Abstract
BackgroundTherapeutic adherence of patients with chronic obstructive pulmonary disease (COPD) is poor. It is therefore necessary to determine the magnitude of non-adherence to develop strategies to correct this behaviour. The purpose of this study was to analyse the diagnostic validity of indirect adherence methods.MethodsSample: 195 COPD patients undergoing scheduled inhaled treatment attending 5 Primary Care Centres of Malaga, Spain. Variables: Sociodemographic profile, illness data, spirometry, quality of life (St. George Respiratory Questionnaire: SGRQ), and inhaled medication counting (count of dose/pill or electronic monitoring) were collected. The patient's knowledge of COPD (Batalla test:BT),their attitude towards treatment (Morisky-Green test: MGT) and their self-reported therapeutic adherence (Haynes-Sackett test: HST) were used as methods of evaluating adherence. The follow-up consisted four visits over one year (the recruitment visit: V0; and after 1 month:V1; 6 months:V2; and 1 year:V3).ResultsThe mean age was 69.59 (95% CI, 68.29-70.89) years old and 93.8% were male. Other findings included: 85.4% had a low educational level, 23.6% were smokers, 71.5% mild-moderate COPD stage with a FEV1 = 56.86 (SD = 18.85); exacerbations per year = 1.41(95% CI, 1-1.8). The total SGRQ score was 44.96 (95% CI, 42.46-47.46), showing a mild self-perceived impairment in health. The prevalence of adherence (dose/pill count) was 68.1% (95% CI, 60.9-75.3) at V1, 80% (95% CI, 73-87) at V2 and 84% (95% CI, 77.9) at V3. The MGT showed a specificity of 67.34% at V1, 76.19% at V2 and 69.62% at V3. The sensitivity was 53.33% at V1, 66.66% at V2 and 33.33% at V3.The BT showed a specificity of 55.1% at V1, 70.23% at V2 and 67.09% at V3. The sensitivity was 68.88% at V1, 71.43% at V2 and 46.66% at V3. Considering both tests together, the specificity was 86.73% at V1, 94.04% at V2 and 92.49% at V3 and the sensitivity was 37.77% at V1, 47.62% at V2 and 13.3% at V3.ConclusionsThe prevalence of treatment adherence changes over time. Indirect methods (dose/pill count and self-reported) can be useful to detect non-adherence in COPD patients. The combination of MGT and BT is the best approach to test self-reported adherence.
Highlights
Therapeutic adherence of patients with chronic obstructive pulmonary disease (COPD) is poor
The objective of this study was to asses the diagnostic validity to estimate the prevalence of non-adherence in COPD patients with inhaled medication using three selfreported methods that could be useful and easy in clinical practice, considering the electronic monitoring or the pill count as the reference method
Morinsky Green test (MGT) We measured the attitude towards treatment using the MGT [22], adapted by us for use with inhaled medication: (1) Do you ever forget to take your inhaled medication? (2) Are you careless at times about taking your inhaled medication? (3) When you feel better, do you sometimes stop taking your inhaled medication? (4) Sometimes, if you feel worse when you take the inhaled medication, do you stop taking it? We considered good adherence to be when all four questions were answered suitably
Summary
Therapeutic adherence of patients with chronic obstructive pulmonary disease (COPD) is poor. Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death world-wide. The effectiveness of treatment relies on patient agreement with adherence to the therapy regime. As with all chronic diseases, non-adherence in patients with COPD is common and contributes to adverse health outcomes, reduced quality of life and increased healthcare expenditure [4]. According to the World Health Organization, patient adherence to long-term therapy averages 50% [5]. In the Lung Health Study [6], therapeutic adherence with inhaled treatment recorded by self-reported methods after one year of follow-up was 60%, decreasing to 50% after five years of follow-up
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