Concordance between medication advice through a remote primary care electronic Asthma/COPD service and patient-reported inhalation medication

Aim: To support general practitioners (GPs), the asthma/COPD service (AC-service) is implemented in the northern part of the Netherlands by providing a working diagnosis and treatment advised by a pulmonologist to the GPs. The aim of this study is to examine the concordance between the advised inhalation medication at the first visit and the patient-reported inhalation medication at the second visit at the AC-service.Methods: Data from the Dutch AC-service were studied retrospectively. These data include, for every patient, current medication use, patient-reported outcomes (Asthma Control Questionnaire [ACQ] and Clinical COPD Questionnaire [CCQ]), and spirometry. Descriptive statistics were used to describe the concordance. In case of discordance, the current medication use was investigated.Results: In total 3,837 patients (asthma n=2,250; COPD n=1,102; ACO n=485) were included in the analysis. A concordance of 64.8% was found for asthma patients, 49.5% for COPD patients, and 52.6% for ACO-patients. In case of discordance, in general, more medication was used, i.e. ICS or long-acting bronchodilator in addition to the advised medication. In case of discordance more pulmonary symptoms (CCQ/ACQ) and more exacerbations were observed. Conclusion: For about half to almost two-third of the patients, the medication advice provided by the AC-service was followed. In case of discordance, patients reported poorer health status and more exacerbations. The changes in inhalation medication are partially in line with the current guidelines for symptomatic patients. It could be possible that GPs did not adhere to the advice of the reinstated drugs because of the decreased health of the patients. In the future, the AC-service may alert GPs about the advised inhalation medication with high discordance, i.e. ICS-advice in asthma patients, LAMA-advice in COPD patients, and ICS/LABA in ACO patients may advise the GPs to closely monitor the health status and number of exacerbations to possibly prevent further deterioration. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest This study is funded by General Practitioners Research Institute (GPRI) References and Clinical Trial Registry Information