title: A Tablet-Based Multimedia Education Tool Improves Provider and Subject Knowledge of Inhaler Use Techniques.
abstract: BACKGROUND
  Although inhaled medications are effective therapies for COPD, many patients and providers use them incorrectly.
  
  
  METHODS
  We recruited providers who prescribe inhalers or teach inhaler technique and assessed their use of metered-dose inhalers (MDIs), various dry powder inhalers (DPIs), and Respimat using predefined checklists. Then they watched tablet-based multimedia educational videos that demonstrated correct inhaler technique by a clinical pharmacist with teach-back from a patient and were re-evaluated. We also recruited patients with COPD and assessed their use of their prescribed inhalers and then retested them after 3-6 months. Baseline and follow-up respiratory symptoms were measured by the COPD Assessment Test.
  
  
  RESULTS
  Fifty-eight providers and 50 subjects participated. For all providers, correct inhaler technique (reported as percentage correct steps) increased after the videos: MDI without a spacer (72% vs 97%) MDI with a spacer (72% vs 96%), formoterol DPI (50% vs 94%), mometasone DPI (43% vs 95%), tiotropium DPI (73% vs 99%), and Respimat (32% vs 93%) (before vs after, P < .001 for all comparisons). Subjects also improved their inhaler use technique after viewing the educational videos: MDI without a spacer (69% vs 92%), MDI with a spacer (73% vs 95%), and tiotropium DPI (83% vs 96%) (before vs after, P < .001 for all comparisons). The beneficial effect of this educational intervention declined slightly for subjects but was durably improved after several months. COPD Assessment Test scores did not demonstrate any change in respiratory symptoms.
  
  
  CONCLUSIONS
  A tablet-based inhaler education tool improved inhaler technique for both providers and subjects. Although this intervention did show durable efficacy for improving inhaler use by patients, it did not reduce their respiratory symptoms.
authors.affiliation: Divison of Pulmonary, Critical Care, and Sleep Medicine, Cincinnati Veterans Affairs Medical Center and the Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio. mulhalan@ucmail.uc.edu.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Mulhall
authors.affiliation: Divison of Pulmonary, Critical Care, and Sleep Medicine, Cincinnati Veterans Affairs Medical Center and the Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Zafar
authors.affiliation: Division of Clinical Pharmacy, Cincinnati Veteran Affairs Medical Center, Cincinnati, Ohio.
authors.forename: Samantha
authors.initials: S
authors.lastname: Record
authors.affiliation: Division of Primary Care, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio.
authors.forename: Herman
authors.initials: H
authors.lastname: Channell
authors.affiliation: Divison of Pulmonary, Critical Care, and Sleep Medicine, Cincinnati Veterans Affairs Medical Center and the Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Panos
mesh_terms: D000368:Aged; D000068600:Albuterol, Ipratropium Drug Combination / Q000008:administration & dosage; D018926:Anti-Allergic Agents / Q000008:administration & dosage; D001993:Bronchodilator Agents / Q000008:administration & dosage; D057189:Checklist; D034201:Computers, Handheld; D058995:Dry Powder Inhalers; D004501:Education, Medical / Q000379:methods; D018961:Educational Technology; D005260:Female; D005500:Follow-Up Studies; D000068759:Formoterol Fumarate / Q000008:administration & dosage; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000188:drug therapy; D008297:Male; D036501:Metered Dose Inhalers; D008875:Middle Aged; D000068656:Mometasone Furoate / Q000008:administration & dosage; D019212:Multimedia; D010353:Patient Education as Topic / Q000379:methods*; D010820:Physicians; D011446:Prospective Studies; D063189:Symptom Assessment; D000069447:Tiotropium Bromide / Q000008:administration & dosage
chemical_list: D000068600:Albuterol, Ipratropium Drug Combination; D018926:Anti-Allergic Agents; D001993:Bronchodilator Agents; D000068656:Mometasone Furoate; D000068759:Formoterol Fumarate; D000069447:Tiotropium Bromide
keywords: education; health-care providers; inhaler technique; inhalers; multimedia