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Redundant medication use during acute exacerbation of chronic obstructive pulmonary disease in hospitalized patients

Abstract

Background Few clinical studies have evaluated redundant therapy during an exacerbation of chronic obstructive pulmonary disease in hospitalized patients, but clinical practice guidelines endorse this practice. Objective The aim of this study is to measure the frequency of redundant therapy and explore its association with clinical outcomes, adverse effects, and cost among adults hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Setting Six hospitals within an academic health system in the United States. Method A retrospective cohort study of adults with a principal diagnosis of acute exacerbation of chronic obstructive pulmonary disease between January 1, 2016 and March 31, 2016 was performed. Main outcome measure The primary outcome was the proportion of patients who received redundant therapy during inpatient management of acute exacerbation of chronic obstructive pulmonary disease. Results Overall, 137 patients were included and 99 (72.7%) received redundant medication therapy. Redundant therapy was not associated with significant differences in clinical outcomes such as median hospital length of stay, 30-day readmission, tachycardia, thrush, psychiatric symptoms or urinary retention in the univariate or multivariate analyses. The median medication acquisition cost per patient was nearly 11-fold higher among those receiving redundant medication therapy [$135.14 (49.21) vs 12.50 (17.02); p < 0.001]. After controlling for confounding variables using multivariate linear regression, the cost of redundant medication therapy was $50.20 higher on average (p < 0.001). Conclusion Redundant inhaled therapy for acute exacerbation of chronic obstructive pulmonary disease in the hospital setting was not associated with improved clinical outcomes or more adverse effects but did significantly increase medication cost. The findings of this study should be considered exploratory.

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Acknowledgements

Jessel C Dela Cruz PharmD. candidate for helping with the background literature search; Allisha L Gabriel, Pharm.D. for collecting data; Louisa K Sullivan Pharm.D. for collecting data; Linh Y Tran, PharmD. candidate for helping with the background literature search, Yongyue Qi for helping with data analysis.

Funding

This study was unfunded.

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Correspondence to Ryan Dull.

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This retrospective cohort study was approved as exempt by the university institutional review board (IRB project number 972710-1).

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Dull, R., Dull, S. Redundant medication use during acute exacerbation of chronic obstructive pulmonary disease in hospitalized patients. Int J Clin Pharm 42, 1278–1285 (2020). https://doi.org/10.1007/s11096-020-01064-7

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Keywords

  • Chronic obstructive pulmonary disease
  • COPD
  • Costs
  • Duplicate medication
  • Redundant medication
  • Redundant medications
  • United States