Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada; Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montréal, QC, Canada.
Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada; Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montréal, QC, Canada; Research Centre, Centre Intégré Universitaire de santé et de services sociaux de l'Estrie-CHUS, Sherbrooke, QC, Canada.
Respir Med. 2021 Aug-Sep;185:106510. doi: 10.1016/j.rmed.2021.106510. Epub 2021 Jun 16.
In recent years, there has been growing interest in studying asthma treatment escalation patterns in the real-world setting, particularly with the advent of expensive biologic therapies. Healthcare administrative claims databases can be used to study treatment escalation patterns at a population-level; however, the reported definitions for claims-based asthma treatment escalation are highly variable in the literature.
The aim of this study was to develop an operational definition of treatment escalation in adults with asthma that can be applied to healthcare administrative data.
A mixed-methods research design incorporating the Delphi process was used to establish an expert consensus for this definition. A multi-disciplinary expert panel participated in three iterative rounds of online questionnaires covering treatment escalation criteria inspired by a systematic review, which was conducted as part of this study. The final definition was constructed using criteria for which a 75% level of agreement was achieved among the experts.
We developed a claims-based treatment escalation definition that was adapted from the Global Initiative for Asthma (GINA) strategy. The definition comprised seven treatment steps, as well as escalation options for treatments that are not typically included in clinical guidelines. The definition also incorporated methods to identify treatments in severe asthma, such as oral corticosteroid maintenance therapy and chronic azithromycin use.
The operational definition of treatment escalation developed in this study bridges the gap between clinical guidelines and real-world clinical practice and lays the groundwork for future observational studies on treatment escalation patterns among patients with asthma.
近年来，人们对在真实环境中研究哮喘治疗升级模式越来越感兴趣，尤其是随着昂贵的生物疗法的出现。医疗保健管理索赔数据库可用于在人群层面研究治疗升级模式；然而，文献中基于索赔的哮喘治疗升级的报告定义差异很大。
本研究旨在为成人哮喘的治疗升级制定一个可应用于医疗保健管理数据的操作定义。
采用结合德尔菲法的混合方法研究设计来确定该定义的专家共识。一个多学科专家小组参与了三回合在线问卷调查，这些问卷的治疗升级标准是受本研究中进行的系统评价启发的。最终的定义是使用专家达成 75%共识的标准构建的。
我们制定了一个基于索赔的治疗升级定义，该定义改编自全球哮喘倡议 (GINA) 策略。该定义包括七个治疗步骤，以及通常不包含在临床指南中的治疗选择。该定义还纳入了识别严重哮喘治疗方法的方法，如口服皮质类固醇维持治疗和慢性阿奇霉素使用。
本研究中制定的治疗升级操作定义弥合了临床指南和真实临床实践之间的差距，为未来关于哮喘患者治疗升级模式的观察性研究奠定了基础。
