Inhaler reminders improved asthma controller adherence

Inhaler reminders substantially improved controller adherence when compared with training general practitioners in personalized adherence discussions for asthma patients, according to research presented at the American Thoracic Society International Conference in San Diego.

“Reminders and feedback are a low burden intervention for GPs [general practitioners] and patients, which is feasible and effective for improving controller adherence and exacerbation rates in asthma, even in socially disadvantaged populations,” Juliet M. Foster, PhD, research psychologist, Woolcock Institute of Medical Research, University of Sydney, Australia, told Healio.com.

Juliet M. Foster

Foster and colleagues conducted a 6-month cluster randomized controlled trial to compare inhaler reminders with adherence feedback (IRF), personalized adherence discussions (PAD) and IRF combined with PAD with active usual care control (UC). Training was given to GPs, so they could provide active UC to patients with a written action plan and inhaler technique check. One hundred forty-three patients with asthma (mean age, 40.3 years) who had been prescribed a combination controller inhaler for at least 3 months and had a mean Asthma Control Test (ACT) score of 14.6 were enrolled by 43 GPs.

The time and date of each puff was recorded by electronic monitors, which uploaded data to a secure website. Inhaler monitors included reminder ringtones for missed doses and time since last dose on a digital screen for the IRF patients. Online medication use graphs could be accessed by IRF patients and their GPs. Two hours of communication and telephone-booster training on motivational interviewing and collaborative goal-setting were provided to GPs in PAD groups. ACT was conducted at baseline, 2, 4 and 6 months.

IRF cohorts had greater controller adherence during 6 months (73% ± 26%) compared with non-IRF patients (46% ± 28%, P<.0001).

“Asthma control improved significantly in all groups (overall mean change in ACT 4.5 ± 4.9, P<.001), but there was no significant difference between the four study groups or between IRF and non-IRF groups,” the researchers reported.

“This study demonstrates that inhaler reminders and feedback are feasible for implementation in primary care, and qualitative feedback indicates that the intervention is acceptable to and valued by both patients and GPs, including those from culturally and linguistically diverse populations,” Foster said. “This intervention could be upscaled to a broader asthma population as it requires minimal intervention on the part of the GP and at $50 to $100 per electronic monitor (which can be reused by the patient), it is a potentially cost-effective approach.”

For more information:

Foster JM. #49603. Presented at: 2014 American Thoracic Society International Conference; May 16-21; San Diego

Disclosure: The Woolcock Institute of Medical Research has received unrestricted funding for research by Foster from GlaxoSmithKline and AstraZeneca, and Foster has participated in advisory boards for Vertex Pharmaceuticals and delivered independent educational presentations for GlaxoSmithKline and AstraZeneca.