Efficacy of a multifactorial intervention on therapeutic adherence in patients with chronic obstructive pulmonary disease (COPD): a randomized controlled trial

Abstract

BackgroundTherapeutic adherence of patients with chronic obstructive pulmonary disease (COPD) is poor. This study evaluated the effectiveness of a multifactorial intervention on improving the therapeutic adherence in chronic obstructive pulmonary disease (COPD) patients with scheduled inhalation therapy.MethodsThe study design consisted of a randomised controlled trial in a primary care setting. 146 patients diagnosed with COPD were randomly allocated into two groups using the block randomisation technique. One-year follow-ups with three visits were performed. The intervention consisted of motivational aspects related to adherence (beliefs and behaviour) in the form of group and individual interviews, cognitive aspects in the form of information about the illness and skills in the form of training in inhalation techniques. Cognitive-emotional aspects and training in inhalation techniques were reinforced during all visits of the intervention group. The main outcome measure was adherence to the medication regimen. Therapeutic adherence was determined by the percentage of patients classified as good adherent as evaluated by dose or pill count.ResultsOf the 146 participants (mean age 69.8 years, 91.8% males), 41.1% reported adherence (41.9% of the control group and 40.3% of the intervention group). When multifactorial intervention was applied, the reported adherence was 32.4% for the control group and 48.6% for the intervention group, which showed a statistically significant difference (p = 0.046). Number needed to treat is 6.37. In the intervention group, cognitive aspects increased by 23.7% and skilled performance of inhalation techniques increased by 66.4%. The factors related to adherence when multifactorial intervention was applied were the number of exacerbations (OR = 0.66), visits to health centre (OR = 0.93) and devices (OR = 2.4); illness severity (OR = 0.67), beta-2-adrenergic (OR = 0.16) and xantine (OR = 0.19) treatment; activity (OR = 1.03) and impact (OR = 1.03) scales of the Saint George Respiratory Questionnaire.ConclusionApplication of the multifactorial intervention designed for this study (COPD information, dose reminders, audio-visual material, motivational aspects and training in inhalation techniques) resulted in an improvement in therapeutic adherence in COPD patients with scheduled inhalation therapy.Trial registrationCurrent Controlled Trials ISRCTN18841601.

Adherence in Asthma and COPD: New Strategies for an Old Problem

“…In a randomized, controlled trial of 146 subjects with COPD, those who received motivational interviewing as part of a comprehensive disease management strategy (ie, disease information, medication reminders, and inhaler education) had higher rates of medication adherence. 56 However, due to the bundling of interventions, it isn't possible to determine what attributes or interventions in this trial were responsible for the improved adherence rates.…”

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“…A multifactorial approach to addressing nonadherence has proven effective, as demonstrated in a randomized controlled trial over 12 months in 146 Spanish patients with COPD. 49 Patients were randomized to either a control group or an intervention group that received motivational interviews to explore beliefs and attitudes plus written and audiovisual materials covering disease information and training in inhaler technique. At the end of the study, the intervention group achieved a 79.5% adherence rate compared with 49% in the control group (P ¼ .002).…”

Adesão Às Orientações Nutricionais: Uma Revisão De Literatura

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