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Utilization and determinants of use of non-pharmacological interventions in COPD: Results of the COSYCONET cohort - 09/09/20

Doi : 10.1016/j.rmed.2020.106087 
Johanna I. Lutter a, , Marco Lukas a, b, c, Larissa Schwarzkopf a, d, Rudolf A. Jörres e, Michael Studnicka f, Kathrin Kahnert g, Stefan Karrasch e, h, Burkhard Bewig i, Claus F. Vogelmeier j, Rolf Holle a, c
for the

COSYCONET Study Group

a Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, GmbH – German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany 
b Pettenkofer School of Public Health, Marchioninistr. 15, 81377, Munich, Germany 
c Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany 
d IFT-Institut für Therapieforschung, Leopoldsstr. 175, 80804, Munich, Germany 
e Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ziemssenstr. 1, 80336, Munich, Germany 
f Department of Pneumology, Paracelsus Medical University Salzburg, Universitätsklinikum Salzburg, Müllner Hauptstrasse 48, 5020, Salzburg, Austria 
g Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, 80336, Munich, Germany 
h Institute of Epidemiology, Helmholtz Zentrum München (GmbH) – German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany 
i University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany 
j Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Baldingerstrasse, 35043, Marburg, Germany 

Corresponding author. Institute of Health Economics and Healthcare Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.Institute of Health Economics and Healthcare ManagementHelmholtz Zentrum München (GmbH) - German Research Center for Environmental HealthIngolstädter Landstraße 1Neuherberg85764Germany

Abstract

Background

Guidelines for chronic obstructive pulmonary disease (COPD) recommend supplementing pharmacotherapy with non-pharmacological interventions. Little is known about the use of such interventions by patients. We analyzed the utilization of a number of non-pharmacological interventions and identified potential determinants of use.

Methods

Based on self-reports, use of interventions (smoking cessation, influenza vaccination, physiotherapy, sports program, patient education, pulmonary rehabilitation) and recommendation to use were assessed in 1410 patients with COPD. The utilization was analyzed according to sex and severity of disease. Potential determinants of utilization included demographic variables and disease characteristics and were analyzed using logistic regression models.

Results

Influenza vaccination in the previous autumn/winter was reported by 73% of patients. About 19% were currently participating in a reimbursed sports program, 10% received physiotherapy, 38% were ever enrolled in an educational program, and 34% had ever participated in an outpatient or inpatient pulmonary rehabilitation program. Out of 553 current or former smokers, 24% had participated in a smoking cessation program. While reports of having received a recommendation to use mainly did not differ according to sex, women showed significantly (p < 0.05) higher utilization rates than men for all interventions except influenza vaccination. Smoking was a predictor for not having received a recommendation for utilization and also significantly associated with a reduced odds of utilization. We found a correlation between recommendation to use and utilization.

Conclusions

Utilization of non-pharmacological interventions was lower in men and smokers. A recommendation or offer to use by the physician could help to increase uptake.

Le texte complet de cet article est disponible en PDF.

Highlights

Women reported higher utilization of all non-pharmacological interventions than men.
Smoking was significantly associated with a reduced utilization of interventions.
Therapy options requiring a high degree of behavioral change were used less often.
Physicians' advice to participate was linked to higher utilization of interventions.

Le texte complet de cet article est disponible en PDF.

Keywords : Treatment guidelines, Non-pharmacological intervention, Gender differences, Vaccination, Smoking cessation


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Vol 171

Article 106087- septembre 2020 Retour au numéro
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