A Tablet-Based Multimedia Education Tool Improves Provider and Subject Knowledge of Inhaler Use Techniques.

BACKGROUND: Although inhaled medications are effective therapies for COPD, many patients and providers use them incorrectly. METHODS: We recruited providers who prescribe inhalers or teach inhaler technique and assessed their use of metered-dose inhalers (MDIs), various dry powder inhalers (DPIs), and Respimat using predefined checklists. Then they watched tablet-based multimedia educational videos that demonstrated correct inhaler technique by a clinical pharmacist with teach-back from a patient and were re-evaluated. We also recruited patients with COPD and assessed their use of their prescribed inhalers and then retested them after 3-6 months. Baseline and follow-up respiratory symptoms were measured by the COPD Assessment Test. RESULTS: Fifty-eight providers and 50 subjects participated. For all providers, correct inhaler technique (reported as percentage correct steps) increased after the videos: MDI without a spacer (72% vs 97%) MDI with a spacer (72% vs 96%), formoterol DPI (50% vs 94%), mometasone DPI (43% vs 95%), tiotropium DPI (73% vs 99%), and Respimat (32% vs 93%) (before vs after, P < .001 for all comparisons). Subjects also improved their inhaler use technique after viewing the educational videos: MDI without a spacer (69% vs 92%), MDI with a spacer (73% vs 95%), and tiotropium DPI (83% vs 96%) (before vs after, P < .001 for all comparisons). The beneficial effect of this educational intervention declined slightly for subjects but was durably improved after several months. COPD Assessment Test scores did not demonstrate any change in respiratory symptoms. CONCLUSIONS: A tablet-based inhaler education tool improved inhaler technique for both providers and subjects. Although this intervention did show durable efficacy for improving inhaler use by patients, it did not reduce their respiratory symptoms.

National estimates of enrollment in disease management programs in the United States: an analysis of the National Ambulatory Medical Care Survey data.

Disease management (DM) programs have demonstrated improvement in clinical and economic outcomes for patients with chronic conditions; however, the extent of utilization of these programs in the United States is not known. The rate of enrollment in DM programs was estimated using data from the National Ambulatory Medical Care Survey (NAMCS). Logistic regression analysis was used to identify predictors of enrollment in DM programs. The complex sampling design of the NAMCS was accounted in all analyses. The final study sample included 14,405 patient visits and indicated that only 21.3% of patients with at least 1 chronic condition utilize DM programs. Regression analysis demonstrated that patients who visit specialty physicians (excluding internal medicine) are more likely to be enrolled in a DM program than patients who visit general medicine/family practice physicians (P < 0.01). Patients with depression, diabetes, hyperlipidemia, or obesity were significantly more likely to be enrolled in a DM program than patients without these chronic conditions. Enrollment in a DM program was also affected by the total number of chronic conditions--patients with 2-4 chronic conditions were 1.29 times more likely to be enrolled in a DM program than patients with a single chronic condition (P = 0.026). In conclusion, although benefits of DM programs have been documented, their adoption rate remains extremely low. Additional studies are needed to identify other predictors and to tailor interventions to increase the adoption of such programs.