longitudinal asthma management profiles
TRANSCRIPT
LONGITUDINAL ASTHMA MANAGEMENT PROFILES: VISUALISATION OF PATIENT HISTORIES USING MULTIPLE DATA
SOURCES
REG Annual SummitLyon15 &16 April 2016
Eric van Ganse on behalf of the ASTROLAB group
ASTROLAB consortium: Consorcio Mar Parc de Salut de Barcelona, IMS Health, Kappa Santé SAS, Lyon Ingénierie Projets, University Claude Bernard Lyon 1, University of Amsterdam, University of
Nottingham
Background
Computerized Health DataCHD
Valuable information for research and clinical case management with real-life data, but currently underused.
CHD limitations: - Limited information on medication use
from single data source- Health outcomes from single data
source- No obvious way to build patient full
medical histories.
ASTROLAB Design: Linkage of multiple data sources: 1. Direct patient follow-up (PROs)2. EHRs from GPs3. French national claims data
Objective
To develop longitudinal asthma management patient profiles for the ASTROLAB cohort by integrating data on prescription and dispensation events, and patient-reported information on medication use and occurrence of severe asthma exacerbations (SAEx).
Better understanding of asthma management.To check the asthma care model developed by ASTROLAB
Methods: patients• 1,051 children and adults with persistent asthma (6 to 40 years old)
• From France and the United Kingdom (UK)
• On a stable therapy pattern (for ≥6 of 12 baseline months) of either: – Long acting β-agonists (LABAs) without inhaled corticosteroids (ICs)– ICs without LABAs– LABAs + ICs in separate canisters– LABAs/ICs fixed-dose combination (FDC)
Methods: cohort design
Main outcome: Severe Asthma Exacerbation (SAEx) Occurrence of asthma-related courses of oral corticosteroids Unscheduled medical visits Unscheduled hospital contacts (ER visits, overnight hospitalizations) Death due to asthma
PATIENTS
- Phone interviews- Text messages- Online
Questionnaires
HEALTHCARE PROFESSIONALS
- Online Questionnaires
- Electronic Medical Records
Methods: multiple data sources
FRENCH CLAIMS DATA
- Refills- Medical resource
utilization (MRU)
Probabilistic linkage with French Claims Data
CATI M4 Non-use in the past 7
days
How to interpret longitudinal asthma management profiles?
Prescription with duration
Corresponding dispensation (D) on the same day
M0
CATI M8 Use in the
past 7 days
CATI M12Use in the
past 7 days
D
D
D
D
D
D
D
D
CATI M16Non-use in the
past 7 days
CATI M20
CATI M24
Exacerbation
Exacerbation
Exacerbation
Prescription with duration
Prescription with duration
D
D
Examples of application
1. Between countries comparison of prescribing patterns, or dispensation patterns, or patterns of use (patients) in persistent asthma
2. Identification of therapy switch3. Therapeutic context of asthma exacerbation
1. Comparison of asthma prescribing patterns between countries
Example 1: difference in prescribing patterns between France and the UK
2. Identification of switch of therapy (2/3)
Example 2: illustration of treatment switch
CATI M4
CATI M0
CATI M8
Use in the past 7 days
Switch to fixed-dose combination
CATI M12
CATI M16
Regular prescribing and dispensations, drug used
before CATI
3. Therapeutic context of asthma exacerbation
Example 3: illustration of prescribing, dispensing and actual use reported by patientsand occurrence of outcome CATI M4
CATI M0
CATI M8
CATI M12(misisng)
CATI M16
No dispensation
Actual use of therapy before and during exacerbation
period? (no dispensations)
No dispensation
Conclusions
Longitudinal asthma management profiles: visualisation enables an improved understanding of:• Irregular exposure to controllers: distinction between
– non-prescription– unfilled prescribed therapy– non-use of dispensed drug
• Therapeutic context of asthma exacerbation:– Non-exposure to controllers before an exacerbation?– Consequences of exacerbation on subsequent therapy pattern:
reinforcement? switch?
• Generation of hypotheses to document issues in asthma management
CHD valorisation
THANK YOUProject funded by the European Commission
through the Seventh Framework Programme under GA n° 282593
Contact: Dr Eric van [email protected]
http://www.astrolab-project.eu