Patients' geography impacts guideline-concordant COPD care

Geographical challenges to accessing care increase the likelihood of receiving guideline-discordant inhaler regimens following hospitalization for chronic obstructive pulmonary disease (COPD) exacerbation, according to a study published online in the October issue of The Lancet Regional Health: Americas.

Arianne K. Baldomero, M.D., from the Minneapolis Veterans Affairs Health Care System, and colleagues assessed patient-level differences in guideline-discordant inhaler regimens by rurality, drive time to pulmonary specialty care, and fragmented care. The analysis included 33,785 VA patients with COPD who received primary care and prescriptions (2017 to 2020).

The researchers found that 48.6% of patients received guideline-discordant inhaler regimens three months after hospitalization for COPD exacerbation.

There were higher odds of guideline-discordant inhaler regimens among rural residents versus their urban counterparts (adjusted odds ratio, 1.18). With longer drive time to pulmonary specialty care, the odds of receiving guideline-discordant inhaler regimens increased (adjusted odds ratio, 1.38 for drive time >90 minutes versus <30 minutes). Higher odds of guideline-discordant inhaler regimens were also seen with fragmented care (adjusted odds ratio, 1.56).

"Our findings suggest the need for development of innovative programs to improve delivery of guideline-concordant COPD care, especially in high-risk COPD patients with geographic barriers to care and fragmented care," the authors write.

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