Cachim Afonso, Pereira Ana Margarida, Almeida Rute, Amaral Rita, Alves-Correia Magna, Vieira-Marques Pedro, Chaves-Loureiro Claudia, Ribeiro Carmelita, Cardia Francisca, Gomes Joana, Vidal Carmen, Silva Eurico, Rocha Sara, Rocha Diana, Marques Maria Luís, Páscoa Rosália, Morais Daniela, Cruz Ana Margarida, Santalha Marta, Simões José Augusto, da Silva Sofia, Silva Diana, Gerardo Rita, Todo Bom Filipa, Morete Ana, Vieira Inês, Vieira Pedro, Monteiro Rosário, Raimundo Maria Rosário, Monteiro Luís, Neves Ângela, Santos Carlos, Penas Ana Margarida, Regadas Rita, Marques José Varanda, Rosendo Inês, Aguiar Margarida Abreu, Fernandes Sara, Cardoso Carlos Seiça, Pimenta Filipa, Meireles Patrícia, Gonçalves Mariana, Fonseca João Almeida, Jácome Cristina
Faculty of Medicine, University of Porto, Porto, Portugal.
Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.
Clin Transl Allergy. 2023 Feb;13(2):e12210. doi: 10.1002/clt2.12210.
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.
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).
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).
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.
先前的研究已证明使用哮喘应用程序来支持药物管理和依从性的可行性，但未能与当前临床实践中使用的其他措施进行比较。然而，在临床环境中，任何额外的依从性测量都必须从患者和医生的角度进行评估，以便它也有助于改善共同决策的过程。因此，我们旨在比较临床实践中哮喘控制吸入器依从性的不同测量方法，即通过应用程序、患者自我报告和医生评估。
本研究是对三项前瞻性多中心观察性研究的二次分析，研究对象为从葡萄牙61个初级和二级医疗中心招募的持续性哮喘患者（≥13岁）。邀请患者使用InspirerMundi应用程序并记录他们吸入的药物。应用程序将依从性测量为服用剂量数除以每天预定剂量数，并考虑两个时间点进行分析：1周和1个月。在基线时，患者和医生使用视觉模拟量表（VAS 0-100）独立评估前一周对哮喘控制吸入器的依从性。
共有193名患者（72%为女性；年龄中位数[P25-P75]为28[19-41]岁）纳入分析。应用程序测量的依从性较低（1周：31[0-71]%；1个月：18[0-48]%），低于患者自我报告（80[60-95]）和医生评估（(82[51-94]）（p<0.001）。应用程序与主观测量之间发现了可忽略不计的非显著相关性（ρ0.118-0.156，p>0.05）。患者自我报告与医生评估之间存在中度相关性（ρ=0.596，p<0.001）。
应用程序测量的依从性低于患者或医生报告的依从性。这是预期的，因为客观测量通常低于主观评估，主观评估往往高估依从性。然而，应用程序测量的低依从性也可能受到应用程序本身使用的影响，这在未来的研究中需要考虑。
