Asthma and lower airway diseaseInhaler reminders improve adherence with controller treatment in primary care patients with asthma
Section snippets
Study design
We conducted a 6-month pragmatic cluster 2 × 2 factorial parallel-group randomized controlled trial in general practices in Greater Sydney, Australia, during the period 2010 to 2013. GPs were randomized to either the active group or the control group for each intervention and trained to deliver the intervention(s) with patients from their practice. The interventions (detailed later) were as follows: personalized audiovisual inhaler reminders and feedback (IRF) and brief personalized adherence
GP participants
Sixty GPs were randomized, 55 attended training, and 43 were available to enroll patients. Five GPs withdrew before training while unaware of their allocation, 9 withdrew after training, and 3 were lost to follow-up (Fig 2). Of these 43 GPs (mean age, 54 ± 9 years; 56% men), more than half practiced in a socially disadvantaged location (Table II). The 17 GPs who withdrew differed from continuing GPs only with respect to having attended asthma or chronic obstructive pulmonary disease training in
Discussion
In this novel primary care–based intervention study of patients with moderate-severe asthma who were prescribed twice-daily ICS/LABA, those who received electronic inhaler reminders for missed doses plus medication use feedback (IRF), on average, took 1.5 times more ICS/LABA over 6 months than did patients who received UC or PAD alone (73% vs 46%). At 6 months, mean adherence in reminder/feedback groups was double that in nonreminder/feedback groups (60% vs 29%). Clinically important
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Funding for this study was provided by the National Health and Medical Research Council of Australia (ID571053). The Asthma Control Test was used with permission of GlaxoSmithKline and in accordance with conditions specified by GlaxoSmithKline under the terms of its license with the copyright holder, QualityMetric Incorporated. One month's supply of controller and 1 spacer per patient was provided by GlaxoSmithKline. SmartTrack devices were purchased from Nexus6 (Auckland, New Zealand). SIM cards for the remote upload of adherence data were provided by Vodaphone, New Zealand. None of the above bodies had any role in the design, conduct, analysis, or interpretation of the study, nor did they see the manuscript before submission. The authors alone are responsible for the content and writing of the article.
Disclosure of potential conflict of interest: The Woolcock Institute of Medical Research has received unrestricted funding for research by J. M. Foster from GlaxoSmithKline (GSK) and AstraZeneca. J. M. Foster has received compensation for board membership from Vertex Pharmaceuticals, as well as payment for delivering lectures from GSK, the Pharmaceutical Society of Australia, and AstraZeneca; has received payment for the development of educational presentations from the Pharmaceutical Society of Australia, and AstraZeneca; J.M. Foster's institution has also received writing assistance, medicines, equipment, and administrative support from GSK, as has the institution of H. K. Reddel. T. Usherwood's institution has received funding from the National Health and Medical Research Council. L. Smith's institution has received funding from the National Health and Medical Research Council; she has received consultancy fees from the Pharmaceutical Society of Australia, as well as payment for delivering lectures, and for the development of educational presentations. S. Sawyer's institution has received consultancy fees from AstraZeneca. C. S. Rand has participated in advisory boards for Merck Foundation/Merck Childhood Asthma Network and TEVA Pharmaceuticals; has received consultancy fees from TEVA and Merck, as well as payment for delivering lectures from TEVA; her institution has received a grant from the National Institutes of Health (R18HL107223, unrelated to the present study). H. K. Reddel has received compensation for board membership from AstraZeneca, Boehringer Ingelheim, GSK, Merck, and Novartis; has received consultancy fees from AstraZeneca, GSK, iNova, and Mundipharma; her institution has received grants or has grants pending from AstraZeneca and GSK; she has received payment for delivering lectures from AstraZeneca, GSK, and Novartis, as well as for the development of educational presentations; she has received compensation for travel and other meeting-related expenses from Novartis and Boehringer Ingelheim; is participating in a data monitoring and safety board for AstraZeneca, GSK, Merck, and Novartis relating to the safety of long-acting β2-agonists; has provided independent continuing medical education for AstraZeneca, GSK, and Novartis; and has received unrestricted research grants from AstraZeneca and GSK. The rest of the authors declare that they have no relevant conflicts of interest.