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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 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, Spain
4Hospital Regional Universitario de Málaga, Malaga, Spain
5Hospital Universitario Espases-IdISBa and CIBERES, Mallorca, Spain

J Investig Allergol Clin Immunol 2021; Vol 31(1) : 58-64
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 nonadherence 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 multicenter 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. Nonadherence was defined as TAI <50 or <80% pharmacy refill rate (PRR) in the previous 6 months.
Results: A total of 816 patients (mean age, 60) were included. Nonadherence rates were 58.1% (TAI) and 28.6% (PRR) compared with 64.6% for the combined data (P<.0001). Concordance between the 2 measures was weak (к=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 nonadherent asthma or COPD patients than either instrument alone.

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