Emerging Technologies for Electronic Monitoring of Adherence, Inhaler Competence, and True Adherence

Abstract

Despite the availability of effective treatments for respiratory disorders, disease control is often suboptimal, due in part to the failure of patients to adhere to prescribed regimens, or to demonstrate competence with the often complex steps in the administration of inhaled medications. The cost of poor true adherence, a combined measure of adherence and inhaler competence, is considerable, both economically and in terms of health-related impact. While patient education is recognized as essential, there exist many barriers to healthcare professional-led monitoring and promotion of true adherence. Successful intervention remains a challenging task, dependent upon understanding and addressing the distinct issues associated with poor adherence and inhaler competence, and lessening the perceived burden on healthcare professionals. Electronic monitors provide an accurate and objective indication of adherence and may also be of value in assessing inhaler competence. The information provided by such devices is a helpful aid to understanding the challenging nature of true adherence, and may be crucial to the development and assessment of true adherence promoting interventions. This article provides a background to the impact of suboptimal adherence and inhaler competence, and the challenges associated with the promotion of true adherence, with an emphasis on respiratory therapies. Contemporary electronic monitors of adherence and inhaler competence are critically reviewed, and case studies of emerging technologies are provided to illustrate the use of innovative monitoring devices in the promotion of true adherence in practice. Potential future directions, including increased targeting and individualization, enhanced coordination of care, and a greater focus on inhaler competence are considered to be important additions to currently available technologies in this rapidly evolving field.

A quantitative evaluation of adherence and inhalation technique among respiratory patients: An observational study using an electronic inhaler assessment device

“…[3][4][5][6][7][8][9] For respiratory patients, some scholars argue for the incorrect use of inhalers to be a form of poor adherence or non-adherence. 9,10 Whereas a third group of scholars [27][28][29][30][31] highlight that the notion of what is called true adherence incorporates two distinct components namely adherence and competence, with competence mainly being related to the patient's ability to use a medication in a correct and effective way, which is also commonly referred to as technique. 9,10 Whereas a third group of scholars [27][28][29][30][31] highlight that the notion of what is called true adherence incorporates two distinct components namely adherence and competence, with competence mainly being related to the patient's ability to use a medication in a correct and effective way, which is also commonly referred to as technique.…”

“…18,24,26 Other scholars see that poor adherence can be triggered by the incorrect IT of the patient because of the latter's dissatisfaction with the medication response. 9,10 Whereas a third group of scholars [27][28][29][30][31] highlight that the notion of what is called true adherence incorporates two distinct components namely adherence and competence, with competence mainly being related to the patient's ability to use a medication in a correct and effective way, which is also commonly referred to as technique. Hence, in case of inhaled medication, adherence and IT should be taken into consideration to reflect true adherence.…”

Objective Assessment of Patient Inhaler User Technique Using an Audio-Based Classification Approach

“…Patient inhaler user technique is assessed most commonly using checklists based on visual/aural assessment by a healthcare professional 20 , 21 . However, this method of assessment is subjective, it gives equal rating to all errors, is prone to overestimate patient performance and cannot be used to monitor how patients use their inhaler outside of clinical visits 22 , 23 . Inhaler training devices have been reported to improve patient inhaler user technique 10 , 24 .…”

An Audio-Based Method for Assessing Proper Usage of Dry Powder Inhalers

“…The main method to assess a patient's inhaler user technique is by using checklists based on visual/aural assessment, where a healthcare professional supervises the whole process [11,12]. However, this method of assessment is based on the healthcare professional's perception, it gives an equal rating to all errors, it could overestimate patient performance and it cannot be used to monitor how patients use their inhaler outside of clinical visits, without the supervision of a doctor [13,14]. It is reported that the inhaler user technique from patients can be improved by inhaler training devices [15].…”

“…Detection and classification of sound events produced by the use of an inhaler is a field with emerging research as is shown by recent work [13,23]. Holmes et al [24] developed audio-signal processing methods to automatically detect inhaler events.…”