A pharmacist-led intervention study to improve treatment adherence in patients with chronic obstructive pulmonary disease

doi:10.5246/jcps.2023.01.005

Abstract

Abstract:

Non-adherence to chronic obstructive pulmonary disease (COPD) treatment is associated with poor disease control. Little data exist from China on inhalation adherence and patient satisfaction. We investigated the improvement in inhalation adherence in patients with COPD following a pharmacist’s intervention on dry powder inhaler (DPI) use. The participants were patients with COPD who used DPIs for at least 2 months. DPIs included Turbohaler, Discus, and HandiHaler. On enrolment, the inhaler technique, patient satisfaction, and adherence were assessed by a pharmacist, who guided the patients on the use of inhalants and addressed dissatisfaction issues based on the results of a medication satisfaction survey. Follow-ups were conducted at 1 and 3 months. Finally, the inhalation technique, satisfaction, and adherence at 6 months were compared with those before the intervention. A total of 135 patients completed the study. The higher the COPD assessment test (CAT) score and the higher the number of disease exacerbations in the past year, the worse the adherence. The proportion of patients with at least one error in the inhalation technique at baseline was 86.44% for Turbohaler, 76.60% for Discus, and 54.17% for HandiHaler. After pharmacist intervention, the error rate was decreased to 32.20% for Turbohaler, 29.79% for Discus, and 22.92% for HandiHaler. The average score of the Patient Satisfaction and Preference Questionnaire was increased from 74.44 ± 7.48 to 83.97 ± 5.88 (P < 0.001), and the average adherence score was increased from 4.78 ± 1.46 to 6.52 ± 1.11 (P < 0.001). Users of all three devices showed significant increases in satisfaction with performance (P < 0.001), and the increase in intentional adherence was more significant than that in unintentional adherence (P < 0.001). This study found that inhaler training and medication management by pharmacists were feasible and could improve inhaler technique, patient satisfaction, and adherence.

Key words: Satisfaction, Adherence, Dry powder inhaler, Chronic obstructive pulmonary disease, Intervention

Supporting:

Supplementary Table 1. Validated questions included in the PASAPQ

Ling Yuan, Qing Yang, Xinping Xu, Deyin Tong, Lihui Geng. A pharmacist-led intervention study to improve treatment adherence in patients with chronic obstructive pulmonary disease[J]. Journal of Chinese Pharmaceutical Sciences, 2023, 32(1): 52-63.

Figures/Tables 6

Table 1. Univariate analysis of factors associated with COPD patients’ adherence to inhaler therapy.

Table 2. Numbers and percentages of mistakes per step in patients with an incorrect inhalation technique.

Table 3. Assessment of PASAPQ scores (x ± s).

Table 4. Investigation results of patients' adherence to inhalation devices (x ± s).

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