Autor(es):
Jácome, C ; Almeida, R ; Pereira, AM ; Amaral, R ; Vieira-Marques, P ; Mendes, S ; Alves-Correia, M ; Ferreira, JA ; Lopes, I ; Gomes, J ; Araújo, L ; Couto, M ; Chaves Loureiro, C ; Maia Santos, L ; Arrobas, A ; Valério, M ; Todo Bom, A ; Azevedo, J ; Teixeira, MF ; Ferreira-Magalhães, M ; Leiria Pinto, P ; Pinto, N ; Castro Neves, A ; Morête, A ; Todo Bom, F ; Costa, A ; Silva, D ; Vasconcelos, MJ ; Falcão, H ; Marques, ML ; Mendes, A ; Cardoso, J ; Cidrais Rodrigues, JC ; Oliveira, G ; Carvalho, J ; Lozoya, C ; Santos, N ; Menezes, F ; Gomes, R ; Câmara, R ; Rodrigues Alves, R ; Moreira, AS ; Abreu, C ; Silva, R ; Bordalo, D ; Alves, C ; Lopes, C ; Taborda-Barata, L ; Fernandes, RM ; Ferreira, R ; Chaves-Loureiro, C ; Cálix, MJ ; Alves, A ; Almeida Fonseca, J
Data: 2021
Identificador Persistente: http://hdl.handle.net/10400.17/4003
Origem: Repositório do Centro Hospitalar de Lisboa Central, EPE
Assunto(s): mHealth; Medication adherence; Patient participation; Self-management; Smartphone; Technology assessment; HDE ALER
Descrição
Background: Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor inhaler adherence while turning it into a positive experience through gamification and social support. Objective: We assessed the medium-term feasibility of the InspirerMundi app to monitor inhaler adherence in real-world patients with persistent asthma (treated with daily inhaled medication). In addition, we attempted to identify the characteristics of the patients related to higher app use. Methods: Two real-world multicenter observational studies, with one initial face-to-face visit and a 4-month telephone interview, were conducted in 29 secondary care centers from Portugal. During an initial face-to-face visit, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients took a photo of the medication (inhaler, blister, or others) using the image-based medication detection tool. Medication adherence was calculated as the number of doses taken as a percentage of the number scheduled. Interacting with the app ≥30 days was used as the cut-off for higher app use. Results: A total of 114 patients {median 20 [percentile 25 to percentile 75 (P25-P75) 16-36] years, 62% adults} were invited, 107 (94%) installed the app and 83 (73%) completed the 4-month interview. Patients interacted with the app for a median of 18 [3-45] days, translated on a median use rate of 15 [3-38]%. Median inhaler adherence assessed through the app was 34 [4-73]% when considering all scheduled inhalations for the study period. Inhaler adherence assessed was not significantly correlated with self-reported estimates. Median adherence for oral and other medication was 41 [6-83]% and 43 [3-73]%, respectively. Patients with higher app use were slightly older (p = 0.012), more frequently taking medication for other health conditions (p = 0.040), and more frequently prescribed long-acting muscarinic antagonists (LAMA, p = 0.024). After 4 months, Control of Allergic Rhinitis and Asthma Test (CARAT) scores improved (p < 0.001), but no differences between patients interacting with the app for 30 days or less were seen. Conclusions: The InspirerMundi app was feasible to monitor inhaler adherence in patients with persistent asthma. The persistent use of this mHealth technology varies widely. A better understanding of characteristics related to higher app use is still needed before effectiveness studies are undertaken.
