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Lavoie KL, Moullec G, Lemiere C, Blais L, Labrecque M, Beauchesne MF, Pepin V, Cartier A, Bacon SL. Efficacy of brief motivational interviewing to improve adherence to inhaled corticosteroids among adult asthmatics: results from a randomized controlled pilot feasibility trial. Patient Prefer Adherence 2014; 8:1555-69. [PMID: 25422587 PMCID: PMC4231985 DOI: 10.2147/ppa.s66966] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Daily adherence to inhaled corticosteroid (ICS) regimens is one of the most important factors linked to achieving optimal asthma control. Motivational interviewing (MI) is a client-centered communication style that focuses on enhancing intrinsic motivation to engage in appropriate self-management behaviors. MI has been shown to improve a variety of health behaviors including medication adherence in other disorders, but its efficacy for the improvement of ICS adherence in asthmatics has yet to be examined. This pilot "proof of concept" trial assessed the feasibility of MI to improve daily ICS adherence and asthma control levels in adult asthmatics. METHODS Fifty-four poorly controlled (Asthma Control Questionnaire [ACQ] score ≥1.5), highly nonadherent (filled <50% of ICS medication in the last year) adult asthmatics were recruited from the outpatient asthma clinic of a university-affiliated hospital. Participants underwent baseline assessments and were randomly assigned to MI (3×30 minutes sessions within a 6-week period, n=26) or a usual care (UC) control group (n=28). ICS adherence (% pharmacy refills) and asthma control (ACQ, Asthma Control Test [ACT]) were measured at 6 and 12 months postintervention. Mixed model repeated measure analyses for both intent-to-treat and per-protocol were used. Results were adjusted for a priori-defined covariates including baseline adherence. Patients in the MI group also reported their impressions of the intervention. RESULTS Six-month adjusted intent-to-treat analyses revealed a mean change in the percentage of ICS refills of 13% in the MI group vs 6% in the UC group (between group net improvement associated with MI =+6% [-12% to 24%]). Twelve-month analyses revealed a mean change in the percentage of ICS refills of 11% (MI group) vs 7% in the UC group (between group net improvement associated with MI =+3% [-11% to 18%]) representing an effect size (ES) of d=0.20 (medium). Six-month adjusted net improvement in ACQ and ACT scores between MI and control groups was -0.2 and +0.7, respectively, with improvements being even more pronounced at 12 months (ACQ =-0.5; ACT =+1.1; ES, d=0.12 and 0.18 [small], respectively). Interestingly, 6- and 12-month net improvements in asthma self-efficacy (which is specifically targeted by MI) improved by +0.4 and +0.4, respectively, with an ES of d=0.46 (marginally large). Patients in the MI group rated the intervention overwhelmingly positively in terms of usefulness, pertinence, feasibility, enjoyableness, and likelihood to change adherence behavior. CONCLUSION Results suggest that a brief (90 minutes) MI intervention that targets ICS adherence can produce clinically significant improvements in adherence behavior, asthma control levels, and asthma self-efficacy in poorly controlled nonadherent asthmatics at 6 months that are maintained for 1 year, and it is well accepted by patients. Future studies including larger sample sizes, modified intervention designs (eg, MI "booster" sessions), and assessments of the extent behavior changes translate into clinical improvements (eg, in asthma control and quality of life) are warranted.
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Affiliation(s)
- Kim L Lavoie
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
- Research Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
- Department of Psychology, University of Quebec at Montreal (UQAM), Succursale Center-Ville, Montreal, Quebec, Canada
- Correspondence: Kim L Lavoie, Department of Psychology, University of Quebec at Montreal (UQAM), PO Box 8888, Succursale Center-Ville, Montreal, Quebec H3C 3P8, Canada, Tel +1 514 987 3000 (3835), Fax +1 514 987 7953, Email
| | - Gregory Moullec
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
- Research Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
| | - Catherine Lemiere
- Research Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
| | - Lucie Blais
- Research Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
| | - Manon Labrecque
- Research Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
| | - Marie-France Beauchesne
- Research Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
| | - Veronique Pepin
- Research Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
| | - André Cartier
- Research Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
| | - Simon L Bacon
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
- Research Centre, Hôpital du Sacré-Coeur de Montréal – A University of Montreal Affiliated Hospital, Montréal, Quebec, Canada
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
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Boulet LP, Hamid Q, Bacon SL, Bergeron C, Boulet LP, Chen Y, Dixon AE, Ernst P, Hamid Q, Holguin F, Irvin CG, Kimoff RJ, Komakula S, Laprise C, Lavoie KL, Shore SA, Teodorescu M, Vohl MC. Symposium on obesity and asthma - November 2, 2006. Can Respir J 2007; 14:201-8. [PMID: 17551594 PMCID: PMC2676363 DOI: 10.1155/2007/342618] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Asthma and obesity are frequently associated, and obesity has been considered a factor contributing to both an increase in severity of asthma and to its development. The present document summarizes the proceedings of a symposium held in Montreal, Quebec, on November 2, 2006, under the auspices of the Réseau en santé respiratoire du Fonds de la recherche en santé du Québec in collaboration with the McGill University - Strauss Severe Asthma Program, Université Laval (Quebec City) and Université de Montréal. It includes an overview of the various aspects of the relationships between asthma and obesity with regard to animal models; genetic, hormonal and physiological determinants; influence of comorbidities (eg, sleep apnea syndrome); epidemiology; clinical and psychological features; and management of asthma in the obese population.
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Affiliation(s)
- Louis-Philippe Boulet
- Centre de Pneumologie, Institut universitaire de cardiologie et de pneumologie de l’Université Laval, Hôpital Laval, Québec
- Correspondence and reprints: Dr Louis-Philippe Boulet, Hôpital Laval, 2725, chemin Sainte-Foy, Québec, Québec G1V 4G5. Telephone 418-656-4747, fax 418-656-4762, e-mail
| | - Qutayba Hamid
- Meakins-Christie Laboratories, McGill University, Montreal, Quebec
| | | | | | - Louis-Philippe Boulet
- Correspondence and reprints: Dr Louis-Philippe Boulet, Hôpital Laval, 2725, chemin Sainte-Foy, Québec, Québec G1V 4G5. Telephone 418-656-4747, fax 418-656-4762, e-mail
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Wise M, Gustafson DH, Sorkness CA, Molfenter T, Staresinic A, Meis T, Hawkins RP, Shanovich KK, Walker NP. Internet telehealth for pediatric asthma case management: integrating computerized and case manager features for tailoring a Web-based asthma education program. Health Promot Pract 2007; 8:282-91. [PMID: 16928987 PMCID: PMC2366971 DOI: 10.1177/1524839906289983] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article reports on the development of a personalized, Web-based asthma-education program for parents whose 4- to 12-year-old children have moderate to severe asthma. Personalization includes computer-based tailored messages and a human coach to build asthma self-management skills. Computerized features include the Asthma Manager, My Calendar/Reminder, My Goals, and a tailored home page. These are integrated with monthly asthma-education phone calls from an asthma-nurse case manager. The authors discuss the development process and issues and describe the current randomized evaluation study to test whether the year-long integrated intervention can improve adherence to a daily asthma controller medication, asthma control, and parent quality of life to reduce asthma-related healthcare utilization. Implications for health education for chronic disease management are raised.
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Affiliation(s)
- Meg Wise
- Center for Health Systems Research and Analysis, University of Wisconsin-Madison in Madison, Wisconsin, USA
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