Background Asthma and chronic obstructive pulmonary disease (COPD) affect millions of people worldwide. While medication can control and improve disease symptoms, incorrect use of medication is a common problem. The eHealth intervention SARA (Service Apothecary Respiratory Advice) aims to improve participants’ correct use of inhalation medication by providing information and as-needed tailored follow-up support by a pharmacist. Objective The primary aim of this study was to investigate the effect of SARA on exacerbation rates in participants with asthma and COPD. Secondary aims were to investigate its effects in terms of adherence to maintenance medication and antimycotic treatment. Methods In this nonrandomized pre-post study, medication dispensing data from 382 Dutch community pharmacies were included. Exacerbation rates were assessed with dispensed short-course oral corticosteroids. Medication adherence between new and chronic users was assessed by calculating the proportion of days covered from dispensed inhalation maintenance medication. Antimycotic treatment was investigated from dispensed oral antimycotics in participants who were also dispensed inhaled corticosteroids (ICS). Outcomes were assessed 1 year before and 1 year after implementation of SARA and were compared between SARA participants and control participants. More specifically, for exacerbation rates and medication adherence, a difference score was calculated (ie, 1 year after SARA minus 1 year before SARA) and was subsequently compared between the study groups with independent-samples t tests. For antimycotics, the relative number of participants who were dispensed antimycotics was calculated and subsequently analyzed with a mixed-effects logistic regression. Results The study population comprised 9452 participants, of whom 2400 (25.39%) were SARA participants. The mean age of the population was 60.8 (15.0) years, and approximately two-thirds (n=5677, 60.06%) were female. The results showed an increase in mean exacerbation rates over time for both study groups (SARA: 0.05; control: 0.15). However, this increase in exacerbation rates was significantly lower for SARA participants (t9450=3.10, 95% CI 0.04-0.16; P=.002; Cohen d=0.06). Chronic users of inhalation medication in both study groups showed an increase in mean medication adherence over time (SARA: 6.73; control: 4.48); however, this increase was significantly higher for SARA participants (t5886=–2.74, 95% CI –3.86 to –0.84; P=.01; Cohen d=–0.07). Among new users of inhalation medication, results showed no significant difference in medication adherence between SARA and control participants in the year after implementation of SARA (t1434=–1.85, 95% CI –5.60 to 0.16; P=.06; Cohen d=–0.10). Among ICS users, no significant differences between the study groups were found over time in terms of the proportion of participants who were dispensed antimycotics (t5654=0.29, 95% CI –0.40 to 0.54; P=.76; Cohen d=0). Conclusions This study provides preliminary evidence that the SARA eHealth intervention might have the potential to decrease exacerbation rates and improve medication adherence among patients with asthma and COPD.

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BACKGROUND eHealth is increasingly considered an important tool for supporting pharmacotherapy management. OBJECTIVE We aimed to assess: 1) use of eHealth in pharmacotherapy management in patients with asthma/chronic obstructive pulmonary disease (COPD), diabetes, or cardiovascular disease (CVD), 2) effectiveness of these interventions on pharmacotherapy management and clinical outcomes, and 3) key factors contributing to the success of eHealth interventions for the pharmacotherapy management. METHODS We conducted a scoping review to assess the use and effectiveness of eHealth interventions on medication pharmacotherapy management in asthma/COPD, CVD, and diabetes patients following the PRISMA statement. Databases searched included Embase, MEDLINE, and Cochrane Library. Screening was conducted by two independent researchers. Eligible articles were randomized controlled trials and cohort studies assessing the effect of an eHealth intervention for pharmacotherapy management compared to usual care on pharmacotherapy management or clinical outcomes in patients with asthma/COPD, CVD, or diabetes. The interventions were categorized by the type of device, pharmacotherapy management, mode of delivery, features, and domains described in the conceptual model for eHealth by Shaw at al. The effectiveness on pharmacotherapy management outcomes and clinical patient- and clinician-reported outcomes was analysed per type of intervention categorised by number of domains and features to identify trends. RESULTS Of 63 studies included, 16 (25%), 31 (49%), 13 (21%), and 3 (5%) included patients with asthma/COPD, CVD, diabetes, or CVD and diabetes, respectively. Most interventions (60%) were targeted at improving medication adherence, often combined to optimize the treatment plan. Six of the asthma/COPD interventions were developed to improve inhaled medication use. Most studies provided an option for feedback to the patient (76%). Most eHealth interventions (32%) combine all three domains of Shaw, followed by 25% combining Interacting for Health with Data Enabling Health. Two-third (42/63) of the studies showed a positive overall effect. Respectively, 48%, 57%, and 39% of the studies reported a positive effect on pharmacotherapy management, clinician-reported clinical, and patient-reported clinical outcomes. Pharmacotherapy management and patient-reported clinical outcomes are more often positive in interventions with ≥3 features, but this was not the case for clinician-reported clinical outcomes. There is a trend toward a higher number of studies reporting a positive effect on all three outcomes with an increasing number of domains by Shaw. Of the studies with interventions providing feedback to the patient more studies showed a positive clinical outcome compared to studies with interventions without feedback. This effect was not seen for pharmacotherapy management outcomes. CONCLUSIONS There is a wide variety of eHealth interventions combining various domains and features to target pharmacotherapy management in asthma/COPD, CVD, and diabetes. Results suggest feedback is a key factor for a positive effect on clinician-reported clinical outcomes. eHealth interventions become more impactful when combining domains by Shaw.

BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) affect millions of people worldwide. Whilst medication can control and improve disease symptoms, incorrect use of medication is a common problem. eHealth intervention ‘SARA’ aims to improve participants’ correct use of inhalation medication by providing information, as well as as-needed tailored follow-up support by a pharmacist. OBJECTIVE The primary aim of this study was to investigate the effect of SARA on exacerbation rates in participants with asthma and COPD. Secondary aims were to investigate its effects in terms of adherence to maintenance medication and antimycotic treatment. METHODS In this non-randomized pre-post study, medication dispensing data of 382 Dutch community pharmacies were included. Exacerbation rates were assessed with dispensed oral corticosteroids short courses. Medication adherence was assessed by calculating the proportion of days covered (PDC) from dispensed inhalation maintenance medication, wherefore a distinction was made between new and chronic users. Antimycotic treatment was investigated from dispensed oral antimycotics in participants who were also dispensed inhaled corticosteroids (ICS). Outcomes were assessed one year before and one year after implementation of SARA and compared between SARA participants and control participants. More specifically, for exacerbation rates and medication adherence, a difference score was calculated (year after SARA minus year before SARA), and subsequently compared between the study groups with independent samples t-tests. For antimycotics, the relative number of participants who were dispensed antimycotics was calculated and subsequently analyzed with a mixed-effects logistic regression RESULTS The study population comprised 9,452 participants, of whom 2,400 were SARA participants. The mean age of the population was about 61, and approximately two-third was female. The results showed an increase in mean exacerbation rates over time for both study groups; 0.05 increase in SARA and 0.15 in controls. However this increase in exacerbations was significantly lower in the SARA condition (t9450= 3.10, 95% CI= 0.04 – 0.16, P= .002, Cohen d = 0.06). Chronic users of inhalation medication showed an increase in medication adherence over time in both study groups (6.73 in SARA and 4.48 control participants respectively); yet, this increase was significantly higher for SARA participants (t5886= -2.74, 95% CI= -3.86 – -0.84, P=.01, Cohen d = -0.07). In new users of inhalation medication, results showed no significant difference in medication adherence between SARA and controls in the year after implementation of SARA (t1434= -1.85, 95% CI= -5.60 – 0.16, P=.06, Cohen d = -0.10). In ICS-users, no significant differences between the study groups were found over time in terms of the proportion of participants who were dispensed antimycotics (t5654= 0.29, 95% CI= -0.40 - 0.54, P=.76, Cohen d = 0.00). CONCLUSIONS This study provides preliminary evidence that eHealth intervention SARA might have the potential to decrease exacerbation rates and improve medication adherence.