Treatment complexity in cystic fibrosis

Trends over time and associations with site-specific outcomes

Gregory S. Sawicki, Clement L. Ren, Michael W. Konstan, Stefanie J. Millar, David J. Pasta, Alexandra Quittner

Research output: Contribution to journalArticle

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Abstract

Background: Patients with cystic fibrosis (CF) have increasing treatment complexity and high treatment burden. We describe trends in treatment complexity and evaluate its relationship with health outcomes. Methods: Using Epidemiologic Study of Cystic Fibrosis (ESCF) data, we developed a treatment complexity score (TCS) from 37 chronic therapies and assessed change by age group (6-13, 14-17, and 18. + years) over a three year period. Differences in average site TCS were evaluated by quartiles based on FEV1, BMI, or Treatment Burden score on the Cystic Fibrosis Questionnaire-Revised (CFQ-R). Results: TCS scores were calculated for 7252 individual patients (42% child, 16% adolescent, 43% adult) across 153 sites. In 2003, mean TCS was 11.1 for children, 11.8 for adolescents, and 12.1 for adults. In all 3 age groups, TCS increased over 3years; the increase in TCS from 2003-2005 for children was 1.25 (95% CI 1.16-1.34), for adolescents 0.77 (0.62-0.93), and for adults 1.20 (1.08-1.31) (all P<0.001 for trend over time). At the site level, there were no significant differences in mean TCS based on FEV1 quartile. Mean TCS was higher in the highest BMI z-score quartile. Across all 3 versions of the CFQ-R, mean TCS was lower at sites in the highest quartiles (lowest burden) for CFQ-R treatment burden scores. Conclusion: Treatment complexity was highest among adults with CF, although over 3. years, we observed a significant increase in treatment complexity in all age groups. Such increases in treatment complexity pose a challenge to patient self-management and adherence. Future research is needed to understand the associations between treatment complexity and subsequent health outcomes to reduce treatment burden and improve disease management.

Original languageEnglish
Pages (from-to)461-467
Number of pages7
JournalJournal of Cystic Fibrosis
Volume12
Issue number5
DOIs
StatePublished - Sep 1 2013

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Cystic Fibrosis
Therapeutics
Age Groups
Health
Self Care
Disease Management

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Sawicki, G. S., Ren, C. L., Konstan, M. W., Millar, S. J., Pasta, D. J., & Quittner, A. (2013). Treatment complexity in cystic fibrosis: Trends over time and associations with site-specific outcomes. Journal of Cystic Fibrosis, 12(5), 461-467. https://doi.org/10.1016/j.jcf.2012.12.009

Treatment complexity in cystic fibrosis : Trends over time and associations with site-specific outcomes. / Sawicki, Gregory S.; Ren, Clement L.; Konstan, Michael W.; Millar, Stefanie J.; Pasta, David J.; Quittner, Alexandra.

In: Journal of Cystic Fibrosis, Vol. 12, No. 5, 01.09.2013, p. 461-467.

Research output: Contribution to journalArticle

Sawicki, Gregory S. ; Ren, Clement L. ; Konstan, Michael W. ; Millar, Stefanie J. ; Pasta, David J. ; Quittner, Alexandra. / Treatment complexity in cystic fibrosis : Trends over time and associations with site-specific outcomes. In: Journal of Cystic Fibrosis. 2013 ; Vol. 12, No. 5. pp. 461-467.
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