Inhaler reminders improve adherence with controller treatment in primary care patients with asthma

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:134

Article

Foster, Juliet M.¹  Usherwood, Tim²  Smith, Lorraine³  Sawyer, Susan M.^4,5,6  Xuan, Wei⁷  Rand, Cynthia S.⁸  Reddel, Helen K.¹ 

[1] Univ Sydney, Woolcock Inst Med Res, Clin Management Grp, Camperdown, NSW 2050, Australia

[2] Univ Sydney, Dept Gen Practice, Sydney Med Sch Westmead, Camperdown, NSW 2050, Australia

[3] Univ Sydney, Fac Pharm, Camperdown, NSW 2050, Australia

[4] Royal Childrens Hosp, Ctr Adolescent Hlth, Parkville, Vic, Australia

[5] Univ Melbourne, Dept Paediat, Melbourne, Vic 3010, Australia

[6] Murdoch Childrens Res Inst, Melbourne, Vic, Australia

[7] Univ New S Wales, South Western Sydney Clin Sch, Ingham Inst Appl Med Res, Sydney, NSW, Australia

[8] Johns Hopkins Sch Med, Dept Pulm & Crit Care Med, Baltimore, MD USA

关键词: Medication adherence;    treatment effectiveness;    intervention studies;    antiasthmatic agents;    asthma;    ambulatory monitoring;    health communication;   

DOI  :  10.1016/j.jaci.2014.05.041

来源: Elsevier

【 摘 要 】

Background: Poor adherence contributes to uncontrolled asthma. Pragmatic adherence interventions for primary care settings are lacking. Objective: To test the effectiveness of 2 brief general practitioner (GP)-delivered interventions for improving adherence and asthma control. Methods: In a 6-month cluster randomized 2 x 2 factorial controlled trial, with GP as unit of cluster, we compared inhaler reminders and feedback (IRF) and/or personalized adherence discussions (PADs) with active usual care alone; all GPs received action plan and inhaler technique training. GPs enrolled patients prescribed combination controller inhalers, with suboptimal Asthma Control Test (ACT) scores (ACT score <= 19). Inhaler monitors recorded fluticasone propionate/salmeterol adherence (covertly for non-IRF groups) and, in IRF groups, provided twice-daily reminders for missed doses, and adherence feedback. PAD GPs received communication training regarding adherence. Outcomes collected every 2 months included ACT scores (primary outcome) and severe exacerbations. Intention-to-treat mixed-model analysis incorporated cluster effect and repeated measures. Results: A total of 43 GPs enrolled 143 patients with moderate-severe asthma (mean age, 40.3 +/- 15.2 years; ACT score, 14.6 +/- 3.8; fluticasone propionate dose, 718 +/- 470 mu g). Over 6 months, adherence was significantly higher in the IRF group than in non-IRF groups (73% +/- 26% vs 46% +/- 28% of prescribed daily doses; P < .0001), but not between PAD and non-PAD groups. Asthma control improved overall (mean change in ACT score, 4.5 +/- 4.9; P < .0001), with no significant difference among groups (P = .14). Severe exacerbations were experienced by 11% of the patients in IRF groups and 28% of the patients in non-IRF groups (P = .013; after adjustment for exacerbation history; P = .06). Conclusions: Inhaler reminders offer an effective strategy for improving adherence in primary care compared with a behavioral intervention or usual care, although this may not be reflected in differences in day-to-day asthma control.

【 授权许可】

Free