Inhaler Refill Adherence among Patients with COPD/Asthma at a General Hospital in Northern Peninsular Malaysia

Keywords: Inhalation devices, treatment adherence, asthma, COPD

Abstract

Background: Most adherence studies are based on self-report measures. There are limited studies on medication refill adherence (MRA) conducted in Malaysia, especially on bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD). The study aimed to investigate the MRA for inhalers with fixed dosing indicated for BA or COPD, prescribed from paediatric and medical clinics in Hospital Tuanku Fauziah and the factors that may affect MRA of COPD/BA inhalers. Methods: A cross-sectional study was conducted on repeat prescriptions (fixed-dose inhalers dispensed as the units of analysis) collected from 1st January 2015 to 31st December 2015 from the specialist clinic pharmacy. Descriptive analysis was conducted based on satisfactory MRA which was set as the dispensed refill of inhalers covering 80-120% of the prescribed treatment time. Logistic regression analysis was used to explore each variable (diagnosis, gender, ethnicity and age) in relation to MRA: overall satisfactory MRA (≥80% MRA) with undersupply (<80% MRA) as the reference group. Results:  Out of the repeat prescriptions analysed (n=199), the majorities were COPD (n=118; 64.3%), male (n=122; 61.4%), Malay (n=175; 88.0%), and aged 60-69 years old (n=56; 28.3%). 44.5% of repeat prescriptions (n=57) for COPD showed satisfactory MRA, compared to only 25.4% (n=18) in BA. Repeat prescriptions for fluticasone/salmeterol accuhalers showed the highest satisfactory MRA at 18.1% (n=36). Diagnosis, gender and ethnicity did not significantly influence the overall MRA while age marginally influenced the overall MRA. Conclusion: More than half of the repeat prescriptions for BA and COPD inhalers showed undersupply and oversupply: patients may not be compliant nor using the inhaler correctly.

References

1. Global strategy for asthma management and prevention. Updated 2017.: Global Initiative for Asthma (GINA); 2017 [24 May 2017]. Available from: http://ginasthma.org/
2. National Health and Morbidity Survey 2011 (NHMS 2011) Vol. II: Non-Communicable Diseases. Kuala Lumpur: Institute for Public Health (IPH); 2011.
3. Kessler RC, Ames M, Hymel PA, Loeppke R, McKenas DK, Richling DE, et al. Using the World Health Organization Health and Work Performance Questionnaire (HPQ) to evaluate the indirect workplace costs of illness. J Occup Environ Med. 2004;46(Suppl 6):S23-37.
4. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Arch Bronconeumol. 2017;53(3):128-49. https://doi.org/10.1016/j.arbres.2017.02.001
5. Islam SM, Purnat TD, Phuong NT, Mwingira U, Schacht K, Froschl G. Non-communicable diseases (NCDs) in developing countries: a symposium report. Global health. 2014;10:81. https://doi.org/10.1186/s12992-014-0081-9
6. Adherence to long-term therapies : evidence for action. Geneva: WHO; 2003.
7. Makela MJ, Backer V, Hedegaard M, Larsson K. Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD. Respir Med. 2013;107(10):1481-90. https://doi.org/10.1016/j.rmed.2013.04.005
8. Gazmararian JA, Kripalani S, Miller MJ, Echt KV, Ren J, Rask K. Factors associated with medication refill adherence in cardiovascular-related diseases: a focus on health literacy. J Gen Intern Med. 2006;21(12):1215-21. https://doi.org/10.1111/j.1525-1497.2006.00591.x
9. Krigsman K, Moen J, Nilsson JL, Ring L. Refill adherence by the elderly for asthma/chronic obstructive pulmonary disease drugs dispensed over a 10-year period. J Clin Pharm Ther. 2007;32(6):603-11. https://doi.org/10.1111/j.1365-2710.2007.00866.x
10. Zermansky AG, Petty DR, Raynor DK, Lowe CJ, Freemantle N, Vail A. Clinical medication review by a pharmacist of patients on repeat prescriptions in general practice: a randomised controlled trial. Health Technol Assess. 2002;6(20):1-86.
11. Restrepo RD, Alvarez MT, Wittnebel LD, Sorenson H, Wettstein R, Vines DL, et al. Medication adherence issues in patients treated for COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(3):371-84.
12. Jones C, Santanello NC, Boccuzzi SJ, Wogen J, Strub P, Nelsen LM. Adherence to prescribed treatment for asthma: evidence from pharmacy benefits data. J Asthma. 2003;40(1):93-101. https://doi.org/10.1081/JAS-120017212
13. Broder MS, Chang EY, Ory C, Kamath T, Sapra S. Adherence and persistence with omalizumab and fluticasone/salmeterol within a managed care population. Allergy Asthma Proc. 2009;30(2):148-57. https://doi.org/10.2500/aap.2009.30.3190
14. Maspero JF, Duenas-Meza E, Volovitz B, Pinacho Daza C, Kosa L, Vrijens F, et al. Oral montelukast versus inhaled beclomethasone in 6- to 11-year-old children with asthma: results of an open-label extension study evaluating long-term safety, satisfaction, and adherence with therapy. Curr Med Res Opin. 2001;17(2):96-104. https://doi.org/10.1111/j.1398-9995.2009.02226.x
15. Taburan penduduk dan ciri-ciri asas demografi(Population distribution and basic demographic characteristics). Kuala Lumpur: Department of Statistics Malaysia; 2011.
16. Guidelines for ATC classification and DDD assignment. 5th. ed. Oslo: WHO Collaborating Centre for Drug Statistics Methodology; 2002.
17. Elkout H, Helms PJ, Simpson CR, McLay JS. Adequate levels of adherence with controller medication is associated with increased use of rescue medication in asthmatic children. PloS One. 2012;7(6):e39130. https://doi.org/10.1371/journal.pone.0039130
18. Andersson K, Melander A, Svensson C, Lind O, Nilsson JL. Repeat prescriptions: refill adherence in relation to patient and prescriber characteristics, reimbursement level and type of medication. Eur J Public Health. 2005;15(6):621-6. https://doi.org/10.1093/eurpub/cki053
19. Krigsman K, Nilsson JL, Ring L. Refill adherence for patients with asthma and COPD: comparison of a pharmacy record database with manually collected repeat prescriptions. Pharmacoepidemiol Drug Saf. 2007;16(4):441-8. https://doi.org/10.1002/pds.1321
20. Krigsman K, Nilsson JL, Ring L. Adherence to multiple drug therapies: refill adherence to concomitant use of diabetes and asthma/COPD medication. Pharmacoepidemiol Drug Saf. 2007;16(10):1120-8. https://doi.org/10.1002/pds.1433
21. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-97. https://doi.org/10.1056/NEJMra050100
22. Prochaska JO, DiClemente CC. The transtheoretical approach: crossing traditional boundaries of therapy. Homewood, IL: Dow Jones-Irwin; 1984.
23. Jaafar S, Noh K, Muttalib K, Othman N, Healy J. Malaysia Health System Review (Health Systems in Transition, Vol. 3 No. 1 2012). New Delhi: World Health Organization, Regional Office for the Western Pacific. 2012.
24. Bender B, Wamboldt FS, O'Connor SL, Rand C, Szefler S, Milgrom H, et al. Measurement of children's asthma medication adherence by self report, mother report, canister weight, and Doser CT. Ann Allergy Asthma Immunol. 2000;85(5):416-21. https://doi.org/10.1016/S1081-1206(10)62557-4
25. McQuaid EL, Kopel SJ, Klein RB, Fritz GK. Medication adherence in pediatric asthma: reasoning, responsibility, and behavior. J Pediatr Psychol. 2003;28(5):323-33. https://doi.org/10.1093/jpepsy/jsg022
26. Cooper WO, Hickson GB. Corticosteroid prescription filling for children covered by Medicaid following an emergency department visit or a hospitalization for asthma. Arch Pediatr Adolesc Med. 2001;155(10):1111-5. http://doi.org/10.1001/archpedi.155.10.1111
27. Bae YJ, Kim TB, Jee YK, Park HW, Chang YS, Cho SH, et al. Severe asthma patients in Korea overestimate their adherence to inhaled corticosteroids. J Asthma. 2009;46(6):591-5. https://doi.org/10.1080/02770900902980908
28. Bender B, Zhang L. Negative affect, medication adherence, and asthma control in children. The J Allergy Clin Immunol. 2008;122(3):490-5. https://doi.org/10.1016/j.jaci.2008.05.041
29. Bender BG, Pedan A, Varasteh LT. Adherence and persistence with fluticasone propionate/salmeterol combination therapy. J Allergy Clin Immunol. 2006;118(4):899-904. https://doi.org/10.1016/j.jaci.2006.07.002
30. Souza-Machado A, Santos PM, Cruz AA. Adherence to treatment in severe asthma: predicting factors in a program for asthma control in Brazil. World Allergy Organ J. 2010;3(3):48-52. https://doi.org/10.1097/WOX.0b013e3181d25e8e
31. Dinwiddie R, Muller WG. Adolescent treatment compliance in asthma. J R Soc Med. 2002;95(2):68-71. https://doi.org/10.1016/j.jaip.2016.07.008
32. Jin J, Sklar GE, Min Sen Oh V, Chuen Li S. Factors affecting therapeutic compliance: A review from the patient's perspective. Ther Clin Risk Manag. 2008;4(1):269-86. https://doi.org/10.2147/TCRM.S1458
33. Sherina B-HC, Noor-Hasliza H, Mohd S. Determinants of medication adherence among adults with type 2 diabetes mellitus in three Malaysian public health clinics: a cross-sectional study. Patient Prefer Adherence. 2015;9:639-48. https://doi.org/10.2147/PPA.S81612
34. Paraidathathu AR, Nur Sufiza A, Thomas. Medication adherence among hypertensive patients of primary health clinics in Malaysia. Patient Prefer Adherence. 2012;6:613-22. https://doi.org/10.2147/PPA.S34704
Published
2019-08-31
How to Cite
1.
Ang WC, Mahdzan M, Mohmad R. Inhaler Refill Adherence among Patients with COPD/Asthma at a General Hospital in Northern Peninsular Malaysia. J Pharm Care. 7(1-2):2-8.
Section
Original Article(s)