Providing Feedback on Adherence Increases Use of Preventive Medication by Asthmatic Children

Abstract

This study investigates the impact of measuring adherence and providing feedback on medication usage by children with unstable asthma. Adherence was measured using an electronic monitoring device. Subjects were randomized to either being told of their adherence during review consultations or for their adherence to remain undisclosed to their parents and treating physician. Subjects were reviewed monthly for 4 months. Twenty-six children aged between 6 and 14 years were recruited. Adherence was significantly higher in the intervention group (79% versus 58%, p <.01). There were significant improvements in clinical measures of disease control compared with baseline in both groups. The change in forced expiratory volume in 1 s (FEV(1)) (% predicted) was greater in those subjects receiving feedback (13.8% versus 9.8%). However, lung function values were lower in the intervention group at baseline and the relative improvement failed to reach statistical significance. Measuring adherence and providing feedback increases the use of preventive medication. A larger study is required to explore implications for disease control.

Improving Pediatric Asthma Care and Outcomes Across Multiple Hospitals

“…[5][6][7][8] Multiple quality improvement (QI) efforts to improve inpatient asthma care for children have been reported, but a positive impact on asthma outcomes is often not demonstrated. 3,[9][10][11][12][13][14][15][16][17][18] No data exist about the sustainability or long-term impact of QI interventions. Furthermore, most of the successful pediatric inpatient asthma interventions are implemented at a tertiary care pediatric centers, with little information available about dissemination to community hospitals.…”

Electronic Monitoring of Adherence to Inhaled Medication in Asthma

“…This standard method of communicating adherence data back to a patient has been used with some success with studies reporting an improvement in patients at high-risk of non-adherence [21,25,41,64]. However, it is important to investigate new and alternative methods of feedback and communication to attempt to utilise this wealth of data.…”

Adherence-Related Issues in Adolescents and Young Adults with Hematological Disorders

“…EM devices attached to pill dispensers not only provide information on the degree of adherence, but represent an effective and proven means for providing feedback on medication-taking behavior and improving adherence in both children [35] and adults [107,122]. The latter may be achieved by equipping patients with cognitive-behavioral skills such as problem-solving and using motivational interviewing [123] which are both facilitated by objective data on adherence.…”

“…This is especially applicable to nonobjective adherence measures. An inherent limitation of research regarding adherence is that patients consenting to take part in a prospective trial may have a higher (or in certain circumstances lower) adherence than nonparticipants and that the act of participating in a clinical trial and monitoring adherence may change adherence-related behavior [35], especially during the first month of the study. EM, especially, has been shown to have an intervention effect which wanes over the course of up to 5 weeks [36,37].…”

“…Therefore, EM feedback is actually a subtype of behavioral counseling. RCTs in this field indicate that there may be a possible effect on clinical outcomes [35,122], and a recent meta-analysis highlighted the superior efficacy of EM feedback compared to other modalities in a general population [107]. A pilot case study has shown its potential in AYAs with hematological disorders [124]; however, this method is costly and may be suitable mainly for complex cases and not for the general population, unless overall cost-effectiveness superior to other AEIs is shown.…”