Personalised medication adherence management in asthma and COPD: a review of effective interventions and development of a practical adherence toolkit

Aim: To develop a practical, evidence-based decision support toolkit for healthcare professionals managing medication non-adherence in adult patients with asthma and/or COPD, by matching the Test of Adherence to Inhalers (TAI) identified adherence barriers to proven effective adherence enhancing interventions.Method: A literature review in PubMed and Embase was performed identifying interventions that show improvement in medication adherence in adult patients with asthma and/or COPD. Randomised controlled trials (RCTs) published in English with full-texts available were included. Effective interventions were assessed by the Cochrane risk of bias tool, categorized, matched with specific TAI responses and intregrated into a practical TAI Toolkit. The Toolkit was assessed on content and usability (System Usability Scale (SUS), scale 0 to 100) by a multidisciplinary group of healthcare professionals (n=8).Results: Forty RCTs were included in the review. In total, seven effective interventions were revealed, informing the TAI Toolkit: reminders, educational interventions, motivational strategies, feedback on medication use, shared decision making, simplifying medication regimen and multiple component interventions. The Toolkit consists of a diagram, which provides recommendations for each of the TAI questions. The wheel is accompanied by a user guide with further elaboration on the practical application of the interventions and the strength of underlying evidence. Healthcare professionals rated the TAI Toolkit with a mean SUS score of 71.4 (range: 57.5-80.0).Conclusion: Medication adherence enhancing interventions for adult patients with asthma and/or COPD were integrated into the practical TAI Toolkit. This Toolkit can help healthcare professionals to personalise adherence management by efficiently selecting the right intervention for the right patient. The TAI Toolkit was well received by healthcare professionals. Further research is required to test its validity, practicality and effectiveness in practice. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest The development of the TAI Toolkit was supported by an unrestricted grant from Chiesi Pharmaceuticals. References and Clinical Trial Registry Information