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Personalizing inhaled medication adherence management with the practical TAI-Toolkit

Published: June 6, 2021

Nonadherence to inhaled asthma/Chronic Obstructive Pulmonary Disease (COPD) medication remains a complex problem without a one-size-fits-all solution, posing challenges to many healthcare professionals. Given the many and diverse underlying causes, a personalized approach is required. To manage nonadherence, the first step is to recognize and classify it. The Test of Adherence to Inhalers (TAI) is an existing validated questionnaire that can identify reasons for nonadherence. However, once completed, no advice is provided regarding which specific intervention a healthcare provider could actually apply to enhance medication adherence. Therefore, novel practical tools are needed.

In the latest issue of The Journal of Allergy and Clinical Immunology: In Practice, Van de Hei et al. set out to develop a practical adherence management tool. First, they performed a literature review in PubMed and Embase identifying interventions that enhanced medication adherence in adults with asthma and/or COPD. Randomized controlled trials published in English with full texts available were included. Effective interventions were assessed for risk of bias and the level of evidence was determined (high, medium or low). Subsequently, interventions identified in the review were integrated into a toolkit that provides recommendations for each nonadherence reason as identified by the TAI: the TAI-Toolkit. Finally, the TAI-Toolkit prototype was assessed for content and usability using the System Usability Scale by a multidisciplinary group of health care professionals.

In total, 40 articles reported on interventions that improved medication adherence in adults with asthma and/or COPD. The interventions were classified into seven groups: (1) reminders, (2) educational interventions, (3) multiple component intervention (e.g. pharmacy care and self-management), (4) motivational strategies, (5) shared decision-making, (6) simplifying the medication regimen, and (7) feedback on medication use. All effective adherence-enhancing strategies were integrated into the TAI-Toolkit. This evidence-based decision support tool provides guidance for healthcare professionals on how to effectively act upon individual causes for nonadherence. It consists of a (digital or paper-based) wheel that is accompanied by a user guide with further elaboration on the practical implementation aspects of each intervention. The TAI-Toolkit is designed to be a dynamic tool that can be periodically updated when novel evidence emerges. The first prototype of the TAI-Toolkit was assessed by a panel of 8 healthcare professionals on usability. The median System Usability Scale score was 71.4 (range, 57.5-80.0) which is well above average.

Despite the advice to assess medication adherence in consultations in international asthma and COPD guidelines, healthcare professionals generally have little time to identify nonadherence, discover the reasons for it, and provide the right intervention all in one consultation. The TAI-Toolkit can help healthcare professionals to personalize adherence management by efficiently selecting the right intervention for the right patient. Furthermore, it could create more awareness about the topic of nonadherence and it could potentially be time saving. Yet, optimal implementation of the TAI-Toolkit in daily practice, including its usability, feasibility and validity, needs to be assessed in future studies.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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