Patient Education Boosts COPD Management Adherence

Omar Ammous, MD

Credit: University Medical Center Göttingen

A systematic review assessing adherence-enhancing interventions for chronic obstructive pulmonary disease (COPD) management found that education improves both adherence and quality of life. Other interventions, like motivation, showed less consistent benefits. Patient interviews suggested that strategies fostering self-efficacy and personalized goals are most effective for improving adherence.

“It is crucial that COPD patients adhere to their medications and take them correctly,” wrote lead investigator Omar Ammous, MD, research associate at the Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany. “Adherence to COPD medications reduces the risk of hospital admissions and thus reduces mortality and costs. Conversely, non-adherent patients are more vulnerable to exacerbations and treatment failure.”

The management of the condition is complex and usually involves the use of corticosteroids, antibiotics and bronchodilators. This complicated treatment regimen, coupled with adverse events, mental health comorbidities and poor inhaler technique, can often lead to a lack of medication adherence among patients.

To determine the effectiveness of adherence-enhancing interventions—both alone and compared with other interventions—among this patient population, investigators conducted a component network meta-analysis. The review was developed with the help of patients with COPD through focus group interviews performed both before and after the systematic review. In the first interview, patients were asked to discuss their needs and prioritize the selection of outcomes. In the second interview, results of the analysis were presented to patients.

The primary outcomes were adherence, COPD exacerbations, functional exercise capacity and health-related quality of life (HRQoL). Other outcomes included mortality, self-efficacy, COPD knowledge, inhaler technique, hospital admission and adverse events.

The search initially identified 33 studies with 5775 participants, of which 13 studies were ultimately included in the analysis. A common theme among findings was a tendency for education and motivation to improve adherence. These also included combinations, such as education+motivation, education+reminder+pulmonary rehabilitation, and education+motivation+telemedicine. The favorable effect was not seen, however, in education+psychosocial support and education+motivation+pulmonary rehabilitation. The certainty of evidence was very low in all the components.

In the six studies that examined quality of life, the benefit of patient education and motivation was again highlighted. No other factors, such as telemedicine, made a significant impact on adherence.

According to the analysis, combining different and/or adding additional components did not further increase adherence.

Patients in the focus groups said factors that may enhance adherence were reliable communication with their providers, inhalation technique training, physical training and being well informed about their condition. They favored interventions that were designed to improve self-efficacy. Conversely, a lack of information, poor communication with their care team, fears about the consequences of their disease and bureaucracy were considered inhibiting factors.

Investigators noted limitations including the small number of studies evaluating multiple components. This may have, in turn, created an overestimation of the effect of single-component interventions, such as education and motivation alone. Further, the inclusion of interventions that did not necessarily focus on adherence may have underestimated the effect of some components.

“Future research should compare different intervention components directly,” investigators concluded. “It may also be valuable to compare single components with multi-component interventions to identify more effective components and assess the additive or synergic effect. The studies should include non-adherent patients or those at risk for non-adherence to avoid ceiling effects. Finally, adherence measurement should be standardized.”