The effects of patient education programs on medication use among asthma and COPD patients: a propensity score matching with a difference-in-difference regression approach

Abstract

BackgroundAdherence to medication is one of the critical determinants of successful management of chronic diseases including asthma and chronic obstructive pulmonary disease (COPD). Given that poor adherence with self-management medication is very common among asthma and COPD patients, interventions that improve the use of chronic disease management medications for this patient group have potential to generate positive health outcomes. In an effort to improve asthma and COPD care, the Lung Association of Saskatchewan has implemented an intervention by providing access to effective and high quality asthma and COPD education for both patients and health care professionals along with increasing access to spirometry.By evaluating the impacts of this intervention, our purpose in this paper is to examine the effectiveness of spirometry use, and asthma and COPD education in primary care setting on medication use among asthma and COPD patients.MethodsAt the time of the intervention, the Lung Association of Saskatchewan has not assigned a control group. Therefore we used a propensity score matching to create a control group using administrative health databases spanning 6 years prior to the intervention. Using Saskatchewan administrative health databases, the impacts of the intervention on use of asthma and COPD medications were estimated for one to four years after the intervention using a difference in difference regression approach.ResultsThe paper shows that overall medication use for the intervention group is higher than that of the control group. On average, intervention group uses more asthma and COPD drugs. Within the asthma and COPD drugs, this intervention creates a persistent effect over time in the form of higher utilization of chronic management drugs equivalent to $157 and $195 in a given year during four years after the intervention.ConclusionsThe study suggests that effective patient education and increasing access to spirometry increases the utilization of chronic disease management drugs among asthma and COPD patients. This type of interventions with patient education focus has potential to save healthcare dollars by providing better disease management among this patient group.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0998-6) contains supplementary material, which is available to authorized users.

How to design an education programme for patients with chronic obstructive disease?

“…Education should be structured to ensure that the measurements are inter-comparable. The education should consider the patients' capabilities, so that the content can be acquired, and it has cost-effective long-term effects: less frequent exacerbations result in decreased use of healthcare resources [29].…”

Towards High Quality Health Care and Sustainable Financing – the Role of Health Care Programmes

“…; Ling et al. ; Lo et al., ; Rankin et al., ; Sari and Osman, ; Warden et al., ). However, some programmes show only minimal improvements (Agren, ),…”

“…Evidence suggests that when properly targeted, patient education can lead to improved health outcomes and costsavings (Expert Panel on effective ways of investing in Health (EXPH), 2014; Hakanson et al2011;Ling et al 2012;Lo et al, 2009;Rankin et al, 2014;Sari and Osman, 2015;Warden et al, 2014). However, some programmes show only minimal improvements (Agren, 2013),…”

“…• Better coordination of care, therefore less medication errors and better adherence to recommendations (Spinewine et al, 2010) • Reduces downstream health service utilization and costs (Gardner et al, 2014, Sari andOsman, 2015) • Improves health outcomes (Gronning et al, 2013) • Improves patient satisfaction with process of care (Naylor et al, 2013) • Patients with poor health literacy will benefit less (Adams, 2010) • May not be equally accessible to all patients (Adams, 2010) • Programmes that are overly time-consuming or complicated to follow are less likely to succeed (Fight Chronic Disease, 2015) • Less accessible to patients with mental health issues (Fight Chronic Disease, 2015) Special population programmes…”

Patient Strength of Preference for Best Practices in Patient Education

“…Lorig et al found that a health education program for self-management in patients with chronic arthritis resulted in a decline in pain, physician visits, and costs [1]. Sari & Osman found that health education and greater access to spirometry resulted in increased medication use in COPD and asthma patients [2]. A systematic review (Cochrane review) looking at interventions aiming to improve medication adherence showed that patient education interventions improve medication adherence, decrease emergency department (ED) visits, and hospital admissions [3].…”