Researching about medication adherence in the Primary Care context. The case of the Chronic Obstructive Pulmonary Disease (COPD)

05 May 2022
Clinical Research Results Abstract Research Idea Abstract Background: The ABC taxonomy established that medication adherence (MA) is the process by which patients take their medication as prescribed, divided into: ‘Initiation’, ‘Implementation’, ‘Discontinuation’.Objective: To describe a consolidated research line to diagnose and improve medication adherence (MA) in COPD patients in Primary Care.Methods: Seven consecutive research projects in Primary Care centres through 2 decades: (1) Cohort study: 278 COPD patients with a 5 year follow-up in which MA was measured using indirect tests (Batalla, Morisky-Green). High variability depending on test used. Evaluating diagnostic validity is needed. (2) CEPOC study: Validation study of diagnostic methods; dosage count as gold standard. Proposed strategy to detect lack of MA in clinical practice: use of both test (Batalla, Morisky-Green) when severe lack of MA, dosage count when is mild. (3) ICEPOC study: Efficacy of a multifactorial intervention (motivational, cognitive and habit building aspects) to improve MA. There was significant MA improvement (NNT = 6.8). Important prevalence of incorrect inhalation technique. (4) ECEPOC study: aims to explore beliefs and perceptions to identify a mental model of the disease through qualitative research in patients from ICEPOC study. (5) TECEPOC/ (6) TIEPOC study: two-educational intervention clinical trials to improve inhalation technique (IT). Sample: 726 subjects. Interventions: (A) written instructions (B) instructor-led training and written instructions vs (C) control (usual care). Cohort A performed as Cohort C and Cohort B significantly improved the IT. Cohort A NNT=3.57 (CI95% 2.41-6.8), Cohort B NNT=1.74 (CI95% 1.47-2.17). (7) PROF-EPOC study: pragmatic cluster randomized clinical trial. Researchers’ intervention on general practitioners (GPs) to improve IT; intervention of GPs on patients. Sample: 267 patients and 20 GPs. NNT=3.03 (CI95% 2.38-4.14). Discussion: to improve MA in COPD patients is necessary to correctly identify it, differentiating technical aspects like IT which can be enhanced through educational interventions applicable in everyday clinical practice. Service Development & Evaluation Abstract Declaration of Interest Authors declare no competing interest.This clinical research is of great relevance as it portrays an answer to one of the most interesting questions to the IPCRG audience in regards to research ideas. Exploring different approach to educational interventions to improve inhalation technique and medication adherence in COPD patients proves to be helpful in devising and applying new strategies to enhance COPD management in clinical practice. References and Clinical Trial Registry Information

Resource information

Respiratory conditions
  • COPD
Type of resource
Abstract
Conference
Malaga 2022
Author(s)
Virginia Patricia Aguiar-Leiva, Instituto CUDECA de Estudios e Investigación en Cuidados Paliativos, Fundación CUDECA, Málaga, España. Instituto de Investigación Biomédica de Málaga-IBIMA Grupo CA-15.