Abstract
BACKGROUND: COPD medications reduce exacerbations and improve quality of life. Despite this, some individuals do not receive medications recommended by practice guidelines. RESEARCH QUESTION: How common is nonreceipt of recommended medications among people with COPD, and what factors are associated with nonreceipt? STUDY DESIGN AND METHODS: This population cohort study was conducted in Ontario, Canada, a province with universal health care insurance and medication coverage for those aged ≥ 65 years. Health administrative data were used to identify people aged ≥ 66 years with physician-diagnosed COPD as of 2018 and group them into cohorts of lower or higher risk for future COPD exacerbations. Proportions of patients in each group who did not receive medications recommended by COPD guidelines were determined. Generalized estimating equation modeling was used to determine associations between patient and physician factors and nonreceipt of recommended medications. RESULTS: About 54% and 88% of people with COPD received sufficient recommended medications in the low and high risk of exacerbation groups, respectively. Longer duration of COPD, higher comorbidity, dementia, and older physician age were associated with nonreceipt of recommended medications in both groups. People who had a co-diagnosis of asthma, who received care by a pulmonologist and who received spirometry were more likely to receive recommended medication. INTERPRETATION: COPD medications seem underused by the COPD population, and various factors are associated with suboptimal receipt. Targeting these factors would help improve the care and health of people with COPD.