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Cachim A, Pereira AM, Almeida R, Amaral R, Alves‐Correia M, Vieira‐Marques P, Chaves‐Loureiro C, Ribeiro C, Cardia F, Gomes J, Vidal C, Silva E, Rocha S, Rocha D, Marques ML, Páscoa R, Morais D, Cruz AM, Santalha M, Simões JA, da Silva S, Silva D, Gerardo R, Todo Bom F, Morete A, Vieira I, Vieira P, Monteiro R, Raimundo MR, Monteiro L, Neves Â, Santos C, Penas AM, Regadas R, Marques JV, Rosendo I, Aguiar MA, Fernandes S, Cardoso CS, Pimenta F, Meireles P, Gonçalves M, Fonseca JA, Jácome C. Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self-report and physician assessment. Clin Transl Allergy 2023; 13:e12210. [PMID: 36825517 PMCID: PMC9930432 DOI: 10.1002/clt2.12210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/27/2022] [Accepted: 09/30/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment. METHODS This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0-100). RESULTS A total of 193 patients (72% female; median [P25-P75] age 28 [19-41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0-71]%; 1 month: 18 [0-48]%) than patient self-report (80 [60-95]) and physician assessment (82 [51-94]) (p < 0.001). A negligible non-significant correlation was found between the app and subjective measurements (ρ 0.118-0.156, p > 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001). CONCLUSIONS Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.
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Affiliation(s)
| | - Ana Margarida Pereira
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal,Allergy UnitInstituto and Hospital CUF‐PortoPortoPortugal
| | - Rute Almeida
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal
| | - Rita Amaral
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Cardiovascular and Respiratory SciencesPorto Health SchoolPolytechnic Institute of PortoPortoPortugal,Department of Women's and Children's HealthPediatric ResearchUppsala UniversityUppsalaSweden
| | - Magna Alves‐Correia
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Allergy UnitInstituto and Hospital CUF‐PortoPortoPortugal
| | - Pedro Vieira‐Marques
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal
| | - Claudia Chaves‐Loureiro
- Pulmonology DepartmentHospitais da Universidade de CoimbraCentro Hospitalar e Universitário de CoimbraCoimbraPortugal,Clinical Academic Center of CoimbraCoimbraPortugal
| | - Carmelita Ribeiro
- Serviço ImunoalergologiaCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - Francisca Cardia
- Unidade de Saúde Familiar (USF) Terras de AzuraraAgrupamento de Centros de Saúde Dão LafõesMangualdePortugal
| | - Joana Gomes
- Serviço de Imunoalergologia, Unidade ICentro Hospitalar Vila Nova de Gaia/EspinhoVila Nova de GaiaPortugal
| | - Carmen Vidal
- Servicio de AlergiaComplejo Hospitalario Universitario de SantiagoSantiago de CompostelaSpain
| | - Eurico Silva
- USF João SemanaAgrupamento de Centros de Saúde (ACES) Baixo VougaOvarPortugal
| | - Sara Rocha
- USF Arte NovaACES Baixo VougaOliveirinhaPortugal
| | - Diana Rocha
- USF Sá de MirandaACES Cávado II ‐ Gerês/CabreiraVila VerdePortugal
| | - Maria Luís Marques
- Serviço de ImunoalergologiaHospital da Senhora da OliveiraGuimarãesPortugal
| | - Rosália Páscoa
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal,USF Abel SalazarACES GaiaVila Nova de GaiaPortugal
| | - Daniela Morais
- USF CorgoACES Douro I ‐ Marão e Douro NorteVila RealPortugal
| | | | - Marta Santalha
- Serviço de PediatriaHospital da Senhora da OliveiraGuimarãesPortugal
| | - José Augusto Simões
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,USF Caminhos do CértomaACES Baixo MondegoPampilhosaPortugal,Department of Medical SciencesUniversity of Beira InteriorCovilhãPortugal
| | - Sofia da Silva
- USF CuidarteUnidade Local de Saúde do Alto MinhoPortuzeloPortugal
| | - Diana Silva
- Faculty of MedicineUniversity of PortoPortoPortugal,Serviço de ImunoalergologiaCentro Hospitalar Universitário de São JoãoPortoPortugal
| | - Rita Gerardo
- Serviço de PneumologiaHospital Santa MartaCentro Hospitalar Universitário de Lisboa CentralLisboaPortugal
| | | | - Ana Morete
- Allergy UnitInstituto and Hospital CUF‐PortoPortoPortugal,Serviço de ImunoalergologiaHospital Infante D PedroCentro Hospitalar Baixo VougaAveiroPortugal
| | - Inês Vieira
- Unidade de Cuidados Saúde Personalizados Arnaldo SampaioACES Pinhal LitoralLeiriaPortugal
| | | | - Rosário Monteiro
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal,USF Homem do LemeACES Porto OcidentalPortoPortugal
| | | | - Luís Monteiro
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,USF Esgueira+ACES Baixo VougaEsgueiraPortugal
| | | | - Carlos Santos
- USF Santo AntónioACES Cávado III ‐ Barcelos/EsposendeBarcelosPortugal
| | | | - Rita Regadas
- USF Aquilino RibeiroACES Douro II ‐ Douro SulMoimenta da BeiraPortugal
| | | | - Inês Rosendo
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,USF Coimbra CentroACES Baixo MondegoCoimbraPortugal
| | | | - Sara Fernandes
- UCSP São João da PesqueiraACES Douro SulSão João da PesqueiraPortugal
| | - Carlos Seiça Cardoso
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,USF CondeixaACES Baixo MondegoCondeixa‐a‐NovaPortugal
| | | | | | | | - João Almeida Fonseca
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal,Allergy UnitInstituto and Hospital CUF‐PortoPortoPortugal,MEDIDA – Medicina, Educação, Investigação, Desenvolvimento e AvaliaçãoPortoPortugal
| | - Cristina Jácome
- Center for Health Technology and Services Research (CINTESIS)Faculty of MedicineUniversity of PortoPortoPortugal,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)Faculty of MedicineUniversity of PortoPortoPortugal
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