Efficacy of a multifactorial intervention on therapeutic adherence in patients with chronic obstructive pulmonary disease COPD: a randomized controlled trialReportar como inadecuado




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BMC Pulmonary Medicine

, 14:70

COPD and occupational lung disease

Abstract

BackgroundTherapeutic adherence of patients with chronic obstructive pulmonary disease COPD is poor. This study evaluated the effectiveness of a multifactorial intervention on improving the therapeutic adherence in chronic obstructive pulmonary disease COPD patients with scheduled inhalation therapy.

MethodsThe study design consisted of a randomised controlled trial in a primary care setting. 146 patients diagnosed with COPD were randomly allocated into two groups using the block randomisation technique. One-year follow-ups with three visits were performed. The intervention consisted of motivational aspects related to adherence beliefs and behaviour in the form of group and individual interviews, cognitive aspects in the form of information about the illness and skills in the form of training in inhalation techniques. Cognitive-emotional aspects and training in inhalation techniques were reinforced during all visits of the intervention group. The main outcome measure was adherence to the medication regimen. Therapeutic adherence was determined by the percentage of patients classified as good adherent as evaluated by dose or pill count.

ResultsOf the 146 participants mean age 69.8 years, 91.8% males, 41.1% reported adherence 41.9% of the control group and 40.3% of the intervention group. When multifactorial intervention was applied, the reported adherence was 32.4% for the control group and 48.6% for the intervention group, which showed a statistically significant difference p = 0.046. Number needed to treat is 6.37. In the intervention group, cognitive aspects increased by 23.7% and skilled performance of inhalation techniques increased by 66.4%. The factors related to adherence when multifactorial intervention was applied were the number of exacerbations OR = 0.66, visits to health centre OR = 0.93 and devices OR = 2.4; illness severity OR = 0.67, beta-2-adrenergic OR = 0.16 and xantine OR = 0.19 treatment; activity OR = 1.03 and impact OR = 1.03 scales of the Saint George Respiratory Questionnaire.

ConclusionApplication of the multifactorial intervention designed for this study COPD information, dose reminders, audio-visual material, motivational aspects and training in inhalation techniques resulted in an improvement in therapeutic adherence in COPD patients with scheduled inhalation therapy.

Trial registrationCurrent Controlled Trials ISRCTN18841601.

KeywordsTherapeutic adherence COPD Educational intervention Electronic supplementary materialThe online version of this article doi:10.1186-1471-2466-14-70 contains supplementary material, which is available to authorized users.

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Autor: José Leiva-Fernández - Francisca Leiva-Fernández - Antonio García-Ruiz - Daniel Prados-Torres - Pilar Barnestein-Fonseca

Fuente: https://link.springer.com/



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