Thesis

Analysis of treatment of respiratory disease in the United Kingdom and United States

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Awarding institution
  • University of Strathclyde
Date of award
  • 2014
Thesis identifier
  • T13855
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Abstract
  • INTRODUCTION: Asthma and chronic obstructive pulmonary disease (COPD) affect 8% and 5% of the population, respectively, in the United Kingdom (UK) and the United States (USA). A variety of medicines are available but how they are utilised in real practice is not fully understood. The aim of this work was to describe and compare the treatment of asthma and COPD in the UK and USA. METHODS: Three retrospective databases (two administrative and one electronic health record datasets) were formed from sources in National Health Service (NHS) Scotland, NHS Forth Valley, Scotland, and Kentucky, USA. Several analyses were conducted, including mapping and evaluation of national medicine utilisation, evaluation of adherence/persistence with chronic therapy, classification of therapy against guideline recommendations, and appraisal of inhaled corticosteroid (ICS) prescribing. RESULTS: National medicine utilisation figures indicated an increasing preference over time for combination therapy with ICS and long-acting beta agonist (LABA) inhalers. Therapy for asthma demonstrated some unanticipated trends, with widespread use of high-dose combination therapy in up to one-third of patients and a lack of standardised therapy approach by clinicians at step 2/3. For COPD, spirometry data was unable to verify diagnosis in up to a quarter of patients, and approximately one-third of patients received unlicensed doses of combination therapy. Adherence and persistence with chronic medicine in both databases was better amongst women, with advancing age and with oral therapy. Direct comparisons between the UK and USA were difficult due to the different healthcare structures and methods for data collection, but doses of ICS in children appeared more aggressive in the USA. CONCLUSION: The treatment of respiratory disease can be optimised in several clinical areas, most notably with ICS prescribing. Further research and quality improvement measures are needed to improve the care of respiratory disease.
Resource Type
DOI
Date Created
  • 2014
Former identifier
  • 1040898

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