Direct clinician-to-patient feedback discussion of inhaled steroid use: its effect on adherence.
OBJECTIVE
To evaluate whether direct feedback discussion on inhaled steroid use might influence subsequent adherence with this therapy.


METHODS
A 10-week, single-blind, randomized trial in asthma patients. Inclusion criteria included forced expiratory volume in 1 second <80%, one or more markers for low socioeconomic status, and the use of inhaled steroids. Inhaled steroid and beta-agonist use were electronically monitored. All patients received standard asthma care. The treatment group received direct clinician-to-patient feedback discussion on their inhaled steroid and beta-agonist use on all subsequent visits, whereas this information was withheld during the study period in the control group.


METHODS
1) Mean weekly inhaled steroid adherence [(number of actuations/prescribed number of actuations) x 100]; 2) number of days with overuse of inhaled steroids; 3) 24-hour and nighttime albuterol use; 4) included forced expiratory volume in 1 second; and 5) Asthma Quality of Life Questionnaire total score.


RESULTS
Ten treatment and nine control patients completed the study. Mean weekly inhaled steroid adherence over the first week was not significantly different in the treatment and control groups: 61 +/- 9% versus 51 +/- 5%, respectively. However, by the second week, adherence increased to 81 +/- 7% in the treatment group, whereas it decreased to 47 +/- 7% in the control group (P = 0.003). Adherence remained above 70% in the treatment group for the entire trial, but continued to decrease in the control group. Overuse of inhaled steroids was low in both groups. There were no group differences in any of the asthma outcomes.


CONCLUSIONS
Direct clinician-to-patient feedback discussion on inhaled steroid use using electronic printouts did improve adherence in the short-term in asthma patients at high-risk for poor adherence.
University of Connecticut School of Medicine, Farmington, Connecticut, USA. rzuwalla@stfranciscare.org
Faustinus
F
Onyirimba
Andrea
A
Apter
Susan
S
Reisine
Mark
M
Litt
Corliss
C
McCusker
MaryLou
M
Connors
Richard
R
ZuWallack
D000280:Administration, Inhalation; D000328:Adult; D000420:Albuterol / Q000008:administration & dosage / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000523:psychology; D062787:Drug Overdose / Q000453:epidemiology; D004359:Drug Therapy, Combination; D030141:Feedback, Psychological; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010348:Patient Care Team; D010349:Patient Compliance; D010817:Physician-Patient Relations; D011788:Quality of Life; D012306:Risk; D016037:Single-Blind Method; D012923:Social Class; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D018927:Anti-Asthmatic Agents; D000420:Albuterol