Open Access
Perspectives

Improving adherence to treatment in COPD. A personalised approach

Open Access
Perspectives

Improving adherence to treatment in COPD. A personalised approach

Johnson George, Job F.M. van Boven
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© dean mitchell/ istockphoto.com models used for illustrative purposes only
© dean mitchell/ istockphoto.com models used for illustrative purposes only

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Dr George is Senior Lecturer in the Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety at Monash University, Melbourne, Vic. Dr van Boven is Assistant Professor of Health Economics and Drug Outcomes Research, Department of Clinical Pharmacy and Pharmacology at the University of Groningen; and Principal Investigator at the Groningen Research Institute for Asthma and COPD at the University Medical Center Groningen, the Netherlands.

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Abstract

Nonadherence is a multidimensional quandary in patients with chronic obstructive pulmonary disease and encompasses a range of physical, economic, psychological and social factors. When assessing for nonadherence, engaging with patients to understand these factors is essential to formulating tailored,  long-term strategies and interventions.

Key Points

  • Nonadherence to chronic obstructive pulmonary disease (COPD) medications is common and is associated with poor clinical outcomes.
  • Nonadherence can result from patient, treatment, health professional or health system factors.
  • It can be classified into intentional and unintentional nonadherence.
  • Each form of nonadherence requires a personalised solution.
  • Structured questionnaires, smart inhalers and patient-centred communication are useful in promoting adherence.

Nonadherence continues to be a major source of frustration for health professionals as it not only contributes to morbidity and mortality, but also results in economic costs and waste of resources. The WHO has recognised the importance of enhancing adherence as a strategy to tackle chronic conditions effectively.1 This article focuses on how GPs can engage with patients to help improve adherence to treatment in chronic obstructive pulmonary disease (COPD). 

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Adherence 

Adherence is defined as ‘the extent to which a person’s behaviour (in terms of taking medications, following diets or executing lifestyle changes) coincides with medical or health advice’ and is a key determinant of health outcomes.1 Definitions for adherence often refer to the amount of medicine taken or treatment received over a given period, or the extent to which medication use correlates to factors such as recommended timing, intended duration and recommended method of use. Adherence to medically prescribed treatment and/or preventive measures ranges from 4.6 to 100% (average, 75.2%) and is dependent on:2

  • method of assessment 
  • focus characteristic chosen for assessment (e.g. use of regular oral medications, inhaler technique) 
  • operational definitions (e.g. defining 80 to 120% utilisation of regular medications as good adherence) 
  • patient population 
  • time points of assessments
  • practice setting 
  • assessor background.