■目前的指南建议对慢性阻塞性肺疾病(COPD)反复加重的患者使用三联疗法维持吸入器;然而,这些维持疗法未得到充分利用。这项研究旨在了解医生如何做出COPD治疗决定,以及如何在现实世界中使用组合维持疗法。
■这个探索性的,产生假设,非干预性研究使用了一项横断面在线调查,该调查对美国的执业医师样本进行了分析.该调查包括五个虚构的插图,详细介绍了COPD患者的常见症状。调查问题包括医生在决策中考虑的因素,以及处方治疗的障碍。进行了重复测量多变量分析,以评估医生转换为三联疗法与不改变患者当前的维持疗法或改变为另一种维持疗法的可能性。
■总共,200名医生完成了调查。据报道,治疗费用和患者获得治疗的机会是医生在处方决策中考虑的最常见障碍。如果考虑到患者的新症状史,医生更有可能将患者的维持吸入器转换为三联疗法,而不更换维持吸入器。保险状况,和临床指南在他们的决定。有更多经验治疗COPD患者的医生,那些每周治疗更多COPD患者的人,与不更换维持吸入器相比,更有可能改用三联疗法。
这项研究表明,在为COPD患者开处方治疗时,可能影响医生决策的因素的复杂性,包括治疗成本的考虑,患者的访问和依从性,患者合并症,目前的治疗效果,临床指南,以及提供者治疗COPD的经验水平。进一步的研究可能有助于阐明影响医生决策的因素的相对重要性,并告知哪些类型的决策支持工具最有益。
慢性阻塞性肺疾病(COPD)症状可以通过维持治疗得到有效控制,这是常规治疗,以帮助改善症状。在中度至重度COPD患者中,三种不同疗法的组合(三联疗法维持)已被证明比两种不同疗法的组合(双重疗法维持)更有效。然而,维持疗法,包括三联疗法,没有得到充分利用。这项研究旨在探讨医生如何为COPD患者做出治疗决定,以及如何使用组合维持疗法。要做到这一点,我们对美国的执业医师进行了一项调查.该调查包括五项基于临床的,虚构的个人资料,或者小插曲,COPD患者,描述了常见的症状和患者特征。然后,医生被要求回答关于他们将为每个患者开什么治疗方法的问题,以及他们在决定患者治疗时考虑的任何因素。我们发现,治疗费用和患者获得治疗是医生在选择治疗时考虑的最常见障碍。如果考虑到患者的新症状史,医生也更有可能将患者的维持吸入器转换为三联疗法维持吸入器。患者的保险状况,以及做出决定时的临床指南。我们的研究表明,在决定COPD患者的治疗时,有许多复杂的因素会影响医生的决定。
UNASSIGNED: Current guidelines recommend triple therapy maintenance inhalers for patients with recurrent exacerbations of chronic obstructive pulmonary disease (COPD); however, these maintenance therapies are underutilized. This
study aimed to understand how physicians make COPD treatment decisions, and how combination maintenance therapies are utilized in a real-world setting.
UNASSIGNED: This exploratory, hypothesis-generating, non-interventional
study used a cross-sectional online survey that was administered to a sample of practicing physicians in the United States. The survey included five fictitious vignettes detailing common symptoms experienced by patients with COPD. Survey questions included factors physicians consider in their decisions, and perceived barriers to prescribing treatments. Repeated measures multivariable analyses were conducted to evaluate how likely physicians were to switch to triple therapy versus no change to patient\'s current maintenance therapy or change to another maintenance therapy.
UNASSIGNED: In total, 200 physicians completed the survey. Cost of treatment and patient access to treatment were reported as the most common barriers physicians consider in their prescribing decisions. Physicians were more likely to switch a patient\'s maintenance inhaler to triple therapy versus no change to maintenance inhaler if they considered the patient\'s history of new symptoms, insurance status, and clinical guidelines in their decision. Physicians with more experience treating patients with COPD, and those who treat more patients with COPD per week, were more likely to switch to triple therapy versus no change to maintenance inhaler.
UNASSIGNED: This
study demonstrates the complexity of factors that can influence physicians\' decisions when prescribing treatments for patients with COPD, including considerations of treatment cost, patient access and adherence, patient comorbidities, efficacy of current treatment, clinical guidelines, and provider\'s level of experience treating COPD. Further research may help elucidate the relative importance of the factors influencing physicians\' decisions and inform what types of decision-support tools would be most beneficial.
Chronic obstructive pulmonary disease (COPD) symptoms can be effectively managed with maintenance therapies, which are treatments that are taken routinely to help improve symptoms. A combination of three different therapies (triple therapy maintenance) has been shown to be more effective than a combination of two different therapies (dual therapy maintenance) in patients with moderate-to-severe COPD. However, maintenance therapies, including triple therapy, are underutilized. This
study aimed to explore how physicians make their treatment decisions for patients with COPD, and how combination maintenance therapies are utilized. To do so, we administered a survey to a sample of practicing physicians in the United States. The survey included five clinically based, fictitious profiles, or vignettes, of patients with COPD, with common symptoms and patient characteristics being described. Physicians were then asked to answer questions about what treatment they would prescribe for each patient, and any factors they considered when deciding on a treatment for a patient. We found that cost of treatment and patient access to treatment were the most common barriers that physicians considered when choosing a treatment. Physicians were also more likely to switch a patient’s maintenance inhaler to a triple therapy maintenance inhaler if they considered the patient’s history of new symptoms, patient’s insurance status, and clinical guidelines when making their decisions. Our
study shows that there are many complex factors that influence physicians’ decisions when deciding on a treatment for patients with COPD.