Dataset Information

COPD treatment pathways in France: a retrospective analysis of electronic medical record data from general practitioners.

ABSTRACT: Background:Increasing availability of therapeutic options for COPD may drive new treatment pathways. This study describes COPD treatment in France, focusing on identifying initial treatment modifications in patients with COPD who either initiated long-acting bronchodilator (LABD)-based therapy or escalated to triple therapy (long-acting muscarinic antagonist [LAMA] + long-acting ?2-agonist [LABA] + inhaled corticosteroid [ICS]). Methods:This retrospective analysis of patients with COPD in a large general practitioner database (IQVIA Longitudinal Patient Database) in France included two cohorts: Cohort 1 - new initiators of LABD-based therapy (LAMA, LABA, LAMA + LABA, LAMA + ICS, LABA + ICS or LAMA + LABA + ICS); Cohort 2 - patients escalating to triple therapy from mono- or dual-bronchodilator-based maintenance treatment. Both cohorts were indexed on the date of initiation/escalation (January 2008-December 2013), and the first treatment modification (at class level) within the 18-month post-index observational period was described. Five mutually exclusive outcomes were defined: continuous use (no modification), discontinuation (permanent [?91 days with no restart] or temporary [?91 days with subsequent restart]), switch, and augmentation (Cohort 1 only). Exploratory analysis of Cohort 1 explored potential drivers of treatment initiation. Results:Overall, 5,065 patients initiated LABD-based therapy (Cohort 1), and 501 escalated to triple therapy (Cohort 2). In Cohort 1, 7.0% of patients were continuous users, 46.5% discontinued permanently, 28.5% discontinued temporarily, 2.8% augmented (added LAMA and/or LABA and/or ICS), and 15.2% switched therapy. In Cohort 2, 18.2% of patients were continuous users, 7.2% discontinued permanently, 27.9% discontinued temporarily, and 46.7% switched therapy. Exploratory analyses showed that time since COPD diagnosis was first recorded, pre-index exacerbation events, and concomitant medical conditions were potential drivers of initial maintenance treatment choices. Conclusion:Discontinuation among new initiators of LABD-based therapy was high in France, whereas few switched or augmented treatment. In comparison, permanent discontinuation within 18 months was low in patients escalating to triple therapy.

SUBMITTER: Meeraus W

PROVIDER: S-EPMC6305135 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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COPD treatment pathways in France: a retrospective analysis of electronic medical record data from general practitioners.

Meeraus Wilhelmine W Wood Robert R Jakubanis Rafal R Holbrook Tim T Bizouard Geoffray G Despres Johanna J Silva Camille Correia Da CCD Nachbaur Gaelle G Landis Sarah H SH Punekar Yogesh Y Aguilaniu Bernard B Ismaila Afisi S AS

International journal of chronic obstructive pulmonary disease 20181218

<h4>Background</h4>Increasing availability of therapeutic options for COPD may drive new treatment pathways. This study describes COPD treatment in France, focusing on identifying initial treatment modifications in patients with COPD who either initiated long-acting bronchodilator (LABD)-based therapy or escalated to triple therapy (long-acting muscarinic antagonist [LAMA] + long-acting β<sub>2</sub>-agonist [LABA] + inhaled corticosteroid [ICS]).<h4>Methods</h4>This retrospective analysis of pa ...[more]

PMID: 30587961

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Project description:Background:Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenemia, oligo-anovulation, and numerous ovarian cysts. Hospital electronic medical records provide an avenue for investigating polycystic ovary morphology commonly seen in PCOS at a large scale. The purpose of this study was to develop and evaluate the performance of two machine learning text algorithms, for classification of polycystic ovary morphology (PCOM) in pelvic ultrasounds. Methods:Pelvic ultrasound reports from patients at Boston Medical Center between October 1, 2003 and December 12, 2016 were included for analysis, which resulted in 39,093 ultrasound reports from 25,535 unique women. Following the 2003 Rotterdam Consensus Criteria for polycystic ovary syndrome, 2000 randomly selected ultrasounds were expert labeled for PCOM status as present, absent, or unidentifiable (not able to be determined from text alone). An ovary was marked as having PCOM if there was mention of numerous peripheral follicles or if the volume was greater than 10?ml in the absence of a dominant follicle or other confounding pathology. Half of the labeled data was used to develop and refine the algorithms, and the other half was used as a test set for evaluating its accuracy. Results:On the evaluation set of 1000 random US reports, the accuracy of the classifiers were 97.6% (95% CI: 96.5, 98.5%) and 96.1% (94.7, 97.2%). Both models were more adept at identifying PCOM-absent ultrasounds than either PCOM-unidentifiable or PCOM-present ultrasounds. The two classifiers estimated prevalence of PCOM within the whole set of 39,093 ultrasounds to be 44% PCOM-absent, 32% PCOM-unidentifiable, and 24% PCOM-present. Conclusions:Although accuracy measured on the test set and inter-rater agreement between the two classifiers (Cohen's Kappa?=?0.988) was high, a major limitation of our approach is that it uses the ultrasound report text as a proxy and does not directly count follicles from the ultrasound images themselves.

Project description:BackgroundComplex electronic medical records (EMRs) presenting large amounts of data create risks of cognitive overload. We are designing a Learning EMR (LEMR) system that utilizes models of intensive care unit (ICU) physicians' data access patterns to identify and then highlight the most relevant data for each patient.ObjectivesWe used insights from literature and feedback from potential users to inform the design of an EMR display capable of highlighting relevant information.MethodsWe used a review of relevant literature to guide the design of preliminary paper prototypes of the LEMR user interface. We observed five ICU physicians using their current EMR systems in preparation for morning rounds. Participants were interviewed and asked to explain their interactions and challenges with the EMR systems. Findings informed the revision of our prototypes. Finally, we conducted a focus group with five ICU physicians to elicit feedback on our designs and to generate ideas for our final prototypes using participatory design methods.ResultsParticipating physicians expressed support for the LEMR system. Identified design requirements included the display of data essential for every patient together with diagnosis-specific data and new or significantly changed information. Respondents expressed preferences for fishbones to organize labs, mouseovers to access additional details, and unobtrusive alerts minimizing color-coding. To address the concern about possible physician overreliance on highlighting, participants suggested that non-highlighted data should remain accessible. Study findings led to revised prototypes, which will inform the development of a functional user interface.ConclusionIn the feedback we received, physicians supported pursuing the concept of a LEMR system. By introducing novel ways to support physicians' cognitive abilities, such a system has the potential to enhance physician EMR use and lead to better patient outcomes. Future plans include laboratory studies of both the utility of the proposed designs on decision-making, and the possible impact of any automation bias.

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Dataset Information

COPD treatment pathways in France: a retrospective analysis of electronic medical record data from general practitioners.

Publications

COPD treatment pathways in France: a retrospective analysis of electronic medical record data from general practitioners.

Similar Datasets

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