A telepharmacy intervention to improve inhaler adherence in veterans with chronic obstructive pulmonary disease

Patients’ adherence to medications for chronic obstructive pulmonary disease (COPD) is low, and many patients do not use their inhaler properly.1,2 Interventions to improve inhaler use in patients with COPD have yielded conflicting results and are difficult to compare as they use various methods.3,–5 In addition, these interventions usually require patients to physically travel to a clinic, which can be a barrier to treatment. The Veterans Health Administration (VHA) has a strong history of using ambulatory care pharmacists as medication management specialists in clinics for many diseases.6 To improve veterans’ access to care, many of these clinics are starting to incorporate telemanagement services.7 The objective of this study was to examine the feasibility of a telepharmacy counseling intervention to improve veterans’ use of inhaled medications for COPD. Specifically, we assessed patient recruitment and retention and participants’ opinions and attitudes about the intervention. This six-month, prospective, randomized, single-blind intervention study was designed similarly to a telepharmacy intervention feasibility study in patients with asthma.8 This study was approved by the UW Health Sciences institutional review board and VHA research and development committees. All veterans age 60 years or older whose inhaler refill history revealed that fewer than 80% of expected refills were actually refilled over the previous six months were invited to participate. Exclusions included a diagnosis of cognitive disorder or significant hearing impairment. A baseline survey was conducted to assess participants’ demographic characteristics. After the baseline survey, participants were randomized using computer-generated random numbers.