Efficacy of interventions to improve adherence to inhaled corticosteroids in adult asthmatics: Impact of using components of the chronic care model

• Published in: Respiratory medicine 2012-09, Vol.106 (9), p.1211-1225
• Main Authors: Moullec, Gregory, Gour-Provencal, Gabrielle, Bacon, Simon L, Campbell, Tavis S, Lavoie, Kim L
• Format: Article
• Language: English
• Subjects: Administration, Inhalation; Adrenal Cortex Hormones - administration & dosage; Adult; Aged; Anti-Asthmatic Agents - administration & dosage; Asthma; Asthma - drug therapy; Behavioral medicine; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Chronic Disease; Chronic illnesses; Chronic obstructive pulmonary disease, asthma; Disease management; Female; Humans; Inhaled corticosteroids; Male; Medical research; Medical sciences; Medication Adherence; Meta-analysis; Middle Aged; Pharmacology. Drug treatments; Pneumology; Pulmonary/Respiratory; Randomized Controlled Trials as Topic; Studies; Treatment Outcome
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2012.06.001

Summary Background Adherence to inhaled corticosteroids (ICS) remains poor among asthmatics, yet little is known about the efficacy of interventions to improve adherence. Implementing the Chronic Care Model (CCM) components among patients with respiratory disorders has been associated with an improvement in outcomes, yet little is known about its effects on ICS adherence in asthmatics. Objective We conducted a systematic review to assess the efficacy of interventions to improve ICS adherence among adult-asthmatics, and whether the use of CCM components (i.e., teaching self-management skills, providing decision support, delivery system design, and clinical information systems) resulted in greater ICS adherence. Methods All English language articles testing the efficacy of an intervention including ICS medication on outcome from MEDLINE and PsychINFO databases through Aug-2010 were reviewed. Interventions were categorized based on the inclusion of CCM components. We standardized treatment effects to obtain effect-size’s (ES's) and we combined the ES's of studies according to the number of CCM components included in their interventions. Results Eighteen studies met inclusion criteria. Inclusion of a greater number of CCM components within interventions was associated with stronger effects on ICS adherence outcomes, with interventions featuring one, two, and four CCM components having medium (ES = 0.29; 95%CI, 0.16–0.42), large (0.53; 0.40–0.66), and very-large (0.83; 0.69–0.98) effects respectively. Conclusions Findings provide support for using the CCM as a framework for the design and implementation of interventions to improve adherence among adult-asthmatics.