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van Boven JFM, Lavorini F, Agh T, Sadatsafavi M, Patino O, Muresan B. Cost-Effectiveness and Impact on Health Care Utilization of Interventions to Improve Medication Adherence and Outcomes in Asthma and Chronic Obstructive Pulmonary Disease: A Systematic Literature Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1228-1243. [PMID: 38182099 DOI: 10.1016/j.jaip.2023.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/08/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Poor adherence to asthma and chronic obstructive pulmonary disease maintenance therapies impairs health outcomes. Proven and cost-effective programs to promote adherence and persistence are not yet in regular widespread use. Implementation costs are a potential barrier to uptake of such programs. OBJECTIVE We undertook a systematic literature review and narrative synthesis of studies investigating the cost-effectiveness of treatment adherence-promoting programs or that determined their impact on health care budget directly or via health care resource use (HCRU). METHODS We identified relevant publications using Medline and PreMEDLINE (PubMed), Embase (Embase.com, Elsevier), and EconLit for publications between January 2000 and July 2021. We also searched clinical trial databases and selected conference proceedings. RESULTS Of 1,910 potentially relevant articles, 26 met prespecified inclusion criteria and underwent data extraction. Eleven reported a direct assessment of adherence, 15 included economic evaluations, and 17 described HCRU. None included an analysis of biologic medication use. When they were studied, interventions were often found to be highly cost-effective, with dominant incremental cost-effectiveness ratios in some cases. Reductions in direct costs and HCRU (health care visits, hospital admissions, and/or the use of medications, including add-on/reliever treatment and antibiotics) were frequently reported. Reported use of maintenance treatments improved in some studies. Counseling and/or digitally informed programs were used in all cases in which favorable outcomes were observed. CONCLUSIONS Adherence-promoting interventions are mostly cost-effective and often result in reduced HCRU and associated costs. Multidisciplinary care involving one-to-one advice and digitally enhanced communications appear to offer the greatest benefit.
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Affiliation(s)
- Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, Groningen Research Institute for Asthma and COPD, University Medical Centre Groningen, Groningen, University of Groningen, Groningen, The Netherlands.
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Tamas Agh
- Syreon Research Institute, Budapest, Hungary; Center for Health Technology Assessment and Pharmacoeconomic Research, University of Pecs, Pecs, Hungary
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Oliver Patino
- Teva Pharmaceuticals Europe BV, Amsterdam, The Netherlands
| | - Bogdan Muresan
- Teva Pharmaceuticals Europe BV, Amsterdam, The Netherlands
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Visser CD, Antonisse LLM, Alleda FM, Bos C, Saini P, Kuipers E, Guchelaar HJ, Teichert M. Self-management support with the Respiratory Adherence Care Enhancer instrument in asthma and chronic obstructive pulmonary disease: An implementation trial. Br J Clin Pharmacol 2024; 90:1344-1356. [PMID: 38403776 DOI: 10.1111/bcp.16025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/15/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024] Open
Abstract
AIM Suboptimal self-management with controller inhalation therapy in asthma and COPD is frequently observed with poor treatment outcomes. The developed 'Respiratory Adherence Care Enhancer' (RACE) instrument identifies and addresses individual barriers to self-management with a theoretical underpinning. This study investigates the feasibility of pharmaceutical support with this instrument. METHODS An implementation trial was conducted with asthma and COPD patients in 5 community pharmacies in the Netherlands. Patients were allocated to standard care or add-on support with the RACE instrument. Patients were invited to complete the RACE questionnaire at baseline, 5-week and 10-week follow-up. Barrier profiles were accessible for the intervention group with subsequent consultations at baseline and 5-weeks. Experiences were collected from patients and consultants with a questionnaire and reported findings. Primary endpoints focused on the acceptability, practicality and implementation process. Secondary endpoints included between-group differences in barrier and disease control outcomes from baseline at 10-weeks follow-up. RESULTS In total, 84 patients were included; 48 were assigned to intervention and 36 to standard care. Patient satisfaction of support with the RACE instrument was high (71%). Patients felt motivated, reassured and more confident about their disease management. Consultants reported an increase in awareness of patient barriers. Patient recognition of barrier profiles was 83.9% (±12.9%). The barrier inhaler techniques decreased significantly for the intervention group at follow-up with odds ratio 0.30 (95% confidence interval, 0.10-0.91). No significant differences were observed for changes in number of barriers and disease control. CONCLUSION Self-management support with the RACE instrument is feasible and appreciated, facilitating behaviour change with patient-centred pharmaceutical care in asthma and COPD.
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Affiliation(s)
- Claire D Visser
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisanne L M Antonisse
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Floor M Alleda
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Colin Bos
- Department of Digital Engagement, Behavior and Cognition, Philips Research, Eindhoven, The Netherlands
| | - Privender Saini
- Department of Digital Engagement, Behavior and Cognition, Philips Research, Eindhoven, The Netherlands
| | - Esther Kuipers
- Community Pharmacy Empel, 's-Hertogenbosch, The Netherlands
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martina Teichert
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
- Royal Dutch Pharmacists Association (KNMP), The Hague, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Vauterin D, Van Vaerenbergh F, Vanoverschelde A, Quint JK, Verhamme K, Lahousse L. Methods to assess COPD medications adherence in healthcare databases: a systematic review. Eur Respir Rev 2023; 32:230103. [PMID: 37758274 PMCID: PMC10523153 DOI: 10.1183/16000617.0103-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/20/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The Global Initiative for Chronic Obstructive Lung Disease 2023 report recommends medication adherence assessment in COPD as an action item. Healthcare databases provide opportunities for objective assessments; however, multiple methods exist. We aimed to systematically review the literature to describe existing methods to assess adherence in COPD in healthcare databases and to evaluate the reporting of influencing variables. METHOD We searched MEDLINE, Web of Science and Embase for peer-reviewed articles evaluating adherence to COPD medication in electronic databases, written in English, published up to 11 October 2022 (PROSPERO identifier CRD42022363449). Two reviewers independently conducted screening for inclusion and performed data extraction. Methods to assess initiation (dispensing of medication after prescribing), implementation (extent of use over a specific time period) and/or persistence (time from initiation to discontinuation) were listed descriptively. Each included study was evaluated for reporting variables with an impact on adherence assessment: inpatient stays, drug substitution, dose switching and early refills. RESULTS 160 studies were included, of which four assessed initiation, 135 implementation and 45 persistence. Overall, one method was used to measure initiation, 43 methods for implementation and seven methods for persistence. Most of the included implementation studies reported medication possession ratio, proportion of days covered and/or an alteration of these methods. Only 11% of the included studies mentioned the potential impact of the evaluated variables. CONCLUSION Variations in adherence assessment methods are common. Attention to transparency, reporting of variables with an impact on adherence assessment and rationale for choosing an adherence cut-off or treatment gap is recommended.
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Affiliation(s)
- Delphine Vauterin
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Frauke Van Vaerenbergh
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Anna Vanoverschelde
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jennifer K Quint
- School of Public Health and National Heart and Lung Institute, Imperial College London, London, UK
| | - Katia Verhamme
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lies Lahousse
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Biset N, Lelubre M, Pochet S, De Vriese C. Asthma and COPD: Comparison with International Guidelines and Medication Adherence in Belgium. Pharmaceuticals (Basel) 2023; 16:1030. [PMID: 37513942 PMCID: PMC10386066 DOI: 10.3390/ph16071030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are major chronic conditions. It is possible to limit their impact by controlling symptoms, which limits exacerbations and worsening of the disease, by choosing the appropriate treatment and ensuring that the patient adheres to it. The main purpose of this study was to assess medication adherence and persistence with inhaled medications for chronic treatment of asthma and COPD, as well as to evaluate the factors influencing this adherence. Medication adherence was measured from January 2013 to December 2016 using continuous multiple-interval measures of medication availability (CMA). Persistence was evaluated by treatment episodes (TE). We analyzed the influence of different factors on CMA such as sex, age, type of device, and the realization of the "new medicines service" (NMS), introduced in Belgium in October 2013 to support patients in adhering to their treatment. We also analyzed the consumption of these inhaled medications within the Belgian population and compared them with the Global Initiative for Asthma (GINA) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations. Medication adherence varied greatly between the different pharmacological classes: inhaled corticosteroids (ICS) alone or in combination with long-acting beta agonists (LABA) had the lowest medication adherence and persistence, while adherence was highest for the long-acting muscarinic antagonists (LAMA) and LABA/LAMA associations. The NMS seemed to have a positive impact on medication adherence, although few patients completed the two guidance interviews offered by the service. In addition, only a minority of the targeted patients took advantage of this new service.
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Affiliation(s)
- Natacha Biset
- Department of Pharmacotherapy and Pharmaceutics, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Mélanie Lelubre
- Department of Pharmacotherapy and Pharmaceutics, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Stéphanie Pochet
- Department of Pharmacotherapy and Pharmaceutics, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Carine De Vriese
- Department of Pharmacotherapy and Pharmaceutics, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
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Poberezhets V, Kasteleyn MJ. Telemedicine and home monitoring for COPD - a narrative review of recent literature. Curr Opin Pulm Med 2023; 29:259-269. [PMID: 37140553 DOI: 10.1097/mcp.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE OF REVIEW Home monitoring is one of the methods of using telemedical technologies aimed to provide care at home and maintain a connection between patients and healthcare providers. The purpose of this review is to describe recent advancements in the use of home monitoring for the care and management of chronic obstructive pulmonary disease (COPD) patients. RECENT FINDINGS Recent studies focused on remote monitoring for patients with COPD proved the positive effect of home monitoring interventions on the frequency of exacerbations and unscheduled healthcare visits, duration of patients' physical activity, proved sensitivity and overall specificity of such interventions and highlighted the effectiveness of self-management.Assessing end-user experience revealed high satisfaction levels among patients and healthcare staff who used home monitoring interventions. The majority of physicians and staff responded positively about the interventions' facilitation of communication with patients. Moreover, healthcare staff considered such technologies useful for their practice. SUMMARY Home monitoring for COPD patients improves medical care and disease management despite minor drawbacks and obstacles to its wide implementation. Involving end-users in evaluating and co-creating new telemonitoring interventions has the potential to improve the quality of remote monitoring for COPD patients in the near future.
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Affiliation(s)
- Vitalii Poberezhets
- Department of Propedeutics of Internal Medicine, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Marise J Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Center
- National eHealth Living Lab, Leiden, The Netherlands
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Jamil N, Zainal ZA, Alias SH, Chong LY, Hashim R. A systematic review of behaviour change techniques in pharmacist-delivered self-management interventions towards patients with chronic obstructive pulmonary disease. Res Social Adm Pharm 2023:S1551-7411(23)00256-5. [PMID: 37202279 DOI: 10.1016/j.sapharm.2023.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/11/2023] [Accepted: 05/08/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Self-management interventions often employ behaviour change techniques in order to produce desired target behaviours that are necessary for day-to-day living with a chronic disease. Despite the large number of self-management interventions for patients with chronic obstructive pulmonary disease (COPD), previously reported interventions have been typically delivered by healthcare providers other than the pharmacist. OBJECTIVE This systematic review examined the components of pharmacists-delivered COPD self-management interventions according to an established taxonomy of behaviour change techniques (BCTs). METHODS A systematic search was conducted on PubMed, ScienceDirect, OVID, and Google Scholar from January 2011 to December 2021 for studies of pharmacist-delivered self-management interventions in COPD patients. RESULTS A total of seventeen studies of intervention were eligible for inclusion in the narrative review. Interventions were educational and were delivered individually and face-to-face for the first session. Across studies, pharmacists spent an average of 35 min on the first meeting and had an average of 6 follow-up sessions. Recurrent BCTs in pharmacist interventions were "Information on the health consequence", "Feedback on behaviour", "Instruction on how to perform a behaviour", "Demonstration of the behaviour" and "Behavioural practice/rehearsal". CONCLUSIONS Pharmacists have provided interventions towards improving health behaviours, especially on adherence and usage of inhaler devices for patients with COPD. Future self-management interventions should be designed using the identified BCTs for the improvement of COPD self-management and disease outcomes.
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Affiliation(s)
- Nurdiana Jamil
- Faculty of Pharmacy, University of Cyberjaya, Persiaran Bestari, 63000, Cyberjaya, Selangor, Malaysia.
| | - Zainol Akbar Zainal
- Faculty of Pharmacy, University of Cyberjaya, Persiaran Bestari, 63000, Cyberjaya, Selangor, Malaysia.
| | - Siti Hazlina Alias
- Faculty of Psychology and Social Sciences, University of Cyberjaya, Persiaran Bestari, 63000, Cyberjaya, Selangor, Malaysia.
| | - Li Yin Chong
- Serdang Hospital, Ministry of Health Malaysia, Jalan Puchong, 43000, Kajang, Selangor, Malaysia.
| | - Rosnani Hashim
- Faculty of Pharmacy, University of Cyberjaya, Persiaran Bestari, 63000, Cyberjaya, Selangor, Malaysia.
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Vila M, Rosa Oliveira V, Agustí A. Telemedicine in the management of chronic obstructive pulmonary disease: A systematic review. Med Clin (Barc) 2023; 160:355-363. [PMID: 36801105 DOI: 10.1016/j.medcli.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/18/2023]
Abstract
Telemedicine is defined as the use of electronic technology for information and communication by healthcare professionals with patients (or care givers) aiming at providing and supporting healthcare to patients away from healthcare institutions. This systematic review over the last decade (2013-2022) investigates the use of telemedicine in patients with chronic obstructive pulmonary disease (COPD). We identified 53 publications related to: (1) home tele-monitorization; (2) tele-education and self-management; (3) telerehabilitation; and (4) mobile health (mHealth). Results showed that, although evidence is still weak in many of these domains, results are positive in terms of improvement of health-status, use of health-care resources, feasibility, and patient satisfaction. Importantly, no safety issues were identified. Thus, telemedicine can be considered today as a potential complement to usual healthcare.
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Affiliation(s)
- Marc Vila
- Equipo de Asistencia Primaria Vic , Vic, Barcelona, España; Cátedra Salud Respiratoria, Universidad de Barcelona, Barcelona, España; Equipo de investigación de Metodología, Métodos, Modelos y Resultados de las Ciencias Sociales y de la Salud (M3O), Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic - Universidad Central de Cataluña (UVic-UCC), España.
| | - Vinicius Rosa Oliveira
- Equipo de investigación de Metodología, Métodos, Modelos y Resultados de las Ciencias Sociales y de la Salud (M3O), Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic - Universidad Central de Cataluña (UVic-UCC), España
| | - Alvar Agustí
- Cátedra Salud Respiratoria, Universidad de Barcelona, Barcelona, España; Instituto Respiratorio, Hospital Clínico, Barcelona, España; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, España; CIBER Enfermedades Respiratorias, España
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Skerry L, Kervin E, Freeze TA, Brillant A, Woodland J, Hanson N. "It's a lonely battle": A qualitative study of older adult Canadians' experiences with chronic obstructive pulmonary disease medication adherence and support. Can Pharm J (Ott) 2022; 156:32-41. [PMID: 36686315 PMCID: PMC9849920 DOI: 10.1177/17151635221140412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Medication adherence is critical for optimal management of chronic obstructive pulmonary disease (COPD) and is influenced by patient, treatment and societal factors. Currently, little is known about the patient perspectives of older adult Canadians with COPD regarding medication adherence. Therefore, the purpose of this study was to explore the lived experiences of older Canadian adults with COPD regarding medication adherence and management. Methods Semi-structured interviews were conducted with 20 community-dwelling older adults with COPD, and iterative thematic analysis was performed. Results Six themes emerged from these data: (1) continuity of care, (2) importance of pharmacy for information and care, (3) medication self-management, (4) "there needs to be more information," (5) drug costs a concern and (6) "it's a lonely battle." Conclusion Findings suggested a need for improved continuity of care, disease-related information provision and means of addressing psychosocial needs. Holistic approaches to patient education and self-management, with consideration for varying health literacy, are needed.
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Affiliation(s)
- Leanne Skerry
- Horizon Health Network, Research Services,
Saint Joseph’s Hospital, Saint John, New Brunswick
| | - Emily Kervin
- Horizon Health Network, Research Services,
Saint Joseph’s Hospital, Saint John, New Brunswick
| | - Tracy A. Freeze
- Horizon Health Network, Research Services,
Saint Joseph’s Hospital, Saint John, New Brunswick
| | - Andrew Brillant
- Pharmacy Services, Saint Joseph’s Hospital,
Saint John, New Brunswick
| | - Jennifer Woodland
- Horizon Health Network, Research Services,
Saint Joseph’s Hospital, Saint John, New Brunswick
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