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A4832 - Adherence Monitoring and Inhaler Reminders Benefit GPs and Patients in Family Practice Settings
Author Block: J. Foster1, H. K. Reddel2; 1Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia, 2Woolcock Inst of Medical Research, Glebe, Australia.
RATIONALE: Little is known about family doctors' (GP) attitudes to electronic adherence monitoring and inhaler reminders for missed controller doses. This pilot qualitative study aimed to explore GPs’ perceptions of the acceptability and utility of providing these interventions to their patients in primary care. METHODS: Participants: GPs enrolled in a 6-month cluster randomized controlled trial of adherence interventions for asthma. Monitoring: An electronic monitor attached to inhalers uploaded usage data to a secure website on which the GP could view graphs of their patients’ controller use. Reminders: Monitors sounded ringtones for missed doses. Interviews: Pilot interviews with four GPs explored their perceptions of the acceptability/utility of providing adherence monitoring and reminders in their practice. Interviews were conducted by telephone, audio-recorded, transcribed and thematically analysed. RESULTS: Four themes emerged from the analysis. Benefits to patients: GPs noticed improved patient adherence and asthma control as a result of monitoring and reminders. Clinical benefit appeared to occur through patients establishing medication-taking habits. Benefits to GP: Monitoring provided reliable evidence of patients’ adherence. This prompted GPs to ask about reasons for poor adherence and facilitated the brainstorming of potential solutions between GPs and patients. One GP felt discussion about adherence saved time overall by concentrating effort in the right area. How to have conversations about adherence: Most GPs felt patients found adherence conversations acceptable. They considered it necessary to develop good doctor-patient rapport prior to discussing adherence, and to pitch conversations in a manner which avoided offense. One GP said some patients felt guilty about poor adherence and, to excuse it, claimed they had removed the monitor. Another GP wanted to provide a rationale for advising improved adherence so linked adherence discussions with evidence of poor asthma control, using patient’s peak flow readings. Future use of monitoring and reminders: All GPs wanted to use reminders in the future. One GP was keen to use reminders and monitoring in all his asthma patients. Other GPs felt implementation of adherence monitoring with all asthma patients in their practice would be too time consuming, especially a GP who rarely used the internet. One GP considered adherence graphs too complex for his patients. CONCLUSION: This pilot study is limited by small numbers but provides the first, useful insights into GP’s opinions about electronic adherence interventions. More data are needed to fully understand the barriers/facilitators to utilizing monitoring data and discussing adherence data with patients in family practice.