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A4560 - Reduction in COPD Related Healthcare Utilization with Use of Electronic Inhaler Monitoring
Author Block: K. Alshabani1, M. Smith2, A. Attawy1, R. Rice1, X. Wang3, X. Han3, U. S. Hatipoglu1; 1Pulmonary Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH, United States, 2Internal Medicine, Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, United States, 3Quantitative Health Sciences, Research Institute, Cleveland Clinic Foundation, Cleveland, OH, United States.
Background
Chronic Obstructive Pulmonary Disease (COPD) patients may have frequent exacerbations requiring emergency departments (ED) visits and hospitalizations. Low adherence to long acting bronchodilators has been associated with increased healthcare utilization. Electronic inhaler monitoring (EIM) consists of tools that allow real-time tracking of medication utilization. Clinical studies in patients with asthma suggest that EIM may foster adherence and thus reduce healthcare utilization. We report our experience with EIM in a cohort of COPD patients with history of increased healthcare utilization.
Methods
Cleveland Clinic initiated an EIM program for patients with COPD and high healthcare utilization, defined as at least one hospitalization or ED visit during the prior year. COPD patients who have completed at least 6 months of EIM were included in this analysis. EIM alerted the monitoring team when patients did not use maintenance inhalers for 4 consecutive days and when rescue inhaler use increased compared to baseline. Patients were contacted in response to these alerts to encourage adherence and assess for presence of a COPD exacerbation. Adherence data were made available to treating physicians. All analyses were two-tailed. SAS 9.3 software (SAS Institute, Cary, NC) was used for all analyses.
Results
20 patients completed at least 6 months of EIM. Mean EIM duration was 266.1 days (187.0-345.0). Baseline characteristics included a mean age of 69.6 (10.3) years, male gender in 11 patients (55%), African-American ethnicity in 16 patients (80%), and a mean BMI of 28.2 (8.3) kg/m2. Mean FEV1 was 51.8 (17.3) % predicted. Baseline MMRC and CAT scores were 2.8 (1.1) and 21.4 (7.4), respectively. Mean Charlson Comorbidity index was 5.8 (3.1).
Annualized all-cause healthcare utilization (number of hospitalizations + ED visits) was lower during EIM when compared to the year prior to enrollment, 3.2 (2.3) versus 5.2 (3.5) events (p=0.034, Kruskal-Wallis Test). COPD-related utilization also tended to be lower during EIM, 2.3 (2.2) versus 3.9 (3.2) events (p=0.07).
Conclusion
EIM is associated with lower healthcare utilization among COPD patients with frequent hospitalization and ED visits. Further studies are warranted to investigate the potential role of EIM in reducing COPD related healthcare costs.