부산대학교 도서관

Introduction: Inhaler therapy is a cornerstone of treatment for patients with chronic obstructive pulmonary disease (COPD), and symptomatic patients always need long-term inhaler usage. However, poor therapeutic adherence and poor inhaler usage techniques are challenges to treatment efficacy. The participation of a clinician and a pharmacist in COPD management has been discussed in recent years. Some previous studies have provided evidence that such models could have positive effects on medication adherence and correct inhaler usage. Methods: This was a single-center study conducted in southern Taiwan. The COPD care service was provided by a multidisciplinary team, including a clinician, a pharmacist and a case manager as the core members. Patients with COPD (group B, C or D) were enrolled into the intervention group (clinician and pharmacist care service model) or the control group (standard care). We evaluated the patients' inhaler use technique and medication adherence by assessing the percentage of inhalation steps performed correctly and using the Morisky Medication Adherence Scale (MMAS-8), respectively, at both baseline and 12 months after study enrollment. Results: A total of 692 patients with stable COPD were recruited for our study; 118 patients (17%) were enrolled into the intervention group and 574 patients (83%) into the standard care group. The intervention group showed significant improvement in their inhaler technique total score compared with the standard care group (92.7±10.4 vs 88.5±13.4, P＜0.01). Medication adherence was also improved in the intervention group (percentage of high adherence patients increased from 22 (18.6%) to 26 (22%)). However, there was no significant improvement in the rate of correct inhaler usage after a 12-month interval in both groups. Conclusion: The multidisciplinary team-care model, with clinician and pharmacist participation, may result in improvement in inhaler usage and medication adherence in patients with COPD. In the intervention group, there was similar correct inhaler usage with all of the different devices.