A pharmacy e-health intervention promoting correct medication use in patients with asthma and COPD: a non-randomized pre-post study
Background: Asthma and chronic obstructive pulmonary disease (COPD) affect millions of people worldwide. While medications can control and improve disease symptoms, the incorrect use of medications is a common problem. The SARA (Service Apothecary Respiratory Advice) eHealth intervention aims to improve the correct use of inhaled medications by participants by providing them with information and appropriate follow-up by a pharmacist as needed.
Objective: The primary objective of this study was to investigate the effect of SARA on exacerbation rates in participants with asthma and COPD. The secondary objectives were to study its effects in terms of adherence to maintenance medication and antifungal treatment.
Methods : In this non-randomized pre-post study, drug distribution data from 382 Dutch community pharmacies were included. Exacerbation rates were assessed with dispensed short-course oral corticosteroids. Medication adherence between new users and chronic users was assessed by calculating the proportion of days covered by inhaled maintenance medications dispensed. Antimycotic treatment was studied from oral antifungals given to participants who also received inhaled corticosteroids (ICS). Outcomes were assessed 1 year before and 1 year after SARA implementation and were compared between SARA participants and control participants. Specifically, for exacerbation rates and medication adherence, a difference score was calculated (i.e., 1 year after SARA minus 1 year before SARA) and then compared between groups of study with independent samples you trials. For antimycotics, the relative number of participants who received antimycotics was calculated and then analyzed with mixed-effects logistic regression.
Results: The study population included 9452 participants, of which 2400 (25.39%) were SARA participants. The mean age of the population was 60.8 (15.0) years and approximately two-thirds (n=5677, 60.06%) were female. Results showed an increase in mean exacerbation rates over time for both study groups (SARA: 0.05; control: 0.15). However, this increase in exacerbation rates was significantly lower for SARA participants (you9450=3.10, 95% CI 0.04-0.16; P=.002; Cohen D=0.06). Chronic inhaled medication users in both study groups showed an increase in mean medication adherence over time (SARA: 6.73; control: 4.48); however, this increase was significantly greater for LEP participants (you5886=–2.74, 95% CI –3.86 to –0.84; P=.01; Cohen D=–0.07). Among new inhaled medication users, results showed no significant difference in medication adherence between SARA and control participants during the year following SARA implementation (you1434=–1.85, 95% CI –5.60 to 0.16; P=.06; Cohen D=–0.10). Among ICS users, no significant differences between study groups were found over time in the proportion of participants who were dispensed antifungals (you5654=0.29, 95% CI -0.40 to 0.54; P=.76; Cohen D=0).
Conclusion : This study provides preliminary evidence that the SARA eHealth intervention may have the potential to reduce exacerbation rates and improve medication adherence in patients with asthma and COPD.