Pragmatic and Observational Research最新文献

{"title":"Treatment Compliance Communications Between Patients with Severe Mental Illness and Treating Healthcare Providers: A Retrospective Study of Documentation Using Healthcare Reimbursement Claims and Medical Chart Abstraction.","authors":"Carolyn Martin,&nbsp;Eleena Koep,&nbsp;John White,&nbsp;Angela Belland,&nbsp;Heidi Waters,&nbsp;Felicia Forma","doi":"10.2147/POR.S303453","DOIUrl":"https://doi.org/10.2147/POR.S303453","url":null,"abstract":"<p><strong>Introduction: </strong>Successful treatment for serious mental illnesses (SMIs) requires a good therapeutic alliance with healthcare providers and compliance with prescribed therapies such as antipsychotic medications. This retrospective study, which utilized administrative claims linked with abstracted medical chart data, addressed a data gap regarding compliance-related discussions between providers and patients.</p><p><strong>Methods: </strong>Commercially insured patients in ambulatory care post-acute (emergency or inpatient) event were eligible. Criteria included age 18-65 years; schizophrenia, bipolar disorder, or major depressive disorder diagnoses; continuous enrollment 6 months before to 12 months after the first acute event claim dated 01/01/2014 to 12/31/2015; and antipsychotic medication prescription. Demographic and clinical data, and patient-provider discussions about treatment compliance were characterized from claims and abstracted medical charts.</p><p><strong>Results: </strong>Ninety patients (62% female, mean age 41 years) were included and 680 visits were abstracted; only 58% had first-visit antipsychotic compliance discussions. Notably, 18% of patients had discussions using the specific terms \"compliance,\" \"persistence,\" or \"adherence,\" whereas half were identified by more general terms. Compliance discussions were observed least often among the patients with schizophrenia, as compared with bipolar or major depressive disorders-a counterintuitive finding.</p><p><strong>Discussion: </strong>Compliance discussions may represent intervention opportunities to optimize treatment, yet their study is a complex endeavor. The results of this study show an opportunity to improve this valuable treatment step.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":" ","pages":"49-63"},"PeriodicalIF":8.9,"publicationDate":"2021-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d4/28/por-12-49.PMC8214573.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39100556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Willingness to Take COVID-19 Vaccine Among People Most at Risk of Exposure in Southern Ethiopia.","authors":"Bewunetu Zewude,&nbsp;Tewodros Habtegiorgis","doi":"10.2147/POR.S313991","DOIUrl":"https://doi.org/10.2147/POR.S313991","url":null,"abstract":"<p><strong>Background: </strong>Acceptance of a vaccine or hesitancy towards it have great public health implications as they partly determine the extent to which people are exposed to infections that could have otherwise been prevented. The present study examined the willingness of primary and secondary school teachers, bank employees, and university instructors in southern Ethiopia to take a Covid-19 vaccine and the factors associated with their willingness.</p><p><strong>Methods: </strong>An institutional-based cross-sectional study design was used with a quantitative research approach. Primary data were gathered mainly through the use of a survey research method in which a self-administered questionnaire was distributed to randomly selected research participants in Wolaita Sodo town. Data analysis was conducted using statistical techniques, including percentages, frequency distributions, and logistic regression analysis.</p><p><strong>Results: </strong>Research participants generally had a low (46.1%) willingness to take a COVID-19 vaccine. The main reason for most (37%) respondents' hesitancy to take the vaccine is found to be the concern over the safety and/or the side effects of the vaccine (37%), followed by doubt about the vaccine's effectiveness (20.7%), and lack of adequate information (12.7%). Moreover, 38.9% of survey participants revealed that they would like to take a COVID-19 vaccine other than AstraZeneca whereas 61.1% of respondents replied that they do not want to take any kind of COVID-19 vaccine. Furthermore, respondents' willingness to take a COVID-19 vaccine is significantly associated with attitude towards the vaccine (OR = 2.830; 95% CI = 1.834-4.368), belief that Covid-19 exists in the study area (OR = 0.221; 95% CI = 0.083-0.589), the perception that prevalence and death rate reports of the government are real (OR = 0.365; 95% CI = 0.197-0.676), status of chronic diseases (OR = 2.883; 95%CI = 1.039-7.999), and having a close relative/friend ever infected by COVID-19 (OR = 2.602; 95% CI = 1.117-6.063).</p><p><strong>Conclusion: </strong>The findings of the research demonstrated that there is generally low willingness to take a COVID-19 vaccine among university instructors, bank employees, and primary and secondary school teachers in southern Ethiopia. Therefore, the federal ministry of health, Ethiopian food and drug controlling agency, the media, and all other concerned organizations should create increased awareness about the safety/side effects issues and the need to take the vaccine.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":" ","pages":"37-47"},"PeriodicalIF":8.9,"publicationDate":"2021-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/49/a8/por-12-37.PMC8166351.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39055361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maximizing Adherence and Gaining New Information For Your Chronic Obstructive Pulmonary Disease (MAGNIFY COPD): Study Protocol for the Pragmatic, Cluster Randomized Trial Evaluating the Impact of Dual Bronchodilator with Add-On Sensor and Electronic Monitoring on Clinical Outcomes.","authors":"David Price,&nbsp;Rupert Jones,&nbsp;Pascal Pfister,&nbsp;Hui Cao,&nbsp;Victoria Carter,&nbsp;Anu Kemppinen,&nbsp;Björn Holzhauer,&nbsp;Alan Kaplan,&nbsp;Allan Clark,&nbsp;David M G Halpin,&nbsp;Hilary Pinnock,&nbsp;James D Chalmers,&nbsp;Job F M van Boven,&nbsp;Kai M Beeh,&nbsp;Konstantinos Kostikas,&nbsp;Nicolas Roche,&nbsp;Omar Usmani,&nbsp;Paul Mastoridis","doi":"10.2147/POR.S302809","DOIUrl":"https://doi.org/10.2147/POR.S302809","url":null,"abstract":"<p><strong>Background: </strong>Poor treatment adherence in COPD patients is associated with poor clinical outcomes and increased healthcare burden. Personalized approaches for adherence management, supported with technology-based interventions, may offer benefits to patients and providers but are currently unproven in terms of clinical outcomes as opposed to adherence outcomes.</p><p><strong>Methods: </strong>Maximizing Adherence and Gaining New Information For Your COPD (MAGNIFY COPD study), a pragmatic cluster randomized trial, aims to evaluate the impact of an adherence technology package (interventional package), comprising an adherence review, ongoing provision of a dual bronchodilator but with an add-on inhaler sensor device and a connected mobile application. This will compare time to treatment failure and other clinical outcomes in patients identified at high risk of exacerbations with historic poor treatment adherence as measured by prescription collection to mono/dual therapy over one year (1312 patients) versus usual care. Treatment failure is defined as the first occurrence of one of the following: (1) moderate/severe COPD exacerbation, (2) prescription of triple therapy (inhaled corticosteroid/long-acting β₂-agonist/long-acting muscarinic antagonist [ICS/LABA/LAMA]), (3) prescription of additional chronic therapy for COPD, or (4) respiratory-related death. Adherence, moderate/severe exacerbations, respiratory-related healthcare resource utilization and costs, and intervention package acceptance rate will also be assessed. Eligible primary care practices (N=176) participating in the Optimum Patient Care Quality Improvement Program will be randomized (1:1) to either adherence support cluster arm (suitable patients already receiving or initiated Ultibro^® Breezhaler^® [indacaterol/glycopyrronium] will be offered interventional package) or the control cluster arm (suitable patients continue to receive usual clinical care). Patients will be identified and outcomes collected from anonymized electronic medical records within the Optimum Patient Care Research Database. On study completion, electronic medical record data will be re-extracted to analyze outcomes in both study groups.</p><p><strong>Registration number: </strong>ISRCTN10567920.</p><p><strong>Conclusion: </strong>MAGNIFY will explore patient benefits of technology-based interventions for electronic adherence monitoring.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":" ","pages":"25-35"},"PeriodicalIF":8.9,"publicationDate":"2021-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ac/7a/por-12-25.PMC8163732.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39055360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification and Comparison of Patient Characteristics for Those Hospitalized with COVID-19 versus Influenza Using Machine Learning in a Commercially Insured US Population.","authors":"Xiaoxue Chen,&nbsp;Zhi Wang,&nbsp;Samantha G Bromfield,&nbsp;Andrea DeVries,&nbsp;David Pryor,&nbsp;Vincent Willey","doi":"10.2147/POR.S304220","DOIUrl":"https://doi.org/10.2147/POR.S304220","url":null,"abstract":"Background The novel severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 (COVID–19), continues to spread in the US through the 2020–2021 influenza season and beyond. Approaches to identify those most at risk for poor outcomes for the two viral infections are needed for future planning. As influenza is a well-known respiratory disease sharing some similarities to COVID-19, such comparison will aid physicians and health systems to predict disease trajectory and allocate health resources most efficiently. A retrospective cohort study using a French national administrative database found that patients hospitalized with COVID-19 were more frequently obese or overweight, diabetic, and hypertensive. 1 Patients hospitalized with influenza more frequently had heart failure, chronic respiratory disease, and cirrhosis. 1 Similar observations were reported in an international network study that included US, South Korea, and Spain. 2 While this information provides useful context to the current understanding of characteristics of patients hospitalized with COVID-19 in several countries, understanding of the overall risk profile for the two viral infections is lacking in a broad US population. Advanced modelling, machine learning, and artificial intelligence (AI) techniques have been employed to detect, diagnose, evaluate, and prioritize for Examples include laboratory examination frameworks to prioritize patients with COVID-19, AI techniques in the detection and classification of COVID-19 medical images, and models to predict the spread of disease. An increasing number of severe COVID-19 outcome risk assessment studies found that demographic factors, comorbidities, radiographic findings, and laboratory markers may individually or collectively predict worse outcomes. 3 deepen the understanding of COVID-19,","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":" ","pages":"9-13"},"PeriodicalIF":8.9,"publicationDate":"2021-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/76/5d/por-12-9.PMC8080116.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38939538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicians' Attitude Toward Computer-Guided Implant Surgery Approach: Survey in Saudi Arabia.","authors":"Linah M Ashy","doi":"10.2147/POR.S243623","DOIUrl":"https://doi.org/10.2147/POR.S243623","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the attitude of clinicians in Saudi Arabia towards dental implant treatment using different implant surgery approaches.</p><p><strong>Materials and methods: </strong>This cross-sectional observational study was conducted using a web-based questionnaire wherein 56 clinicians ranked their attitude toward computer-guided implant surgery (CGIS) and conventional non-computer-guided surgery (non-CGIS) in terms of advantages, disadvantages and clinical indications. Statistical analysis was conducted by the Spearman correlation test, Kruskal-Wallis test, and Wilcoxon rank sum tests, at a significance level of <i>P</i><0.05.</p><p><strong>Results: </strong>The survey results indicated that the most significant advantages of CGIS from the participants' perspective were low levels of stress during surgery (<i>P</i> = 0.003) and minimal requirement of surgical skills (<i>P</i> = 0.04). Notably, the advantages of accurate outcome and predictable flapless surgery were not considered significantly higher for CGIS than for non-CGIS (<i>P</i> = 0.2 and 0.7, respectively). The high treatment cost was the most significant disadvantage of CGIS when compared to non-CGIS (<i>P</i> = 0.002), and complete edentulism was the most recommended clinical condition for CGIS.</p><p><strong>Conclusion: </strong>Clinicians acknowledged the advantages of CGIS over non-CGIS, especially in complete edentulism. The significant advantages of CGIS were the clinician's state of low stress and minimal skills required rather than the patient's interest in treatment predictability. CGIS is an attractive approach for most participants, in spite of the low rate of actual use.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":" ","pages":"1-8"},"PeriodicalIF":8.9,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/78/ba/por-12-1.PMC8021253.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25589672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability of Vaccination Against COVID-19 Among Healthcare Workers in the Democratic Republic of the Congo.","authors":"Michel Kabamba Nzaji, Leon Kabamba Ngombe, Guillaume Ngoie Mwamba, Deca Blood Banza Ndala, Judith Mbidi Miema, Christophe Luhata Lungoyo, Bertin Lora Mwimba, Aimé Cikomola Mwana Bene, Elisabeth Mukamba Musenga","doi":"10.2147/POR.S271096","DOIUrl":"10.2147/POR.S271096","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to estimate the acceptability of a future vaccine against COVID-19 and associated factors if offered in Congolese health-care workers (HCWs), since they have the highest direct exposure to the disease.</p><p><strong>Patients and methods: </strong>We conducted an analytical cross-sectional study among 23 Congolese referral hospitals, including three university hospitals, located in three towns from March through 30 April 2020. The main outcome variable was healthcare workers' acceptance of a future vaccine against COVID-19. The associated factors of vaccination willingness were identified through a logistic regression analysis.</p><p><strong>Results: </strong>A sample of 613 HCWs participated in the study and completed the study questionnaire, including 312 (50.9%) men and 301 (49.1%) women. Only 27.7% of HCWs said that they would accept a COVID-19 vaccine if it was available. From the logistic regression analysis, male healthcare workers (ORa=1.17, 95% CI: 1.15-2.60), primarily doctors (ORa=1.59; 95% CI:1.03-2.44) and having a positive attitude towards a COVID-19 vaccine (ORa=11.49; 95% CI: 5.88-22.46) were significantly associated with reporting willingness to be vaccinated.</p><p><strong>Conclusion: </strong>For acceptability of vaccination against COVID-19 among others education among HCWs is crucial because health professionals' attitudes about vaccines are an important determinant of their own vaccine uptake and their likelihood of recommending the vaccine to their patients.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"11 ","pages":"103-109"},"PeriodicalIF":8.9,"publicationDate":"2020-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/23/74/por-11-103.PMC7605960.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38579669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients with Sore Throat: A Survey of Self-Management and Healthcare-Seeking Behavior in 13 Countries Worldwide.","authors":"Alike W van der Velden,&nbsp;Aurelio Sessa,&nbsp;Attila Altiner,&nbsp;Antonio Carlos Campos Pignatari,&nbsp;Adrian Shephard","doi":"10.2147/POR.S255872","DOIUrl":"https://doi.org/10.2147/POR.S255872","url":null,"abstract":"<p><strong>Background: </strong>Acute sore throat is one of the most common problems for which patients consult their general practitioner and is a key area for inappropriate antibiotic prescribing. The objective of this study was to investigate patients' attitudes related to healthcare-seeking behavior and self-management of sore throat.</p><p><strong>Methods: </strong>We conducted an observational, questionnaire-based study across 13 countries (Australia, Brazil, China, France, Germany, Italy, the Philippines, Russia, Saudi Arabia, South Africa, Thailand, the UK and the USA) on respondents who reported having had a sore throat in the previous 12 months. Data were collected on their experiences, contact with healthcare professionals, treatment practices and opinions about antibiotics.</p><p><strong>Results: </strong>A total of 5196 respondents (approximately 400 per country) completed the survey. Over 80% of respondents sought advice for a sore throat, with 30% consulting a general practitioner. The desire to limit the worsening of symptoms was the main reason for seeking treatment. Other reasons concerned resolving persistent symptoms and reducing the impact on daily life/sleep. Self-management for sore throat was mainly medicated sore throat remedies. \"Wanting an antibiotic\" was rated much lower (55%) than most other reasons for visiting a doctor, but this differed greatly between countries. The percentage of respondents using antibiotics varied widely, for example, 10% in the UK and 45% in Saudi Arabia. There was considerable variation in the proportion of respondents who thought that antibiotics would be effective against sore throat (from 24% in France to 94% in Saudi Arabia).</p><p><strong>Conclusions: </strong>Our findings suggest that knowledge of effective treatments for sore throat varied widely. The results of this study should enable healthcare professionals to better anticipate patients' needs. This will support healthcare professionals in their role as antibiotic stewards, helping to reduce the misuse of antibiotics, and further guiding patients towards symptomatic self-management of sore throat.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"11 ","pages":"91-102"},"PeriodicalIF":8.9,"publicationDate":"2020-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/POR.S255872","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38521663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The CHRONICLE Study of US Adults with Subspecialist-Treated Severe Asthma: Objectives, Design, and Initial Results.","authors":"Christopher S Ambrose, Bradley E Chipps, Wendy C Moore, Weily Soong, Jennifer Trevor, Dennis K Ledford, Warner W Carr, Njira Lugogo, Frank Trudo, Trung N Tran, Reynold A Panettieri","doi":"10.2147/POR.S251120","DOIUrl":"10.2147/POR.S251120","url":null,"abstract":"<p><strong>Background: </strong>Approximately 5-10% of patients with asthma have severe disease. High-quality real-world studies are needed to identify areas for improved management.</p><p><strong>Objective: </strong>Aligned with the International Severe Asthma Registry, the CHRONICLE study (ClinicalTrials.gov: NCT03373045) was developed to address this need in the US.</p><p><strong>Study design: </strong>Learnings from prior studies were applied to develop a real-world, prospective, noninterventional study of US patients with confirmed severe asthma who are treated by subspecialist physicians and require biologic or maintenance systemic immunosuppressant therapy or who are uncontrolled by high-dosage inhaled corticosteroids and additional controllers. Target enrollment is 4000 patients, with patient observation for ≥3 years. A geographically diverse sample of allergist/immunologist and pulmonologist sites approach all eligible patients under their care and report patient characteristics, treatment, and health outcomes every 6 months. Patients complete online surveys every 1-6 months.</p><p><strong>Initial results: </strong>From February 2018 to February 2019, 102 sites screened 1428 eligible patients; 936 patients enrolled. Study sites (40% allergist/immunologist, 42% pulmonologist, 18% both) were similar to other US asthma subspecialist samples. Enrolled patients were 67% female with median ages at enrollment and diagnosis of 55 (range: 18-89) and 26 (0-80) years, respectively. Median body mass index was 31 kg/m²; 3% and 29% were current or former smokers, respectively, and >60% reported ≥1 exacerbation in the prior year and suboptimal symptom control.</p><p><strong>Conclusion: </strong>CHRONICLE will provide high-quality provider- and patient-reported data from a large, real-world cohort of US adults with subspecialist-treated severe asthma.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"11 ","pages":"77-90"},"PeriodicalIF":2.3,"publicationDate":"2020-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b2/64/por-11-77.PMC7371434.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38239305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CPAP Therapeutic Options for Obstructive Sleep Apnea.","authors":"Robert G Hooper","doi":"10.2147/POR.S258632","DOIUrl":"https://doi.org/10.2147/POR.S258632","url":null,"abstract":"<p><strong>Introduction: </strong>There are many options available to patients who are placed on constant positive airway pressure (CPAP) for obstructive sleep apnea. Despite the success of CPAP in correcting apnea, a significant number of patients have difficulty with the therapy. A large number of those patients who have difficulty stop therapy and are often labeled as \"CPAP Failure\". Non-sleep specialists may view CPAP therapy as a singular course of treatment, but there are many ways CPAP may be ordered for a patient. Each patient experiences a unique set of options that constitute a unique order set.</p><p><strong>Methods: </strong>In order to demonstrate the magnitude of the possible options, estimates of the number of unique order sets were calculated. The author chose individual order options and the number of selections possible within each option. The calculated sets included a \"Generous, Limited and Minimal\" number of selections for each option. Calculations were done separately for standard CPAP and for auto-adjusting CPAP. Additional calculations were performed using the number of commercially available masks in the United States.</p><p><strong>Results: </strong>The maximum number of unique order sets was seen using a standard CPAP combined with commercially available masks: 49,152 unique order sets. The fewest number of unique order sets were seen with the auto-adjusting CPAP and the \"Minimal\" selections: 288 unique order sets.</p><p><strong>Discussion: </strong>There are a large number of unique CPAP orders that a patient may experience. CPAP treatment is not a singular or simple therapy. When evaluating obstructive sleep apnea patients with histories of CPAP failure or prior difficulty with CPAP, paying close attention to the patient's treatment experiences may help explain a significant number of those patients' CPAP therapy problems.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"11 ","pages":"67-76"},"PeriodicalIF":8.9,"publicationDate":"2020-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/POR.S258632","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38239304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adequacy of Therapy for People with Both COPD and Heart Failure in the UK: Historical Cohort Study.","authors":"Konstantinos Kostikas,&nbsp;Chin Kook Rhee,&nbsp;John R Hurst,&nbsp;Piergiuseppe Agostoni,&nbsp;Hui Cao,&nbsp;Robert Fogel,&nbsp;Rupert Jones,&nbsp;Janwillem W H Kocks,&nbsp;Karen Mezzi,&nbsp;Simon Wan Yau Ming,&nbsp;Ronan Ryan,&nbsp;David B Price","doi":"10.2147/POR.S250451","DOIUrl":"https://doi.org/10.2147/POR.S250451","url":null,"abstract":"<p><strong>Purpose: </strong>Chronic obstructive pulmonary disease (COPD) and heart failure (HF) often occur concomitantly, presenting diagnostic and therapeutic challenges for clinicians. We examined the characteristics of patients prescribed adequate versus inadequate therapy within 3 months after newly diagnosed comorbid COPD or HF.</p><p><strong>Patients and methods: </strong>Eligible patients in longitudinal UK electronic medical record databases had pre-existing HF and newly diagnosed COPD (2017 GOLD groups B/C/D) or pre-existing COPD and newly diagnosed HF. Adequate COPD therapy was defined as long-acting bronchodilator(s) with/without inhaled corticosteroid; adequate HF therapy was defined as beta-blocker plus angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker.</p><p><strong>Results: </strong>Of 2439 patients with HF and newly diagnosed COPD (mean 75 years, 61% men), adequate COPD therapy was prescribed for 726 (30%) and inadequate for 1031 (42%); 682 (28%) remained untreated for COPD. Adequate (vs inadequate) COPD therapy was less likely for women (35%) than men (45%), smokers (36%) than ex-/non-smokers (45%), and non-obese (41%) than obese (47%); spirometry was recorded for 57% prescribed adequate versus 35% inadequate COPD therapy. Of 12,587 patients with COPD and newly diagnosed HF (mean 75 years, 60% men), adequate HF therapy was prescribed for 2251 (18%) and inadequate for 5332 (42%); 5004 (40%) remained untreated for HF. Adequate (vs inadequate) HF therapy was less likely for smokers (27%) than ex-/non-smokers (32%) and non-obese (30%) than obese (35%); spirometry was recorded for 65% prescribed adequate versus 39% inadequate HF therapy.</p><p><strong>Conclusion: </strong>Many patients with comorbid COPD/HF receive inadequate therapy after new diagnosis. Improved equity of access to integrated care is needed for all patient subgroups.</p>","PeriodicalId":20399,"journal":{"name":"Pragmatic and Observational Research","volume":"11 ","pages":"55-66"},"PeriodicalIF":8.9,"publicationDate":"2020-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/POR.S250451","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38086365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}