ArticleLancet regional health. Americas2023
Guideline-discordant inhaler regimens after COPD hospitalization: associations with rurality, drive time to care, and fragmented care - a United States cohort study.
Article in Lancet regional health. Americas, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Interventions Evaluated to Improve Inhaler Adherence in Patients with Chronic Obstructive Pulmonary Disease: A Scoping Review.International journal of chronic obstructive pulmonary disease · 2026Article
- Inhaled Therapy Adherence in COPD:A COM-B-Based Narrative Review of Determinants and Intervention Strategies.International journal of chronic obstructive pulmonary disease · 2026Review
- Guideline-concordant inhaled medication use in COPD: a systematic review of definitions used in administrative health data.ERJ open research · 2025Article
- Improving Research for COPD in Rural Areas: A Statement from the COPD Foundation Medical and Scientific Advisory Committee.Chronic obstructive pulmonary diseases (Miami, Fla.) · 2025Article
- Geographic Disparities by Rural-Urban Status and Drive Time to Care in Tobacco Treatment for COPD.JAMA network open · 2025Article
- How Does Disease Severity Affect Clinical Outcomes and Economic Burden of Patients with COPD -- A Retrospective Population-Based Cohort Study in Tianjin, China.International journal of chronic obstructive pulmonary disease · 2025Article
- National trend in the prevalence and mortality of COPD in South Korea from 2008 to 2017.BMJ open respiratory research · 2024Article
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Authors and funding
7 authors.
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Abstract
Background: Many patients receive guideline-discordant inhaler regimens after chronic obstructive pulmonary disease (COPD) hospitalization. Geography and fragmented care across multiple providers likely influence prescription of guideline-discordant inhaler regimens, but these have not been comprehensively studied. We assessed patient-level differences in guideline-discordant inhaler regimens by rurality, drive time to pulmonary specialty care, and fragmented care. Methods: Retrospective cohort analysis using national Veterans Health Administration (VA) data among patients who received primary care and prescriptions from the VA. Patients hospitalized for COPD exacerbation between 2017 and 2020 were assessed for guideline-discordant inhaler regimens in the subsequent 3 months. Guideline-discordant inhaler regimens were defined as short-acting inhaler/s only, inhaled corticosteroid (ICS) monotherapy, long-acting beta-agonist (LABA) monotherapy, ICS + LABA, long-acting muscarinic antagonist (LAMA) monotherapy, or LAMA + ICS. Rural residence and drive time to the closest pulmonary specialty care were obtained from geocoded addresses. Fragmented care was defined as hospitalization outside the VA. We used multivariable logistic regression models to assess associations between rurality, drive time, fragmentated care, and guideline-discordant inhaler regimens. Models were adjusted for age, sex, race/ethnicity, Charlson Comorbidity Index, Area Deprivation Index, and region. Findings: Of 33,785 patients, 16,398 (48.6%) received guideline-discordant inhaler regimens 3 months after hospitalization. Rural residents had higher odds of guideline-discordant inhalers regimens compared to their urban counterparts (adjusted odds ratio [aOR] 1.18 [95% CI: 1.12-1.23]). The odds of receiving guideline-discordant inhaler regimens increased with longer drive time to pulmonary specialty care (aOR 1.38 [95% CI: 1.30-1.46] for drive time >90 min compared to <30 min). Fragmented care was also associated with higher odds of guideline-discordant inhaler regimens (aOR 1.56 [95% CI: 1.48-1.63]). Interpretation: Rurality, long drive time to care, and fragmented care were associated with greater prescription of guideline-discordant inhaler regimens after COPD hospitalization. These findings highlight the need to understand challenges in delivering evidence-based care. Funding: NIHNCATS grants KL2TR002492 and UL1TR002494.
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