{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T13:55:38Z","timestamp":1760622938724},"reference-count":43,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2014,12,16]],"date-time":"2014-12-16T00:00:00Z","timestamp":1418688000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Clalit Health Services, Israel","award":["KM241390405"],"award-info":[{"award-number":["KM241390405"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2015,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and objective<\/jats:title><jats:p>Previous studies had demonstrated association between <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>iotropium therapy (once\u2010daily inhaled anticholinergic) and reductions of exacerbations, improvements in dyspnoea and quality of life in chronic obstructive pulmonary disease (<jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content>) patients. Little is known about the influence of adherence to <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>iotropium on health\u2010care utilization. Our objective was to examine whether adherence to <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>iotropium is associated with decreased health\u2010care utilization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A computerized medical database was used to identify patients with <jats:styled-content style=\"fixed-case\">COPD<\/jats:styled-content> registered in an academic pulmonology institute who began therapy of <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>iotropium 18\u2009mg between 2008 and 2011 (<jats:italic>n<\/jats:italic>\u2009=\u2009193). Adherence was assessed by calculating the proportion of days covered and defined as coverage of at least 80% of the follow\u2010up period. Adherence to long\u2010acting beta\u2010agonists and\/or inhaled corticosteroids (<jats:styled-content style=\"fixed-case\">LABA<\/jats:styled-content> and\/or <jats:styled-content style=\"fixed-case\">ICS<\/jats:styled-content>) and health\u2010care utilization were analysed 1 year before and 2 years after initiation of <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>iotropium. A multivariate regression model was applied to examine determinants of change in health\u2010care utilization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median age of study population was 67 (80% male). Forty\u2010one per\u2009cent of study population (<jats:italic>n<\/jats:italic>\u2009=\u200979) adhered to <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>iotropium. Hospitalization costs decreased 1 year following treatment initiation only among adherent patient when their adherence to <jats:styled-content style=\"fixed-case\">LABA<\/jats:styled-content> and\/or <jats:styled-content style=\"fixed-case\">ICS<\/jats:styled-content> improved (\u03b2\u2009=\u2009\u2212463.6, <jats:italic>P<\/jats:italic>\u2009=\u20090.033). This cost did not change significantly in the consecutive second year (\u03b2\u2009=\u2009206.3, <jats:italic>P<\/jats:italic>\u2009=\u20090.583).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Adherence to <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>iotropium was associated with decreased hospitalizations only among patients who improved their adherence to <jats:styled-content style=\"fixed-case\">LABA<\/jats:styled-content> and\/or <jats:styled-content style=\"fixed-case\">ICS<\/jats:styled-content> as well. Exploring reasons for high non\u2010adherence and ways to improve adherence may optimize utilization of the scarce hospital resources.<\/jats:p><\/jats:sec>","DOI":"10.1111\/resp.12453","type":"journal-article","created":{"date-parts":[[2014,12,16]],"date-time":"2014-12-16T07:33:18Z","timestamp":1418715198000},"page":"304-311","source":"Crossref","is-referenced-by-count":5,"title":["<scp>T<\/scp>iotropium as part of inhaled polytherapy: Adherence and associated health\u2010care utilization"],"prefix":"10.1111","volume":"20","author":[{"given":"Tzahit","family":"Simon\u2010Tuval","sequence":"first","affiliation":[{"name":"Department of Health Systems Management Guilford Glazer Faculty of Business and Management Ben\u2010Gurion University of the Negev  Beer\u2010Sheva Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nimrod","family":"Maimon","sequence":"additional","affiliation":[{"name":"Pulmonology Institute Division of Internal Medicine Soroka University Medical Center  Beer\u2010Sheva Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,12,16]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2012.02.005"},{"key":"e_1_2_7_3_1","unstructured":"National Institute of Health National Heart Lung and Blood Institute.Morbidity and mortality: 2012 chart book on cardiovascular lung and blood diseases.2012. 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