Personalized Medication Adherence Management in Asthma and Chronic Obstructive Pulmonary Disease: A Review of Effective Interventions and Development of a Practical Adherence Toolkit

Susanne J van de Hei; Boudewijn J H Dierick; Joyce E P Aarts; Janwillem W H Kocks; Job F M van Boven

doi:10.1016/j.jaip.2021.05.025

Personalized Medication Adherence Management in Asthma and Chronic Obstructive Pulmonary Disease: A Review of Effective Interventions and Development of a Practical Adherence Toolkit

J Allergy Clin Immunol Pract. 2021 Nov;9(11):3979-3994. doi: 10.1016/j.jaip.2021.05.025. Epub 2021 Jun 7.

Authors

Susanne J van de Hei¹, Boudewijn J H Dierick², Joyce E P Aarts³, Janwillem W H Kocks⁴, Job F M van Boven⁵

Affiliations

¹ Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands; General Practitioners Research Institute, Groningen, The Netherlands.
² Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands; Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
³ Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁴ Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands; General Practitioners Research Institute, Groningen, The Netherlands; Observational and Pragmatic Research Institute, Singapore.
⁵ Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands; Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; Medication Adherence Expertise Center of the northern Netherlands, Groningen, The Netherlands. Electronic address: j.f.m.van.boven@rug.nl.

PMID: 34111571
DOI: 10.1016/j.jaip.2021.05.025

Abstract

Background: The management of medication nonadherence of patients with asthma or chronic obstructive pulmonary disease (COPD) remains challenging. Given the multitude of underlying causes, a personalized approach is required. The Test of Adherence to Inhalers (TAI) can identify reasons for nonadherence, but it does not provide guidance regarding how to act effectively after results.

Objective: To develop a practical, evidence-based decision support toolkit for health care professionals managing adult patients with asthma and/or COPD, by matching TAI-identified adherence barriers to proven effective adherence-enhancing interventions.

Methods: We performed a literature review in PubMed and Embase identifying interventions that enhanced medication adherence in adult patients with asthma and/or COPD. Randomized controlled trials published in English with full texts available were included. Effective interventions assessed by the Cochrane risk of bias tool were categorized, matched with specific TAI responses, and developed into a practical TAI Toolkit. The Toolkit was assessed for content and usability (System Usability Scale) by a multidisciplinary group of health care professionals.

Results: In total, 40 randomized controlled trials were included in the review. Seven effective interventions categories were identified, informing the TAI Toolkit: reminders, educational interventions, motivational strategies, feedback on medication use, shared decision-making, simplifying the medication regimen, and multiple component interventions. Health care professionals rated the TAI Toolkit with a mean System Usability Scale score of 71.4 (range, 57.5-80.0).

Conclusions: Adherence can be improved using the different interventions that the TAI Toolkit helps select. The TAI Toolkit was well-received by health care professionals. Further research is required to test its validity, practicality, and effectiveness in practice.

Keywords: Asthma; Chronic obstructive pulmonary disease; Compliance; Inhaler; Medication adherence; Persistence.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Adult
Asthma* / drug therapy
Humans
Medication Adherence
Nebulizers and Vaporizers
Pulmonary Disease, Chronic Obstructive* / drug therapy