학술논문
Monitoring Adherence to Asthma Inhalers Using the InspirerMundi App: Analysis of Real-World, Medium-Term Feasibility Studies
Document Type
Author
Jacome, Cristina; Almeida, Rute; Pereira, Ana Margarida; Amaral, Rita; Vieira-Marques, Pedro; Mendes, Sandra; Alves-Correia, Magna; Ferreira, Jose Alberto; Lopes, Ines; Gomes, Joana; Araujo, Luis; Couto, Mariana; Chaves Loureiro, Claudia; Santos, Lilia Maia; Arrobas, Ana; Valerio, Margarida; Todo Bom, Ana; Azevedo, Joao; Teixeira, Maria Fernanda; Ferreira-Magalhaes, Manuel; Pinto, Paula Leiria; Pinto, Nicole; Neves, Ana Castro; Morete, Ana; Bom, Filipa Todo; Costa, Alberto; Silva, Diana; Vasconcelos, Maria Joao; Falcao, Helena; Marques, Maria Luis; Mendes, Ana; Cardoso, Joao; Cidrais Rodrigues, Jose Carlos; Oliveira, Georgeta; Carvalho, Joana; Lozoya, Carlos; Santos, Natacha; Menezes, Fernando; Gomes, Ricardo; Camara, Rita; Alves, Rodrigo Rodrigues; Moreira, Ana Sofia; Abreu, Carmo; Silva, Rui; Bordalo, Diana; Alves, Carlos; Lopes, Cristina; Taborda-Barata, Luis; Fernandes, Ricardo M. M.; Ferreira, Rosario; Chaves-Loureiro, Carla; Calix, Maria Jose; Alves, Adelaide; Fonseca, Joao Almeida
Source
Frontiers in Medical Technology. 3
Subject
Language
English
ISSN
2673-3129
Abstract
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.