Inhaler reminders improve adherence with controller treatment in primary care patients with asthma - 05/12/14
, Tim Usherwood, BSc, MD, BS b, Lorraine Smith, PhD c, Susan M. Sawyer, MBBS, MD d, e, f, Wei Xuan, MSc, MAppStat, PhD g, Cynthia S. Rand, PhD h, Helen K. Reddel, MBBS, PhD aAbstract |
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 × 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 μg). 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.
Le texte complet de cet article est disponible en PDF.Key words : Medication adherence, treatment effectiveness, intervention studies, antiasthmatic agents, asthma, ambulatory monitoring, health communication
Abbreviations used : ACT, GP, ICS, IRF, LABA, PAD, T, UC
Plan
| Funding for this study was provided by the National Health and Medical Research Council of Australia (ID571053). The Asthma Control Test was used with permission of GlaxoSmithKline and in accordance with conditions specified by GlaxoSmithKline under the terms of its license with the copyright holder, QualityMetric Incorporated. One month's supply of controller and 1 spacer per patient was provided by GlaxoSmithKline. SmartTrack devices were purchased from Nexus6 (Auckland, New Zealand). SIM cards for the remote upload of adherence data were provided by Vodaphone, New Zealand. None of the above bodies had any role in the design, conduct, analysis, or interpretation of the study, nor did they see the manuscript before submission. The authors alone are responsible for the content and writing of the article. |
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| Disclosure of potential conflict of interest: The Woolcock Institute of Medical Research has received unrestricted funding for research by J. M. Foster from GlaxoSmithKline (GSK) and AstraZeneca. J. M. Foster has received compensation for board membership from Vertex Pharmaceuticals, as well as payment for delivering lectures from GSK, the Pharmaceutical Society of Australia, and AstraZeneca; has received payment for the development of educational presentations from the Pharmaceutical Society of Australia, and AstraZeneca; J.M. Foster's institution has also received writing assistance, medicines, equipment, and administrative support from GSK, as has the institution of H. K. Reddel. T. Usherwood's institution has received funding from the National Health and Medical Research Council. L. Smith's institution has received funding from the National Health and Medical Research Council; she has received consultancy fees from the Pharmaceutical Society of Australia, as well as payment for delivering lectures, and for the development of educational presentations. S. Sawyer's institution has received consultancy fees from AstraZeneca. C. S. Rand has participated in advisory boards for Merck Foundation/Merck Childhood Asthma Network and TEVA Pharmaceuticals; has received consultancy fees from TEVA and Merck, as well as payment for delivering lectures from TEVA; her institution has received a grant from the National Institutes of Health (R18HL107223, unrelated to the present study). H. K. Reddel has received compensation for board membership from AstraZeneca, Boehringer Ingelheim, GSK, Merck, and Novartis; has received consultancy fees from AstraZeneca, GSK, iNova, and Mundipharma; her institution has received grants or has grants pending from AstraZeneca and GSK; she has received payment for delivering lectures from AstraZeneca, GSK, and Novartis, as well as for the development of educational presentations; she has received compensation for travel and other meeting-related expenses from Novartis and Boehringer Ingelheim; is participating in a data monitoring and safety board for AstraZeneca, GSK, Merck, and Novartis relating to the safety of long-acting β2-agonists; has provided independent continuing medical education for AstraZeneca, GSK, and Novartis; and has received unrestricted research grants from AstraZeneca and GSK. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 134 - N° 6
P. 1260 - décembre 2014 Retour au numéro
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