Feasibility of implementing a web-based tool built from pharmacy claims data (e-MEDRESP) to monitor adherence to respiratory medications in primary care

Abstract

Objective

e-MEDRESP is a novel web-based tool that provides easily interpretable information on patient adherence to asthma/chronic obstructive pulmonary disease (COPD) medications, using pharmacy claims data. This study investigated the feasibility of implementing e-MEDRESP in primary care.

Material and methods

In this 16-month prospective cohort study, e-MEDRESP was integrated into electronic medical records. Nineteen family physicians and 346 of their patients were enrolled. Counters embedded in the tool tracked physician use during the follow-up. Patient/physician satisfaction with e-MEDRESP was evaluated though telephone interviews and online questionnaires. The capacity of e-MEDRESP to improve adherence was explored using a pre–post analysis.

Results

Overall, 245 patients had at least one medical visit during follow-up. e-MEDRESP was consulted by 15 (79%) physicians for 85 (35%) patients during clinic visits. Seventy-three patients participated in telephone interviews; 84% reported discussing their medication use with their physician; 33% viewed their e-MEDRESP report and indicated that it was easy to interpret. The physicians reported that the tool facilitated their evaluation of their patients’ medication adherence (mean ± standard deviation rating: 4.8 ± 0.7, on a 5-point Likert scale). Although the pre–post analysis did not reveal improved adherence in the overall cohort, adherence improved significantly in patients whose adherence level was <80% and who were prescribed inhaled corticosteroids (26.9% [95% CI 14.3–39.3%]) or long-acting muscarinic agents (26.4% [95% CI 12.4–40.2%]).

Conclusions

e-MEDRESP was successfully integrated in clinical practice. It could serve as a useful tool to help physicians monitor their patients’ medication adherence.

Keywords:

• Medication adherence
• drug monitoring
• health records
• medical records systems
• asthma
• COPD

Transparency

Declaration of financial/other relationships

AY received a doctoral training award from the Fonds de Recherche du Québec – Santé. LB has received research grants and professional fees from AstraZeneca, GlaxoSmithKline, and Genentech for studies unrelated to this work. MFB has received speaker fees and research grants from AstraZeneca, Boehringer-Ingelheim, and Novartis for studies unrelated to this work. CL is a consultant for AstraZeneca, GlaxoSmithKline, Sanofi Genzyme, and TEVA Innovation, and has received research grants from AstraZeneca and TEVA Innovation for studies unrelated to this work. AF has no conflicts of interest to disclose, financial or otherwise.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

AY wrote the first draft of the manuscript. AY, LB, and CL devised the project and the main conceptual ideas. MFB provided clinical expertise to support the development e-MEDRESP. AY and AF conducted the statistical analyses. All authors interpreted the data, revised the manuscript, had access to complete study data, and had authority over manuscript preparation as well as approval of the final version and the decision to submit for publication.

Acknowledgements

Authors would like to thank the patients and physicians who shared their time for the purposes of this project. They would also like to thank Benoit Archambeault for his programming services. Gratitude also goes out to all the research assistants who helped recruit participants and collect data: Geneviève Lalonde, Rébecca Fénélon-Dimanche, Maria-Kim Turcotte, Catherine Dalal, Margot Vinet, Laurie Roy, Thomas Prud’Homme, and Charles Blais-Fortin.

Additional information

Funding

This work was funded by the PRECISION program of AstraZeneca Canada. This study also received funding from the Canadian Foundation for Innovation and OMNIMED. The funding sources had no role in the design of this study and did not have any role during its execution, analyses, interpretation of the data, or decision to submit results. AstraZeneca was given the opportunity to review this manuscript; however, the study authors retained editorial control.