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Many COPD patients face substantial challenges in accessing adequate care

Patients with chronic lung disease face significant barriers in accessing care, including high treatment costs and substandard care, according to a report presented at the annual American Thoracic Society International Conference.

The report, published in The Lancet Respiratory Medicine, summarized opinions from various stakeholders, including industry, health systems, insurance companies, patients, caregivers and medical professionals.

"This report reveals a real patchwork of care for patients with chronic obstructive pulmonary disease. The disease is the third-leading cause of death in the USA, and disproportionately affects some of society's most vulnerable people, yet many patients lack access to basic therapies to improve their quality of life," MeiLan K. Han, MD, lead author of the Lancet Respiratory Medicine Commission from the University of Michigan, Ann Arbor, said in a press release. "As a physician, I can discuss best treatments with my patients, only to later find out it isn't covered by their insurance, or the copay is simply too high. This report aims to move us from debating what ideal care could look like, back to a discussion of what patients are actually facing on a day-to-day basis."

"The burden of chronic obstructive pulmonary disease (COPD) in the USA continues to grow," the authors wrote. "Although progress has been made in the development of diagnostics, therapeutics and care guidelines, whether patients' quality of life is improved will ultimately depend on the actual implementation of care and an individual patient's access to that care."

Their report highlighted that one in three hospital admissions fail to follow the recommended standard care guidelines for patients with COPD. More than 10 million physician visits, 1.5 million ED visits and almost 700,000 hospital stays are linked to COPD, the researchers found. One in five COPD hospital admissions were readmitted within 1 month.

"Health care in the USA is delivered through a patchwork of provider networks, with a wide variation in access to care depending on a patient's insurance, geographical location and socioeconomic status," Han and colleagues stated. "Furthermore, Medicare's complicated coverage and reimbursement structure pose unique challenges for patients with chronic respiratory disease who might need access to several types of services. Throughout this Commission, recurring themes include poor guideline implementation among health care providers and poor patient access to key treatments such as affordable maintenance drugs and pulmonary rehabilitation."

According to the report, copayments for some drugs may cost patients with COPD $75 or more. Due to this, many patient fail to refill their prescriptions or take full doses and many skip days. The researchers found that only half of medication doses are taken as prescribed by patients with COPD.

In addition, even though pulmonary rehabilitation is reported to be the most beneficial treatment for improving quality of life, many patients cannot access it due to lack of programs and inconsistent insurance coverage.

The authors also noted that, despite a focus on reducing hospital readmissions for COPD exacerbations, no methods have been proven and health care systems are failing to meet goals.

"There are no easy solutions, but engaging patients and innovative thinkers in the development of solutions is crucial," Han and colleagues wrote. "Financial incentives might be important in raising engagement of providers and health systems. Lowering copays for maintenance drugs could result in improved adherence and, ultimately, decreased overall health care spending. Given the substantial geographical diversity, health systems will need to find their own solutions to improve care coordination and integration, until better data for interventions that are universally effective become available." – by Chelsea Frajerman Pardes

Reference:

Han MK, et al. COPD care in the U.S.: A special report on behalf of the Lancet Respiratory Medicine Commission. Presented at: American Thoracic Society International Conference; May 13-18, 2016; San Francisco.

Disclosures: Han reports personal fees from GlaxoSmithKline, Regeneron, Boehringer Ingelheim, and Novartis outside the submitted work. Please see the full report for a complete list of all other authors' relevant financial disclosures.