PATIENT COMPLIANCE - PharmXpert Academy

Therapeuticlevels. Clinicians have reported that open routine monitoringcan help support patients in maintaining long-term inhalationtherapy, while use of the information recorded can facilitatethe tailoring of treatment regimens to the individual, whichcan also improve adherence 12 . As such, I-neb Insight Onlinecan be seen as uniquely multifaceted, reflecting the needsof the patient, identified from real-time adherence andcompliance data. This system is currently available in the UK,and will be rolled out across Europe over the coming months.In the previously mentioned handling study, use of I-nebInsight Online in adult CF patients was associated with98% compliance, and 69.4% adherence, resulting in amean True Adherence of 68% 9 . This compares favourablywith the recently reported adherence level of 36%, alsorecorded in adult CF patients using data downloads obtainedfrom the I-neb AAD System 13 . While such a comprehensivetelemedicine system has not yet been developed and trialledfor use in other respiratory disorders, the potential impactof I-neb Insight Online on True Adherence in CF suggeststhat similar systems may also aid treatment optimisation inconditions such as asthma and COPD.Further indication for the potential of telemedicinesolutions in chronic conditions is derived from the UK’sWhole System Demonstrator (WSD). The WSD, the largestrandomised controlled trial of telehealth to date, involvedthe remote monitoring of vital signs in patients with COPD,coronary heart disease, and diabetes. Recent results werepromising, claiming significant reductions in mortality,hospitalisations, length of hospital stay, and overallhealthcare costs 14 .Monitoring vital signs may be seen as a reactive“firefighting” approach to telehealth, which clearly differsfrom I-neb Insight Online’s more proactive focus on TrueAdherence. However, combining the use of I-neb Insight Onlinewith the monitoring of vital signs for the early detection ofexacerbations, and other facets of CF treatment such as dietand physiotherapy, may offer an opportunity for optimisingthe integrated management of the major complicationsof CF. Depending on health status and behaviours of theindividual, certain patients may benefit from specific aspectsof telemedicine alone. However, for those patients withcomplex multisystem disorders, or multiple comorbidities,a combined approach has tremendous potential to addressthis highly challenging area of disease management.References1. Sabate, E. Adherence to long-term therapies: evidence foraction. Geneva: World Health Organization (2003). http://www.who.int/chronic_conditions/en/adherence_report.pdf,visited 13 November 2012.2. Nikander, K., Arheden, L., Denyer, J. & Cobos, N. Parents’adherence with nebulizer treatment of their children whenusing an Adaptive Aerosol Delivery (AAD) system. J. AerosolMed. 16;3, 273-281 (2003).3. Kripalani, S., Yao, X. & Haynes, R.B. Interventions to enhancemedication adherence in chronic medical conditions. Arch.Intern. Med. 167;6, 540-550 (2007).4. Nikander, K., Pearce, L.J., Smith, N.J. & Pritchard, J.N. Theimpact of electronic monitors on patients’ adherenceto inhaled medications. Dalby, R.N., Byron, P.R., Peart, J.,Suman, J.D. & Young, P.M. (Eds) Respiratory Drug Delivery,2012. Phoenix, Arizona., Davis Healthcare InternationalPublishing, River Grove, Illinois. 3, 673-678 (2012).5. Onyirimba, F., Apter, A., Reisine, S., Litt, M., McCusker, C.,Connors, M. & ZuWallack, R. Direct clinician-to-patient feedbackdiscussion of inhaled steroid use: its effect on adherence. Ann.Allergy Asthma Immunol. 90;4, 411-415 (2003).6. Burgess, S.W., Sly, P.D. & Devadason, S.G. Providing feedbackon adherence increases use of preventive medication byasthmatic children. J. Asthma. 47, 198-201 (2010).7. Lareau, S.C. & Yawn, B.P. Improving adherence with inhalertherapy in COPD. Int. J. Chron. Obstruct. Pulmon. Dis. 5,401-406 (2010).8. Devadason, S., Murdzoska, J., Ditcham, W., Roller, C., vonHollen, D. & Nikander, K. Lung deposition of 99mTc-DTPAfrom a pressurised metered dose inhaler and valved holdingchamber, used with facemask or mouthpiece in childrenwith stable asthma - A pilot study. (2012). http://www.rcjournal.com/abstracts/2012/?id=1433375, visited 16November 2012.9. Spencer, T., Daniels, T., Pollard, K., Agent, P., Morgan, G.,Madge, S., Bilton, D. & Peckham, D. I-neb Insight Online - Atelemedicine option in the treatment of cystic fibrosis. J.Cystic Fibrosis. 11(Suppl 1), S78 (2012).10. McCormack, P., McNamara, P.S. & Southern, K. A randomisedcontrolled trial of breathing modes for adaptive aerosoldelivery in children with cystic fibrosis. J. Cystic Fibrosis.10;5, 343-349 (2011).11. Spencer, T., Dyche, T., Nikander, K., Smith, N.J. & Pritchard,J.N. The association of true adherence, inhalation time andtreatment time for patients using the I-neb AAD systemin either TBM or TIM. Dalby, R.N., Byron, P.R., Peart, J.,Suman, J.D. & Young, P.M. (Eds) Respiratory Drug Delivery,2012. Phoenix, Arizona., Davis Healthcare InternationalPublishing, River Grove, Illinois. 3, 679-684 (2012).12. McCormack, P., Southern, K. & McNamara, P. Newnebulizer technology to monitor adherence and nebulizerperformance in cystic fibrosis. J. Aerosol Med. Pulm. Drug.Deliv. 25, 307-309 (2012).13. Daniels, T., Goodacre, L., Sutton, C., Pollard, K., Conway, S. &Peckham, D. Accurate assessment of adherence: Self-reportand clinician report vs electronic monitoring of nebulizers.Chest. 140;2, 425-432 (2011).14. Department of Health. Whole system demonstratorprogramme: Headline findings - December 2011.(2011). Gateway ref. 16972 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_131684, visited 16November 2012.John Pritchard, PhD, is CTO for PhilipsRespironics Drug Delivery, with globalaccountability for the developmentof advanced delivery systems for themonitoring and treatment of respiratorydiseases. He has published widely inthe respiratory drug delivery field, beeneditor to several journals, as well as having served on the boardsof two International Scientific Committees and on InternationalGovernment Advisory Panels.www.JforPC.comJournal For Patient Compliance Strategies to enhance Adherence and Health Outcomes 31