of ICS and to identify sociodemographic and clinical factors associated with ICS prescription among patients with COPD, treated in Balearic primary healthcare. Methods: This cross-sectional study included all patients with a clinical COPD diagnosis, who attended a primary care centre of the Balearic Islands (Spain) during 2012. Also, a sub-population with spirometry-confirmed COPD was defined. Data were obtained on patient demographics, smoking status, spirometry, ICS prescriptions, other respiratory medication, exacerbations and comorbidities. Associations with ICS and high-dose ICS prescription were assessed using multivariate regression analyses. Results: In total, 15,440 patients were included (70% men, mean age 68.6 years), and 44.6% were prescribed ICS. The largest association with ICS prescription was asthma comorbidity (OR: 3.50; 95%CI: 3.12-3.92), followed by exacerbation history (OR: 2.23; 95%CI: 2.07-2.47). In addition, smoking status, spirometry, atopic dermatitis, allergic rhinitis and mean age were significantly (P<0.001) associated with ICS treatment. In the spirometry-confirmed population, asthma (OR: 2.89; 95%CI: 2.29-3.64) and exacerbations were also the major factors (OR: 2.85; 95%CI: 2.45-3.32) followed by severe bronchial-obstruction (OR: 2.63; 95%CI: 2.24-3.08). High-dose ICS prescription was mainly associated with severe obstruction (OR: 2.27; 95%CI: 1.93-2.68). Conclusion: The percentage of COPD patients prescribed ICS in Balearic primary care is relatively low. Asthma comorbidity, exacerbation history, severe bronchial-obstruction, smoking status and a spirometry-confirmed COPD diagnosis were significantly associated with ICS prescription.
publishDate	2016
dc.date.none.fl_str_mv	2016 2016-01-01 2016 2016-01-01
dc.type.none.fl_str_mv	research article http://purl.org/coar/resource_type/c_2df8fbb1
dc.type.openaire.fl_str_mv	info:eu-repo/semantics/article
format	article
dc.identifier.none.fl_str_mv	https://hdl.handle.net/20.500.13003/10515
url	https://hdl.handle.net/20.500.13003/10515
dc.language.none.fl_str_mv	Inglés eng
language_invalid_str_mv	Inglés
language	eng
dc.rights.none.fl_str_mv	open access http://purl.org/coar/access_right/c_abf2 Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv	info:eu-repo/semantics/openAccess
rights_invalid_str_mv	open access http://purl.org/coar/access_right/c_abf2 Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv	openAccess
dc.format.none.fl_str_mv	application/pdf
dc.publisher.none.fl_str_mv	Taylor & Francis Ltd
publisher.none.fl_str_mv	Taylor & Francis Ltd
dc.source.none.fl_str_mv	reponame:Docusalut instname:Conselleria de Salut i Consum del Govern de les Illes Balears
instname_str	Conselleria de Salut i Consum del Govern de les Illes Balears
reponame_str	Docusalut
collection	Docusalut
repository.name.fl_str_mv
repository.mail.fl_str_mv
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Factors associated with inhaled corticosteroids prescription in primary care patients with COPD: A cross-sectional study in the Balearic Islands (Spain)

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