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Medication adherence in asthma and COPD: context analysis and prospects for the development of a digital interprofessional intervention

par Biset, Natacha
Président du jury Dufrasne, François
Promoteur De Vriese, Carine
Co-Promoteur Pochet, Stéphanie
Publication Non publié, 2024-04-03

Thèse de doctorat

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Introduction:Asthma and chronic obstructive pulmonary disease (COPD) are common chronic diseases. According to the World Health Organization, asthma is one of the most common chronic diseases in children, and COPD is the third leading cause of death worldwide. Early detection and appropriate treatment can significantly improve health outcomes.Objectives:This thesis focused on medication adherence in asthma and COPD. First, we aimed to assess the consumption of asthma medications prescribed to children in Belgium. Second, we aimed to assess adherence and persistence with inhaled medications for the chronic treatment of asthma and COPD and to evaluate the factors influencing adherence. Factors examined were gender, age, device type, BIM status, employment status, region of residence, and the new medicines service (NMS) offered by pharmacists. Thirdly, we aimed to determine the expectations of COPD patients and healthcare practitioners towards a mobile application or web platform and to identify potential barriers or facilitators to the use of such digital tools. In addition, we sought to evaluate the current state of collaboration between healthcare practitioners and the impact of a technological tool.Methods:To assess the consumption of asthma medication in children in Belgium, a retrospective study was conducted using anonymized administrative data from Independent Health Insurance Funds for the period 2013-2018. For the second objective, we conducted a retrospective study on the National Institute for Health and Disability Insurance (NIHDI) database containing dispensing data for inhaled medications for the treatment of asthma and COPD from 2013 to 2016. Therapeutic adherence was assessed using the continuous multiple-interval measures of medication availability (CMA). This part was completed by a similar retrospective study on an Independent Health Insurance Funds database, enabling the analysis of new factors influencing adherence for the period 2013 to 2018. Finally, for the third objective, a qualitative study was conducted via individual semi-directive interviews with COPD patients and the professionals involved in their follow-up (general practitioners, pulmonologists, pharmacists, physiotherapists, and nurses).Results: In 2018, 12.9% of children had received at least one asthma medication, and 4.4% had received at least two packages with a minimum of 30 days between deliveries. Young children (aged 2-6 years) were three times more likely to use asthma medications than older children (aged 7-18 years). Inhaled corticosteroids (ICS), in combination or not with long acting β2 mimetics (LABA), were the most commonly dispensed medications for children. Children taking asthma medications were almost twice as likely to receive antibiotics, more likely to end up in the emergency department, and twice as likely to be hospitalized.Medication adherence varied considerably from one pharmacological class to another. Medication adherence was low for ICS, alone or in combination with a LABA. When LABA were administered alone, the proportion of adherent patients was higher. Finally, adherence was higher among patients taking long-acting anticholinergics (LAMA) alone or in combination with LABA. The NMS delivered by pharmacists for asthma patients receiving ICS for the first time appeared to have a positive impact on adherence. Low-income patients tended to be more adherent.In our qualitative study, we were able to identify difficulties encountered by COPD patients, such as: managing the disease and the disease itself, managing treatments (correct intake, choice of treatment, ...), but also a lack of information about the disease and its treatments. The patients interviewed expressed the need for easier contact with their caregivers, personalized follow-up including adapted physical exercises and encouragement. They also want to be able to communicate with other patients suffering from the same disease. The majority of COPD patients feel they have good communication with the professionals around them, although they would like to have easier contact with them.According to the professionals involved in the monitoring of these COPD patients, the main difficulties encountered are lack of patient adherence and misuse of their treatment, complicated communication and lack of patient motivation. The development of a mobile application aimed primarily at patients seems to be favored by these healthcare practitioners. Interprofessional collaboration seems to be seen as essential for good patient care, and professionals mentioned several ways to improve it, such as more face-to-face meetings between providers or more information sharing between them. However, many reported a lack of time to optimize this collaboration.Conclusion:This work confirmed the problem of adherence to inhaled medications for the treatment of asthma and COPD in Belgium. Non-adherence was common to all pharmacological classes, but particularly affected ICS, a class often dispensed to a young population. The NMS dispensed by pharmacists seemed to have a positive impact on medication adherence, although few patients completed the two interviews.Our qualitative study shows that most patients and professionals view a platform positively as a means to support the care of COPD patients and promote interprofessional collaboration. Patients' needs include access to quality information about COPD, its medical treatments and smoking cessation, help in maintaining good physical condition through adapted exercises, incentives and reminders, and crisis management protocols or a logbook. Since patient needs can vary, it would be ideal if the mobile app could be customized.