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Assessing Adherence by Combining the Test of Adherence to Inhalers with Pharmacy Refill Records

Plaza V1, Giner J1, Curto E1, Alonso-Ortiz MB2, Orue MI3, Vega JM4, Cosío BG5 and the group of investigators of the RE-TAI study

1Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
2Hospital Universitario de Gran Canaria Doctor Negrín Las Palmas de Gran Canaria, Spain
3Centro de Salud Javier Sáenz de Buruaga, Bilbao
4Hospital Regional Universitario de Málaga, Spain
5Hospital Universitario Espases-IdISBa and CIBERES, Mallorca, Spain

J Investig Allergol Clin Immunol 2021; Vol. 31(1)
doi: 10.18176/jiaci.0461

Background: The Global Initiative for Asthma (GINA) recommends the concurrent use of self-report and pharmacy refill data to assess treatment adherence. However, clinical evidence to support this combined approach is limited.
Objective: To determine non-adherence to inhaler medication based on a validated questionnaire (Test of Adherence to Inhalers; TAI) and prescription refill data in a community sample of patients with chronic obstructive pulmonary disease (COPD) or asthma. Secondarily, we sought to determine the degree of concordance between these two measures.
Methods: Cross-sectional, observational multicentre study in patients with asthma or COPD. Sociodemographic and clinical data were obtained from clinical records. Refill data were retrieved from electronic pharmacy databases. Participants completed the 12-item TAI during a single visit as part of routine care. Non-adherence was defined as TAI < 50 or < 80% pharmacy refill rate (PRR) in the last six months.
Results: A total of 816 patients (mean age, 60) were included. Non-adherence rates were 58.1% (TAI) and 28.6% (PRR) versus 64.6% for the combined data (p<.0001). Concordance between the two measures was weak (Cohen's kappa=0.205).
Conclusions: These findings confirm the GINA recommendations, indicating that concomitant use of the TAI and pharmacy refill data identifies a higher percentage of non-adherent asthma or COPD patients than either instrument alone.

Key words: Asthma, Adherence to therapy, COPD, Self-reported success, Patient Compliance, Nebulizer

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