A Pharmacy-Based eHealth Intervention Promoting Correct Use of Medication in Patients With Asthma and COPD: Nonrandomized Pre-Post Study

Abstract

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.

“It’s a lonely battle”: A qualitative study of older adult Canadians’ experiences with chronic obstructive pulmonary disease medication adherence and support

“…Indeed, there is evidence to support that pharmacist care is associated with improvements in medication compliance among patients with COPD. 32,33 Russell and colleagues 34 have suggested that community-based practitioners' existing relationships with patients make them well positioned to support COPD patients with self-management. In the same vein, O'Connell et al 17 found that patients want "prompt, physically accessible support, " which could be delivered in part by community pharmacists.…”

Self‐management support with the Respiratory Adherence Care Enhancer instrument in asthma and chronic obstructive pulmonary disease: An implementation trial

“…Furthermore, the Service Apothecary Respiratory Advice is a multicomponent intervention stimulating correct use of inhaler therapy in asthma and COPD. 38 Although this intervention has shown potential to decrease exacerbation rates and improve adherence, this application appears to lack a theoretical underpinning. We therefore developed the RACE instrument to support selfmanagement in asthma and COPD with an integrated theoretical basis adopting TDF and BCTs to further enhance existing interventions in their effectiveness.…”

“…Nevertheless, these instruments do not highlight specific underlying barriers concerning inhalation therapy requiring behaviour change. Furthermore, the Service Apothecary Respiratory Advice is a multicomponent intervention stimulating correct use of inhaler therapy in asthma and COPD 38 . Although this intervention has shown potential to decrease exacerbation rates and improve adherence, this application appears to lack a theoretical underpinning.…”

Asthma and COPD: Comparison with International Guidelines and Medication Adherence in Belgium

“…This was statistically significant for LAMA, LABA and LABA-ICS combinations but not for the LABA-LAMA association. Schnoor et al found that, with regard to COPD, men were more likely to be adherent than women [ 49 ]. An explanation could be that women were more likely to have more severe symptomatology than men for the same level of airway obstruction, for example having greater dyspnea and a lower body mass index.…”