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J Allergy Clin Immunol. 2014 Dec;134(6):1260-1268.e3. doi: 10.1016/j.jaci.2014.05.041. Epub 2014 Jul 22.

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

Author information

1
Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia. Electronic address: j.m.foster@woolcock.org.au.
2
Department of General Practice, Sydney Medical School (Westmead), University of Sydney, Sydney, Australia.
3
Faculty of Pharmacy, University of Sydney, Sydney, Australia.
4
Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia.
5
Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.
6
Department of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Md.
7
Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.

Abstract

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.

KEYWORDS:

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

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  • Reply. [J Allergy Clin Immunol. 2016]
PMID:
25062783
DOI:
10.1016/j.jaci.2014.05.041
[Indexed for MEDLINE]

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