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

doi:10.1016/j.jaip.2021.05.025

The Journal of Allergy and Clinical Immunology: In Practice

Volume 9, Issue 11, November 2021, Pages 3979-3994

https://doi.org/10.1016/j.jaip.2021.05.025 Get rights and content

Under a Creative Commons license

open access

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.

Key words

Asthma

Chronic obstructive pulmonary disease

Medication adherence

Inhaler

Compliance

Persistence

Abbreviations used

COPD

Chronic obstructive pulmonary disease

IRF

Inhaler reminders and feedback

PAD

Personalized adherence discussions

RCT

Randomized controlled trial

TAI

Test of Adherence to Inhalers

WHO

World Health Organization

Cited by (0)

: The development of the TAI Toolkit was supported by an unrestricted grant from Chiesi Pharmaceuticals.

: Conflicts of interest: J.F.M. van Boven reports consultancy fees, speaking fees, and/or research grants from AstraZeneca, Boehringer Ingelheim, Chiesi, European Commission COST Action 19132 (European Network to Advance Best Practices & technology on medication adherence, ENABLE), GSK, Menarini, Novartis, Pill Connect, Teva, and Trudell Medical, all unrelated to this study and all paid to his institution. J.W.H. Kocks reports grants, personal fees, and nonfinancial support from AstraZeneca; grants, personal fees, and nonfinancial support from Boehringer Ingelheim; grants and personal fees from Chiesi Pharmaceuticals; grants, personal fees, and nonfinancial support from GSK; grants and personal fees from Novartis; grants from MundiPharma; and grants from Teva, outside the submitted work, all paid to his institution. J. Kocks holds 72.5% of shares in the General Practitioners Research Institute. The rest of the authors declare that they have no relevant conflicts of interest.