For patients with asthma, self-reported inhaled corticosteroid (ICS) adherence and Short Acting Beta 2 Agonist (SABA) use may be inaccurate. This may lead to inappropriate clinical decision-making, keep patients from achieving their treatment goals and adversely impact healthcare costs. This study compares self-reported ICS and SABA use with objective data from electronic medication monitors (EMM). METHODS: Adults with uncontrolled asthma (defined by Asthma Control Test Scores of <19 and/or NHLBI NAEPP EPR3 guideline criteria) and prescribed ICS and SABA by their asthma specialist (allergist/immunologist/pulmonologist) were enrolled. At visit one, participants' ICS and SABA inhalers were fitted with EMMs (Propeller Health, Madison, WI) to track real-time medication usage over 14 days. Participants were asked to complete paper diaries to self-report medication usage over the same period. Self-reported vs. objective ICS adherence and SABA use was compared using paired t-tests and Wilcoxon signed-rank tests. RESULTS: One hundred participants (80% female, mean age 48.5 years, 60% completed college, 80% privately insured) had complete data. Selfreported mean (standard deviation) daily ICS adherence (79% [31]) and median (interquartile range) SABA use (0.7 puffs [0-1.9]) was higher than objectively measured ICS adherence (69% [29], P50.01) and SABA use (0.3 puffs [0.1-1.1], P<0.001). CONCLUSIONS: There was significant over-reporting of inhaler use, which may result in inappropriate changes to therapy and medication regimen complexity. Use of EMMs can increase the accuracy of medication usage reporting and allow healthcare providers to make more informed clinical decisions for patients.
RATIONALE: NABä stations continue to decrease in numbers. We aim to identify contributing factors through qualitative research methods. METHODS: With Practice, Diagnostics and Therapeutics Committee approval, anonymous participation of the Aerobiology Committee, NABä pollen counters and medical directors were requested. Thematic analysis of SurveyMonkey surveys used the open-ended question: how to improve the provision and communication of effective and efficient pollen count information. Using reflexivity journaling, disclosures, and triangulation, narrative texts were coded and collated using Excel with NVivoTM software. Grounded theory applies, as themes were examined for relationships, thereafter insights were gained after analysis. RESULTS: 30/163 (18%) participated and accepted informed consent. Saturation of data occurred when ideas have become repetitive between participants, the basis of valid sample size estimation of 15. Themes reaching saturation and their frequency included: 21(70%) recommendations, 19(63%) stakeholder engagement, 17 (57%) concerns, 17 (57%) technology, 15 (50%) administration. Other themes included academia 8(27%). Opposing theme comment, 6 (20%) is exemplified by nothing to contribute or current system seems to work. Inter-theme analysis revealed correlating concepts and similar sentiments. Stakeholders identified in order priority were patients > allergy organizations > vendors, physicians > online count providers > allied health staff. CONCLUSIONS: Our novel data supports the diffusion of innovation theory as a possible reason for the slow growth of the NABä. Key driver analysis results of our survey will help prioritize the advancement of the NABä mission using quality improvement iterative projects & key stakeholder engagement.
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