Association between Difficulty Affording Medications and Outcomes in Chronic Obstructive Pulmonary Disease.

Rationale: Medications including inhaled bronchodilators are essential for effective management of chronic obstructive pulmonary disease (COPD) and improve clinical outcomes. However, medications are a major driver of out-of-pocket costs for individuals with COPD. The impact of cost of medications on clinical outcomes in COPD has not been studied.

Guideline Alignment and Medication Concordance in COPD.

Background: Provider adherence to clinical treatment guidelines in COPD is low. However, for patients to receive guideline-aligned care, providers not only must prescribe guideline-aligned care, but also must communicate that regimen successfully to patients to ensure medication concordance. The rate of medication concordance between patients and providers and its impact on clinical management is unknown in COPD.

Up-to-date guidance towards improving medication adherence in patients with chronic obstructive pulmonary disease.

Introduction: Despite efficacious treatment for chronic obstructive pulmonary disease (COPD), medication adherence remains quite poor, with most estimates based on electronic monitoring devices ranging from 20-30%. This degree of nonadherence represents a significant missed opportunity to realize the benefits of treatment of this disease.

Areas Covered: In this article, we review research on the prevalence of nonadherence among patients with COPD, the association of nonadherence with health outcomes, barriers to adherence in this patient population, and potential interventions.

Clinical Practices Surrounding the Prescription of Home Oxygen in Patients With COPD and Desaturation.

Purpose: While home oxygen therapy increases survival in patients with chronic obstructive pulmonary disease (COPD) who have severe resting hypoxemia, recent evidence suggests that there is no survival benefit of home oxygen for patients with COPD who have isolated exertional desaturation. We aimed to understand clinician practice patterns surrounding the prescription of home oxygen for patients with COPD.

Methods: We conducted semi-structured qualitative interviews via videoconference with 15 physicians and 3 nurse practitioners who provide care for patients with COPD.

Powering Bias and Clinically Important Treatment Effects in Randomized Trials of Critical Illness.

Objectives: Recurring issues in clinical trial design may bias results toward the null, yielding findings inconclusive for treatment effects. This study evaluated for powering bias among high-impact critical care trials and the associated risk of masking clinically important treatment effects.

Design, Setting, And Patients: Secondary analysis of multicenter randomized trials of critically ill adults in which mortality was the main endpoint.

Pediatric Emergency Department Return: A Literature Review of Risk Factors and Interventions.

Background And Objective: Children discharged from emergency departments (EDs) are often at risk for ED return. The objective was to identify risk factors and interventions to mitigate or prevent ED return among this patient population.

Methods: Structured literature review of PubMed and clinicaltrials.