Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Digital Engagement, Behavior and Cognition, Philips Research, Eindhoven, The Netherlands.
Br J Clin Pharmacol. 2024 May;90(5):1344-1356. doi: 10.1111/bcp.16025. Epub 2024 Feb 25.
Suboptimal self-management with controller inhalation therapy in asthma and COPD is frequently observed with poor treatment outcomes. The developed 'Respiratory Adherence Care Enhancer' (RACE) instrument identifies and addresses individual barriers to self-management with a theoretical underpinning. This study investigates the feasibility of pharmaceutical support with this instrument.
An implementation trial was conducted with asthma and COPD patients in 5 community pharmacies in the Netherlands. Patients were allocated to standard care or add-on support with the RACE instrument. Patients were invited to complete the RACE questionnaire at baseline, 5-week and 10-week follow-up. Barrier profiles were accessible for the intervention group with subsequent consultations at baseline and 5-weeks. Experiences were collected from patients and consultants with a questionnaire and reported findings. Primary endpoints focused on the acceptability, practicality and implementation process. Secondary endpoints included between-group differences in barrier and disease control outcomes from baseline at 10-weeks follow-up.
In total, 84 patients were included; 48 were assigned to intervention and 36 to standard care. Patient satisfaction of support with the RACE instrument was high (71%). Patients felt motivated, reassured and more confident about their disease management. Consultants reported an increase in awareness of patient barriers. Patient recognition of barrier profiles was 83.9% (±12.9%). The barrier inhaler techniques decreased significantly for the intervention group at follow-up with odds ratio 0.30 (95% confidence interval, 0.10-0.91). No significant differences were observed for changes in number of barriers and disease control.
Self-management support with the RACE instrument is feasible and appreciated, facilitating behaviour change with patient-centred pharmaceutical care in asthma and COPD.
哮喘和 COPD 患者采用控制器吸入疗法进行自我管理时，如果存在治疗效果不佳的情况，通常表明其自我管理存在不达标情况。开发的“呼吸依从性护理增强器（RACE）”工具可识别和解决自我管理的个体障碍，并具有理论依据。本研究旨在调查该工具在药物支持方面的可行性。
在荷兰的 5 家社区药店开展了一项实施性试验，纳入哮喘和 COPD 患者。患者被分配至标准护理或附加 RACE 工具支持。患者在基线、第 5 周和第 10 周随访时被邀请完成 RACE 问卷。干预组可获得障碍档案，并在基线和第 5 周进行后续咨询。患者和顾问通过问卷收集经验并报告研究结果。主要终点侧重于可接受性、实用性和实施过程。次要终点包括 10 周随访时基线时的组间障碍和疾病控制结果差异。
共纳入 84 例患者，其中 48 例分配至干预组，36 例分配至标准护理组。患者对 RACE 工具支持的满意度较高（71%）。患者感到受到激励、放心并对其疾病管理更有信心。顾问报告称，他们对患者障碍的认识有所提高。患者对障碍档案的识别率为 83.9%（±12.9%）。干预组在随访时吸入器技术障碍显著减少，优势比为 0.30（95%置信区间，0.10-0.91）。未观察到障碍数量和疾病控制的变化有显著差异。
RACE 工具的自我管理支持是可行且受欢迎的，它通过以患者为中心的药物护理促进行为改变，为哮喘和 COPD 患者提供支持。
