Abstract
Poor adherence to treatment is a common reason why patients with chronic disease have worse outcomes than might be expected. Poor treatment adherence is of particular concern among people with airways disease because, apart from not taking treatment as prescribed, inhaled medication can also be administered incorrectly. Recently, a number of technological advances that accurately document when an inhaled treatment has been used and, in certain instances, how it was used have been developed. There is good evidence from a number of research groups that these devices, either by patient reminders or physician feedback, promote adherence to inhaled treatments. What is less certain is how, in a real-world setting, these devices change outcomes. In this perspective article, the role of electronic devices in quantifying treatment use and addressing poor treatment adherence and their potential role in clinical practice outside of clinical validation trials are described.
Highlights
It is purported that the physician of ancient times, Hippocrates, stated that “[the physician] should keep aware that patients often lie when they state that they have taken certain medications.” So important is the issue of medication adherence that even the World Health Organization has addressed this challenging problem
To evaluate if electronic adherence monitoring with feedback and alarms improves clinical outcomes in children with poorly controlled asthma
The overall good health outcomes in these patients support the data from most clinical trials evaluating inhaler use in chronic obstructive pulmonary disease (COPD), which show a limited impact on hospital admissions
Summary
It is purported that the physician of ancient times, Hippocrates, stated that “[the physician] should keep aware that patients often lie when they state that they have taken certain medications.” So important is the issue of medication adherence that even the World Health Organization has addressed this challenging problem. The trials all reported significantly increased rates of adherence when the electronic monitoring devices were used compared with usual care. Some aspects of disease control, such as reliever use and hospital admissions, were shown to be improved when the electronic monitoring devices were used to promote adherence.
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