Susan O'Dwyer1, Garrett Greene2, Elaine MacHale3, Breda Cushen3, Imran Sulaiman3, Fiona Boland4, Sinthia Bosnic-Anticevich5, Matshediso C Mokoka3, Richard B Reilly6, Terence Taylor6, Sheila A Ryder7, Richard W Costello8. 1. Boots Retail (Ireland) Limited, Dublin, Ireland; School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, The University of Dublin, Dublin, Ireland. 2. Department of Population Health Science, Royal College of Surgeons in Ireland, Dublin, Ireland. 3. Clinical Research Centre, Beaumont Hospital, RCSI, Dublin, Ireland. 4. Data Science Centre, RCSI, Dublin, Ireland. 5. School of Medical Sciences, University of Sydney, Sydney, NSW, Australia. 6. Trinity Centre for Bioengineering, Trinity College Dublin, The University of Dublin, Dublin, Ireland. 7. School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, The University of Dublin, Dublin, Ireland. 8. Clinical Research Centre, Beaumont Hospital, RCSI, Dublin, Ireland; Department of Respiratory Medicine, RCSI, Dublin, Ireland. Electronic address: rcostello@rcsi.ie.
Abstract
BACKGROUND: Guidelines recommend that patients treated with inhalers receive adherence counseling and device training. Digital technologies that assess both inhaler adherence and technique have been developed. Using these technologies community pharmacists, who have regular contact with patients, are well placed to deliver personalized inhaler education. OBJECTIVE: To determine the impact of a pharmacist intervention, informed by digital technology, on inhaler technique and adherence of patients with asthma in the community. METHODS: A cluster randomized, parallel-group, multisite pharmacy study was conducted over 6 months. All study groups had an electronic device (inhaler compliance assessment device) attached to their maintenance inhaler. A biofeedback group received personalized inhaler training informed by data recorded by the device. The demonstration group received inhaler training, by physical demonstration with a placebo inhaler. The control group received usual care. The primary outcome was inhaler adherence, which was classified as "actual adherence" and expressed as the proportion of expected drug accumulation if adherence and technique had been perfect. Secondary outcomes were quality-of-life scores as measured by the St George's Respiratory Questionnaire, symptoms, and exacerbations. RESULTS: A total of 152 participants (n = 74 biofeedback, n = 56 demonstration, and n = 22 control) were recruited. Asthma was the predominant condition among participants (n = 83), with chronic obstructive pulmonary disease (n = 55) and asthma/chronic obstructive pulmonary disease overlap also reported (n = 8). In intention-to-treat analysis, adherence in the biofeedback group during month 2 was 62%, 18% higher (95% CI, 6 to 30) than that in the demonstration group (P = .004) and 24% higher (95% CI, 9 to 40) than that in the control group (P = .003). During month 6, adherence was 14% higher (95% CI, -1 to 30; P = .07) in the biofeedback group than in the demonstration group and 31% higher (95% CI, 13 to 48; P = .001) than in the control group. At the end of the study, the biofeedback group had a sustained fall in St George's Respiratory Questionnaire from baseline, -6.1 (95% CI, -9 to -0.4; P = .04) and had significantly improved daily respiratory symptoms. CONCLUSIONS: Community pharmacist-delivered inhaler training informed by a digital technology improved adherence and health status.
RCT Entities:
BACKGROUND: Guidelines recommend that patients treated with inhalers receive adherence counseling and device training. Digital technologies that assess both inhaler adherence and technique have been developed. Using these technologies community pharmacists, who have regular contact with patients, are well placed to deliver personalized inhaler education. OBJECTIVE: To determine the impact of a pharmacist intervention, informed by digital technology, on inhaler technique and adherence of patients with asthma in the community. METHODS: A cluster randomized, parallel-group, multisite pharmacy study was conducted over 6 months. All study groups had an electronic device (inhaler compliance assessment device) attached to their maintenance inhaler. A biofeedback group received personalized inhaler training informed by data recorded by the device. The demonstration group received inhaler training, by physical demonstration with a placebo inhaler. The control group received usual care. The primary outcome was inhaler adherence, which was classified as "actual adherence" and expressed as the proportion of expected drug accumulation if adherence and technique had been perfect. Secondary outcomes were quality-of-life scores as measured by the St George's Respiratory Questionnaire, symptoms, and exacerbations. RESULTS: A total of 152 participants (n = 74 biofeedback, n = 56 demonstration, and n = 22 control) were recruited. Asthma was the predominant condition among participants (n = 83), with chronic obstructive pulmonary disease (n = 55) and asthma/chronic obstructive pulmonary disease overlap also reported (n = 8). In intention-to-treat analysis, adherence in the biofeedback group during month 2 was 62%, 18% higher (95% CI, 6 to 30) than that in the demonstration group (P = .004) and 24% higher (95% CI, 9 to 40) than that in the control group (P = .003). During month 6, adherence was 14% higher (95% CI, -1 to 30; P = .07) in the biofeedback group than in the demonstration group and 31% higher (95% CI, 13 to 48; P = .001) than in the control group. At the end of the study, the biofeedback group had a sustained fall in St George's Respiratory Questionnaire from baseline, -6.1 (95% CI, -9 to -0.4; P = .04) and had significantly improved daily respiratory symptoms. CONCLUSIONS: Community pharmacist-delivered inhaler training informed by a digital technology improved adherence and health status.
Authors: Barbara P Yawn; Gretchen M McCreary; John A Linnell; Cara B Pasquale; Elisha Malanga; Radmila Choate; David A Stempel; Rahul Gondalia; Leanne Kaye; Kathryn A Collison; Benjamin S Wu; Daniel Gratie; Richard H Stanford; Ryan Tomlinson Journal: Chronic Obstr Pulm Dis Date: 2021-10-28
Authors: Breda Cushen; Aisling Madden; Deirdre Long; Yvonne Whelan; Michael Emmet O'Brien; Deirdre Carroll; Des O'Flynn; Michelle Forde; Virginia Pye; Loretto Grogan; Margaret Casey; Karolina Farrell; Richard W Costello; Clare Lewis Journal: Ir J Med Sci Date: 2021-05-06 Impact factor: 2.089
Authors: Evalyne M Jansen; Susanne J van de Hei; Boudewijn J H Dierick; Huib A M Kerstjens; Janwillem W H Kocks; Job F M van Boven Journal: J Thorac Dis Date: 2021-06 Impact factor: 2.895