A cluster-randomized trial to provide clinicians inhaled corticosteroid adherence information for their patients with asthma.
BACKGROUND
Inhaled corticosteroid (ICS) nonadherence is common among patients with asthma; however, interventions to improve adherence have often been complex and not easily applied to large patient populations.


OBJECTIVE
To assess the effect of supplying patient adherence information to primary care providers.


METHODS
Patients and providers were members of a health system serving southeast Michigan. Providers (88 intervention; 105 control) and patients (1335 intervention; 1363 control) were randomized together by practice. Patients were age 5 to 56 years, had a diagnosis of asthma, and had existing prescriptions for ICS medication. Adherence was estimated by using prescription and fill data. Unlike clinicians in the control arm, intervention arm providers could view updated ICS adherence information on their patients via electronic prescription software, and further details on patient ICS use could be viewed by selecting that option. The primary outcome was ICS adherence in last 3 months of the study period.


RESULTS
At the study end for the intention-to-treat analysis, ICS adherence was not different among patients in the intervention arm compared with those in the control arm (21.3% vs 23.3%, respectively; P = .553). However, adherence was significantly higher among patients whose clinician elected to view their detailed adherence information (35.7%) compared with both control arm patients (P = .026) and intervention arm patients whose provider did not view adherence data (P = .002).


CONCLUSIONS
Overall, providing adherence information to clinicians did not improve ICS use among patients with asthma. However, patient use may improve when clinicians are sufficiently interested in adherence to view the details of this medication use.
Williams
L Keoki
LK
Center for Health Services Research, Henry Ford Health System, Detroit, MI 48202, USA. kwillia5@hfhs.org
Peterson
Edward L
EL
Wells
Karen
K
Campbell
Janis
J
Wang
Mingqun
M
Chowdhry
Vimal K
VK
Walsh
Matthew
M
Enberg
Robert
R
Lanfear
David E
DE
Pladevall
Manel
M
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D055695:Electronic Prescribing; D005260:Female; D006282:Health Personnel; D006751:Hospital Information Systems; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D012984:Software; D013997:Time Factors
D000305:Adrenal Cortex Hormones