Effectiveness of an asthma integrated care program on asthma control and adherence to inhaled corticosteroids

Abstract

Objective: To measure the effectiveness of an integrated care program for individuals with asthma aged 12–45 years, on asthma control and adherence to inhaled corticosteroids (ICS). Methods: Researchers used a theoretical model to develop the program and assessed effectiveness at 12 months, using a pragmatic controlled clinical trial design. Forty-two community pharmacists in Quebec, Canada recruited participants with either uncontrolled or mild-to-severe asthma. One group was exposed to the program; another received usual care. Asthma control was measured with the Asthma Control Questionnaire; ICS adherence was assessed with the Morisky medication adherence scale and the medication possession ratio. Program effectiveness was assessed with an intention-to-treat approach using multivariate generalized estimating equation models. Results: Among 108 exposed and 241 non-exposed, 52.2% had controlled asthma at baseline. At 12-months, asthma control had improved in both groups but the interaction between study groups and time was not significant (p = 0.09). The proportion of participants with good ICS adherence was low at baseline. Exposed participants showed improvement in adherence and the interaction between study groups and time was significant (p = 0.02). Conclusion: An integrated intervention, with healthcare professionals collaborating to optimize asthma control, can improve ICS adherence.

• Asthma
• asthma control
• inhaled corticosteroids
• integrated care
• medication adherence
• patient education

Acknowledgements

We thank Michel Gaudet, MSc, Caty Blanchette, MSc, Éric Demers, MSc and Nancy Manzerolle, MSc, for assistance in data analysis and Joanne Vidal for assistance in editing the text. We thank Isabelle Dubreuil, Patrick Tremblay, Gabriel Cloutier, Joseph Moisan-De Serres, Émilie Moisan-De Serres and Olivette Welsh for conducting the interviews and for data entry. We are also grateful to Madone Turcotte and to all the healthcare professionals and participants who took part in this study. We confirm that all personal identifiers have been removed or disguised so the person(s) described are not identifiable and cannot be identified through the details of the story.

This research was supported by a grant from the Fonds de la recherche en santé du Québec under the auspices of the program: “Towards Excellence in Asthma Management (TEAM)” from the Réseau québécois de l’asthme et de la MPOC funded by Merck Frosst Canada Inc. and Astra Zeneca Canada.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Supplementary material available online

Supplementary Table 1.