AMDA Clinical Practice Guidelines COPD burden among LTC ... · for COPD maintenance therapy 8 COPD...
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An estimated 1 in 5 LTC residents has COPD 1 Long-acting bronchodilators are recommended for COPD maintenance therapy 8 COPD burden among LTC residents AMDA Clinical Practice Guidelines* † COPD is a major driver of hospital readmissions 5 COPD is the third most common condition associated with potentially avoidable hospital admissions among dual-eligible beneficiaries 5 In 2015, COPD was added to the Centers for Medicare & Medicaid Services (CMS) Hospital Readmissions Reduction Program 6 CMS is proposing to reduce Medicare payment rates for skilled nursing facilities (SNFs) that fail to meet standards for readmission rates. 7 *AMDA does not endorse any specific treatments. † Commonly called AMDA (from American Medical Directors Association, its original name), the Society for Post-Acute and Long-Term Care Medicine is a national organization of long-term care physicians, nurse practitioners, physician assistants, and other members of interdisciplinary teams focused on post-acute and long-term care medicine. 8 Long-acting inhaled bronchodilators are convenient and more effective at producing maintained symptom relief than short-acting bronchodilators. 2 COPD is a leading cause of death 2 Prevalence of COPD is 14% among the population aged ≥65 3 While death rates from heart disease and stroke have fallen significantly over the past 30 years, deaths from COPD have more than doubled 4 AMDA Clinical Practice Guidelines recommend a stepwise approach to COPD therapy 8 : One or more long-acting bronchodilators should be added as maintenance therapy beginning in moderate disease and throughout the course of the disease Inhaled corticosteroid added for those with severe or very severe disease if repeated exacerbations occur Short-acting bronchodilators recommended on a “when needed” basis beginning in mild COPD and throughout the course of the disease Oxygen therapy recommended for very severe disease COPD in the LTC setting References: 1. Zarowitz BJ, O’Shea T. Chronic obstructive pulmonary disease: prevalence, characteristics, and pharmacologic treatment in nursing home residents with cognitive impairment. J Manag Care Pharm. 2012;18(8):598-606. 2. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2016. http://www. goldcopd.org/uploads/users/files/WatermarkedGlobal%20Strategy%202016(1).pdf. Accessed February 2, 2016. 3. Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J. 2006;28(3):523-532. 4. Goodridge DM. COPD as a life- limiting illness: implications for advanced practice nurses. Medscape: Advanced Practice Nursing eJournal. 2006;6(4):1-12. 5. Jiang HJ, Weir LM, Potter DEB, Burgess J. Potentially preventable hospitalizations among Medicare-Medicaid dual eligibles, 2008. http://www.hcup-us.ahrq.gov/reports/statbriefs/ sb96.pdf. Accessed January 27, 2016. 6. Centers for Medicare & Medicaid Services. Readmissions reduction program. https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/ readmissions-reduction-program.html. Accessed January 27, 2016. 7. Luke J. SNF readmission penalties announced: is your facility prepared? California Association of Long Term Care Medicine. http://www. caltcm.org/index.php?option=com_content&view=article&id=242:snf-readmission-penalties-announced- is-your-facility-prepared-&catid=22:news&Itemid=111. Accessed January 27, 2016. 8. The American Medical Directors Association (AMDA). COPD management in the long-term care setting. http://www.amda.com/ tools/guidelines.cfm. Accessed January 28, 2016. 9. Centers for Medicare & Medicaid Services. MDS 3.0 frequency report: Fourth Quarter 2015. C0500: Cognitive Patterns - BIMS Summary Score. https://www. cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/Minimum-Data-Set-3-0- Public-Reports/Minimum-Data-Set-3-0-Frequency-Report.html. Accessed February 22, 2016. 10. Taffet GE, Donohue JF, Alman PR. Considerations for managing chronic obstructive pulmonary disease in the elderly. Clin Int Aging. 2014;9:23-30. 11. Dhand R, Dolovich M, Eng P, et al. The role of nebulized therapy in the management of COPD: evidence and recommendations. COPD. 2012;9:58-72. 12. Sakaan S, Ulrich D, Luo J, Finch CK, Self TH. Inhaler use in hospitalized patients with chronic obstructive pulmonary disease or asthma: assessment of wasted doses. Hosp Pharm. 2015;50(5):386-390. 13. Dolovich MB, MacIntyre NR, Anderson PJ, et al. Consensus statement: aerosols and delivery devices. Respir Care. 2000;45(6):589-596. Sunovion and are registered trademarks of Sumitomo Dainippon Pharma Co., Ltd. Sunovion Pharmaceuticals Inc. is a U.S. subsidiary of Sumitomo Dainippon Pharma Co., Ltd. ©2016 Sunovion Pharmaceuticals Inc. All rights reserved. 3/16 BRO022-16 Shortness of breath and exacerbations are common among LTC residents 1 62% of residents have short-term memory problems; 43% have moderately or severely impaired cognitive skills for daily decision-making 1 Residents may be clinically appropriate for nebulized therapy 11 COPD is a leading cause of death and a major driver of hospital readmissions 2,5 AMDA Clinical Practice Guidelines for residents with moderate-to-severe COPD recommend maintenance therapy with long-acting beta agonist and/or long-acting anticholinergic, and SABA as needed 8 * *AMDA does not endorse any specific treatments. As many as 60% of residents do not receive a long-acting agent (noted among residents who had experienced at least 2 exacerbations), and 17% receive no treatment at all 1 An educational resource for nursing facilities Chronic obstructive pulmonary disease (COPD) in the long-term care (LTC) setting DISK RELEASE CONCENTRICHX FILE NAME: 16BROV0094_Unbranded LTC Leave Behind_M1 COLORS FILE DESCRIPTION: DON - CP Leave Behind MECH: CM 3.3.16 DISK: HANS 031716 Print Scale: NONE CLIENT: SUNOVION BLEED: TRIM: SAFETY: FINAL SIZE: 1.25” X 1.25” 12.5” 16” N/A 6.25” X 8” C M Y K
Transcript of AMDA Clinical Practice Guidelines COPD burden among LTC ... · for COPD maintenance therapy 8 COPD...
An estimated 1 in 5 LTC residents has COPD1Long-acting bronchodilators are recommended
for COPD maintenance therapy8
COPD burden among LTC residentsAMDA Clinical Practice Guidelines*†
COPD is a major driver of hospital readmissions5
COPD is the third most common condition associated with potentially avoidable hospital admissions among dual-eligible benefi ciaries
5
In 2015, COPD was added to the Centers for Medicare & Medicaid Services (CMS) Hospital Readmissions Reduction Program
6
CMS is proposing to reduce Medicare payment rates for skilled nursing facilities (SNFs) that fail to meet standards
for readmission rates.7
* AMDA does not endorse any specific treatments. † Commonly called AMDA (from American Medical Directors Association, its original name), the Society for Post-Acute and Long-Term Care Medicine is a national organization
of long-term care physicians, nurse practitioners, physician assistants, and other members of interdisciplinary teams focused on post-acute and long-term care medicine.8
Long-acting inhaled bronchodilators are convenient and more effective at producing maintained symptom relief than
short-acting bronchodilators.2
COPD is a leading cause of death2
Prevalence of COPD is 14% among the population aged ≥653
While death rates from heart disease and stroke have fallen signifi cantly over the past 30 years, deaths from COPD have more than doubled
4
AMDA Clinical Practice Guidelines recommend a stepwise approach to COPD therapy
8:
One or more long-acting bronchodilators should be added as
maintenance therapy beginning in moderate disease and throughout
the course of the disease
Inhaled corticosteroid added for those with severe or
very severe disease if repeated exacerbations occur
Short-acting bronchodilators recommended on a “when
needed” basis beginning in mild COPD and throughout the
course of the disease
Oxygen therapy recommended for very
severe disease
COPD in the LTC setting
References: 1. Zarowitz BJ, O’Shea T. Chronic obstructive pulmonary disease: prevalence, characteristics, and pharmacologic treatment in nursing home residents with cognitive impairment. J Manag Care Pharm. 2012;18(8):598-606. 2. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2016. http://www.goldcopd.org/uploads/users/fi les/WatermarkedGlobal%20Strategy%202016(1).pdf. Accessed February 2, 2016. 3. Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J. 2006;28(3):523-532. 4. Goodridge DM. COPD as a life-limiting illness: implications for advanced practice nurses. Medscape: Advanced Practice Nursing eJournal. 2006;6(4):1-12. 5. Jiang HJ, Weir LM, Potter DEB, Burgess J. Potentially preventable hospitalizations among Medicare-Medicaid dual eligibles, 2008. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb96.pdf. Accessed January 27, 2016. 6. Centers for Medicare & Medicaid Services. Readmissions reduction program. https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html. Accessed January 27, 2016. 7. Luke J. SNF readmission penalties announced: is your facility prepared? California Association of Long Term Care Medicine. http://www.caltcm.org/index.php?option=com_content&view=article&id=242:snf-readmission-penalties-announced-is-your-facility-prepared-&catid=22:news&Itemid=111. Accessed January 27, 2016. 8. The American Medical Directors Association (AMDA). COPD management in the long-term care setting. http://www.amda.com/tools/guidelines.cfm. Accessed January 28, 2016. 9. Centers for Medicare & Medicaid Services. MDS 3.0 frequency report: Fourth Quarter 2015. C0500: Cognitive Patterns - BIMS Summary Score. https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/Minimum-Data-Set-3-0-Public-Reports/Minimum-Data-Set-3-0-Frequency-Report.html. Accessed February 22, 2016. 10. Taffet GE, Donohue JF, Alman PR. Considerations for managing chronic obstructive pulmonary disease in the elderly. Clin Int Aging. 2014;9:23-30. 11. Dhand R, Dolovich M, Eng P, et al. The role of nebulized therapy in the management of COPD: evidence and recommendations. COPD. 2012;9:58-72. 12. Sakaan S, Ulrich D, Luo J, Finch CK, Self TH. Inhaler use in hospitalized patients with chronic obstructive pulmonary disease or asthma: assessment of wasted doses. Hosp Pharm. 2015;50(5):386-390. 13. Dolovich MB, MacIntyre NR, Anderson PJ, et al. Consensus statement: aerosols and delivery devices. Respir Care. 2000;45(6):589-596.
Sunovion and are registered trademarks of Sumitomo Dainippon Pharma Co., Ltd. Sunovion Pharmaceuticals Inc. is a U.S. subsidiary of Sumitomo Dainippon Pharma Co., Ltd. ©2016 Sunovion Pharmaceuticals Inc. All rights reserved. 3/16 BRO022-16
Shortness of breath and exacerbations are common among LTC residents1
62% of residents have short-term memory problems; 43% have moderately or severely impaired cognitive skills for daily decision-making1
Residents may be clinically appropriate for nebulized therapy11
COPD is a leading cause of death and a major driver of hospital readmissions2,5
AMDA Clinical Practice Guidelines for residents with moderate-to-severe COPD recommend maintenance therapy with long-acting beta agonist and/or long-acting anticholinergic, and SABA as needed8** AMDA does not endorse any specific treatments.
As many as 60% of residents do not receive a long-acting agent (noted among residents who had experienced at least 2 exacerbations), and 17% receive no treatment at all1
An educational resource for nursing facilities
Chronic obstructive pulmonary disease
(COPD) in the long-term care (LTC) setting
DISKRELEASE
CONCENTRICHX FILE NAME: 16BROV0094_Unbranded LTC Leave Behind_M1 COLORS
FILE DESCRIPTION: DON - CP Leave Behind
MECH: CM 3.3.16DISK: HANS 031716
Print Scale: NONECLIENT: SUNOVION
BLEED:TRIM:SAFETY:FINAL SIZE:
1.25” X 1.25”12.5” 16”N/A6.25” X 8”
C M Y K
Nebulization is a useful medication delivery method for many
LTC residents with COPD
Physical and cognitive limitations common in the elderly may interfere with proper administration
of inhaled therapies10
COPD: Undertreated in the LTC setting1
SABA monotherapy in COPD residents with cognitive impairment
Long-acting bronchodilators may be underutilized in residents with COPD1
Outcomes for cognitively impaired residents taking nebulized SABA monotherapy1
Shortness of breath and exacerbations are common in the LTC population.1
Shortness of breath
33% 39% 22% 38%
≥2 exacerbations in 12 months
Cognitively impaired COPD residents treated with nebulized SABA monotherapy
LTC COPD population
48% 58%
≥1 hospital stay in 12-month period
Cognitive impairments are common among residents with COPD
Optimal disease management may be challenging in the cognitively impaired1
Treatment time of 5 to 10 minutes11*
No deep breaths or breath-holding
required11
Medication delivery to the lungs with regular
tidal breathing12
Elderly patients, particularly those aged ≥75, may have cognitive difficulties that hinder inhaler use10
In a study of cognitively impaired patients who were instructed on inhaler use, 50% of patients with borderline cognitive impairment could not operate a metered-dose inhaler correctly 1 day after training10
Residents with significant cognitive impairment may be clinically appropriate candidates for nebulized therapy10
Preparation and device cleaning required13
60%
of residents who have experienced at least 2 exacerbations
do not receive a long-acting agent
As many as
17%
do not receive any respiratory treatment at all
receive a nebulized short-acting beta-agonist
(SABA)
49%
37%
have Alzheimer’s or dementia
43%
have moderately or severely impaired cognitive skills for
daily decision-making
have short-term memory problems
62%
Among residents with COPD1*:
CMS data show a wide range (15% to 70%) of LTC residents demonstrate signs of moderate-to-severe cognitive impairments,
based on mental status interviews.9†
* Based on a 2012 retrospective analysis of claims from skilled nursing facilities.1
† Data measured were from October 2009 to September 2010 and based on the Minimum Data Set (MDS), a standardized assessment tool for nursing facilities that includes items that identify cognitive impairments.1
The majority of LTC residents diagnosed with COPD in this cohort were female (58%) and aged ≥75 (64.7%)1
Moderate-to-severe cognitive impairment was common in this group of LTC residents1
Among residents with COPD1*†:
