Faculty of Pharmacy, Université de Montréal, Montreal, Québec, Canada.
Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montreal, Québec, Canada.
Respir Care. 2020 Sep;65(9):1355-1366. doi: 10.4187/respcare.07328. Epub 2020 Mar 31.
Medication adherence in asthma and COPD is notoriously low. To intervene effectively, family physicians need to assess adherence accurately, which is a challenging endeavor. In collaboration family physicians and individuals with asthma or COPD, we aimed to explore the barriers and facilitators of assessing medication adherence in clinical practice (exploratory phase), and to develop a novel web-based tool (e-MEDRESP) that will allow physicians to monitor adherence using pharmacy claims data (development phase).
We used qualitative research methods and a framework inspired by user-centered design principles. Five focus groups were held: 2 with subjects ( = 15) and 3 with physicians ( = 20), and 10 individual interviews were conducted with physicians. In the exploratory phase, data were analyzed using thematic networks. In the development phase, we identified components to be included in an e-MEDRESP prototype through an iterative approach. The web-based e-MEDRESP tool was constructed by applying algorithms to pharmacy claims data that reflected end-users' recommendations through an informatics approach designed for electronic medical records.
The main barriers to assessing medication adherence included a lack of objective information regarding medication use and short duration of medical visits. Physicians emphasized that identifying patients at risk for nonadherence requires a team effort from pharmacists, respiratory therapists, and nurses. Subjects also agreed that the use of easily interpretable pharmacy claims data could be an important facilitator and contributed to the development of the e-MEDRESP prototype, which contains graphical representations of the adherence to respiratory controller medications and dispensing of rescue medications.
The e-MEDRESP tool has the potential to allow physicians to measure adherence objectively and to facilitate patient-physician communication concerning medication use. Future studies are needed to evaluate the feasibility of implementing e-MEDRESP in clinical practice. It would be relevant to develop strategies that could facilitate the sharing of information presented in e-MEDRESP among primary care health professionals.
哮喘和 COPD 患者的用药依从性通常较低。为了进行有效的干预，家庭医生需要准确地评估依从性，这是一项具有挑战性的工作。我们与哮喘或 COPD 患者合作，旨在探索临床实践中评估药物依从性的障碍和促进因素（探索阶段），并开发一种新的基于网络的工具（e-MEDRESP），该工具将允许医生使用药房理赔数据来监测依从性（开发阶段）。
我们使用定性研究方法和受用户为中心设计原则启发的框架。共进行了 5 次焦点小组讨论：2 次与患者（=15 人），3 次与医生（=20 人），并对 10 名医生进行了个人访谈。在探索阶段，使用主题网络分析数据。在开发阶段，我们通过迭代方法确定了要包含在 e-MEDRESP 原型中的组件。该基于网络的 e-MEDRESP 工具是通过应用算法构建的，该算法反映了药房理赔数据中的用药情况，通过电子病历的信息学方法来反映最终用户的建议。
评估药物依从性的主要障碍包括缺乏关于药物使用的客观信息和就诊时间短。医生强调，识别有非依从性风险的患者需要药剂师、呼吸治疗师和护士的团队合作。患者还认为，使用易于解释的药房理赔数据可能是一个重要的促进因素，并促成了 e-MEDRESP 原型的开发，该原型包含了对呼吸控制器药物的依从性和急救药物配药的图形表示。
e-MEDRESP 工具有可能使医生能够客观地测量依从性，并促进医患之间关于药物使用的沟通。需要进一步研究来评估在临床实践中实施 e-MEDRESP 的可行性。开发策略以促进初级保健专业人员之间共享 e-MEDRESP 中呈现的信息将是相关的。
