Interventions to improve adherence to inhaled steroids for asthma

Kew, Kayleigh M; Normansell, Rebecca; Stovold, Elizabeth

doi:10.1002/14651858.cd012226

Cited by 7 publications

(3 citation statements)

References 21 publications

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“…As much as possible, we carried out this review as presented in the published protocol (Kew 2016) and recorded deviations from it under Differences between protocol and review. We could not perform planned subgroup or sensitivity analyses on some outcomes because studies were too few or fell into a single subgroup.…”

Section: Potential Biases In the Review Processmentioning

confidence: 99%

Interventions to improve adherence to inhaled steroids for asthma

Normansell

Kew

Stovold

2017

Cochrane Database of Systematic Reviews

Self Cite

119

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Pooled results suggest that a variety of interventions can improve adherence. The clinical relevance of this improvement, highlighted by uncertain and inconsistent impact on clinical outcomes such as quality of life and asthma control, is less clear. We have low to moderate confidence in these findings owing to concerns about risk of bias and inconsistency. Future studies would benefit from predefining an evidence-based 'cut-off' for acceptable adherence and using objective adherence measures and validated tools and questionnaires. When possible, covert monitoring and some form of blinding or active control may help disentangle effects of the intervention from effects of inclusion in an adherence trial.

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Section: Potential Biases In the Review Processmentioning

confidence: 99%

Interventions to improve adherence to inhaled steroids for asthma

Normansell

Kew

Stovold

2017

Cochrane Database of Systematic Reviews

Self Cite

119

View full text Add to dashboard Cite

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“…The highest number of parents’ complaints were about the cost and the inappropriate dosage form. Suboptimal adherence leads to poorer clinical outcomes and increased health care costs [ 49 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of pharmaceutically compounded oral caffeine on the impact of medication adherence and risk of readmission among preterm neonates: A single-center quasi-experimental study

et al. 2022

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Background Caffeine is available in an ampoule, used via parenteral and enteral routes in preterm neonates to treat apnea of prematurity (AOP) in neonates of gestational age ≥ 35–40 weeks. A longer duration of therapy has a higher risk of medication non-adherence due to higher costs and inappropriate dosage forms. Pharmaceutically compounded oral caffeine (PCC) could be an appropriate alternate dosage form. The researchers aimed to determine the impact of PCC on medication-related factors influencing medication adherence (MA) and the frequency of hospital readmission with apnea (HRA) in preterm neonates. Methods We conducted a single-center quasi-experimental study for this quality improvement project using PCC among the preterm neonates admitted in a tertiary care level-III NICU at the Aga Khan University Hospital Karachi, Pakistan, received caffeine therapy, and survived at discharge. The researchers compared pre-PCC data (April-December 2017) with post-PCC data (April-Dec 2018) each for nine months, with three months intervals (January-March 2018) of PCC formulation and implementation phase. The study was conducted according to the SQUIRE2.0 guidelines. The Data were collated on factors influencing MA, including the cost of therapy, medication refill rates, and parental complaints as primary outcome measures. The Risk factors of HRA were included as secondary outcomes. Results After PCC implementation cost of therapy was reduced significantly from Rs. 97000.0 (729.0 USD) to Rs. 24500.0 (185.0 USD) (p<0.001), significantly higher (p<0.001) number of patients completed remaining refills (77.6% pre-phase vs 97.5% post-phase). The number of parental complaints about cost, ampoule usage, medication drawing issue, wastage, inappropriate dosage form, and longer duration of therapy reduced significantly in post-phase. HRA reduced from 25% to 6.6% (p<0.001). Post-implementation of PCC (RR 0.14; 95% CI: 0.07–0.27) was a significant independent risk factor for reducing HRA using a multivariate analysis model. Longer duration of caffeine therapy after discharge (RR 1.05; 95% CI: 1.04–1.04), those who were born in multiple births (RR 1.15; 95% CI: 1.15–1.15), and those who had higher number of siblings were other significant independent risk factors for HRA. Conclusions PCC dispensation in the appropriate dosage form at discharge effectively reduced cost, non-adherence to therapy, and risk of hospital readmissions. This neonatal clinical and compounding pharmacist-led model can be replicated in other resource-limiting setting.

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“…Adherence of asthmatics to long-term inhaled treatment has contributed substantial to asthma control and to morbidity reduction, yet, in general, it still remains suboptimal ( 13 – 16 ). The suboptimal adherence leads to poorer clinical outcomes and increased health care costs ( 17 , 18 ).…”

Section: Introductionmentioning

confidence: 99%

Interventions on Adherence to Treatment in Children With Severe Asthma: A Systematic Review

et al. 2018

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Introduction: Poor adherence to inhaled medication is a commonly encountered problem among children with asthma. However, there is a relatively paucity of data regarding the adherence of children with severe asthma, as well as the merit of any interventions to improve this adherence.Objectives: The aim of this systematic review was to identify the available literature on the rate of adherence and the influence of interventions in improving adherence to controller inhaled medication, in children with severe asthma.Methods: A systematic literature search was performed in MEDLINE/PubMed, Cochrane Library, and Scopus databases. Studies were included in the present review if their target population were children and/or adolescents with severe asthma and presented data on medication adherence before and after a given intervention.Results: A total of seven studies, conducted in USA, Canada, and UK, and published between 2012 and 2018, met the inclusion criteria. Adherence to controller medication was assessed via either objective or subjective measures (questionnaires), or a combination of them. Interventions included communication during pediatric visits and audio-taped medical visits, individualized care programs, electronic monitoring devices, interactive website and peak–flow prediction with feedback. Adherence rates for the baseline (before intervention) or for the control groups ranged from 28 to 67%. In general, there was a significant improvement of adherence after intervention with rates increasing to 49–81%.Conclusion: Adherence rate in children with severe asthma is not satisfactory but it can be improved after proper interventions. Nevertheless, the heterogeneity among adherence assessment tools, and the variety of interventions, in combination with the lack of studies focusing on severe asthma, highlight the need for further research in this field.

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Interventions to improve adherence to inhaled steroids for asthma

Cited by 7 publications

References 21 publications

Interventions to improve adherence to inhaled steroids for asthma

Interventions to improve adherence to inhaled steroids for asthma

Evaluation of pharmaceutically compounded oral caffeine on the impact of medication adherence and risk of readmission among preterm neonates: A single-center quasi-experimental study

Interventions on Adherence to Treatment in Children With Severe Asthma: A Systematic Review

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