Abstract
BackgroundTherapeutic adherence of patients with chronic obstructive pulmonary disease (COPD) is poor. This study evaluated the effectiveness of a multifactorial intervention on improving the therapeutic adherence in chronic obstructive pulmonary disease (COPD) patients with scheduled inhalation therapy.MethodsThe study design consisted of a randomised controlled trial in a primary care setting. 146 patients diagnosed with COPD were randomly allocated into two groups using the block randomisation technique. One-year follow-ups with three visits were performed. The intervention consisted of motivational aspects related to adherence (beliefs and behaviour) in the form of group and individual interviews, cognitive aspects in the form of information about the illness and skills in the form of training in inhalation techniques. Cognitive-emotional aspects and training in inhalation techniques were reinforced during all visits of the intervention group. The main outcome measure was adherence to the medication regimen. Therapeutic adherence was determined by the percentage of patients classified as good adherent as evaluated by dose or pill count.ResultsOf the 146 participants (mean age 69.8 years, 91.8% males), 41.1% reported adherence (41.9% of the control group and 40.3% of the intervention group). When multifactorial intervention was applied, the reported adherence was 32.4% for the control group and 48.6% for the intervention group, which showed a statistically significant difference (p = 0.046). Number needed to treat is 6.37. In the intervention group, cognitive aspects increased by 23.7% and skilled performance of inhalation techniques increased by 66.4%. The factors related to adherence when multifactorial intervention was applied were the number of exacerbations (OR = 0.66), visits to health centre (OR = 0.93) and devices (OR = 2.4); illness severity (OR = 0.67), beta-2-adrenergic (OR = 0.16) and xantine (OR = 0.19) treatment; activity (OR = 1.03) and impact (OR = 1.03) scales of the Saint George Respiratory Questionnaire.ConclusionApplication of the multifactorial intervention designed for this study (COPD information, dose reminders, audio-visual material, motivational aspects and training in inhalation techniques) resulted in an improvement in therapeutic adherence in COPD patients with scheduled inhalation therapy.Trial registrationCurrent Controlled Trials ISRCTN18841601.
Highlights
Therapeutic adherence of patients with chronic obstructive pulmonary disease (COPD) is poor
The main objective of this study was to evaluate the effectiveness of a multifactorial intervention (COPD information, dose reminders, audio-visual material, motivational aspects and training in inhalation techniques) on improving the therapeutic adherence in COPD patients with scheduled inhalation therapy after 1 year of follow-up with two reinforcement visits (3 and 6 months after intervention)
Patients had consulted with the health centre because of COPD a mean of 1.8 times over the last year, which accounted for 26% of the total health visits
Summary
Therapeutic adherence of patients with chronic obstructive pulmonary disease (COPD) is poor. This study evaluated the effectiveness of a multifactorial intervention on improving the therapeutic adherence in chronic obstructive pulmonary disease (COPD) patients with scheduled inhalation therapy. Chronic obstructive pulmonary disease (COPD) is characterised by airflow limitations that are not fully reversible. COPD is presently the fourth leading cause of death, but the World Health Organization (WHO) predicts that it will become the third leading cause of death by 2030 [5], as mortality resulting from cardiac diseases and stroke decreased over the last 30 years, while that of COPD doubled over the same period [6]. As with all chronic diseases, therapy non-adherence in patients with COPD is a common problem and contributes to adverse health outcomes, reduced quality of life and increased healthcare expenditures [7]. Adherence rates in clinical trials may be as high as 70 to 90% [9,10,11], but in clinical practice, they range from 10 to 40% [12,13,14]
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