Validation of the 'Test of the Adherence to Inhalers' (TAI) for Asthma and COPD Patients

Vicente Plaza, Concepción Fernández-Rodríguez, Carlos Melero, Borja G Cosío, Luís Manuel Entrenas, Luis Pérez de Llano, Fernando Gutiérrez-Pereyra, Eduard Tarragona, Rosa Palomino, Antolín López-Viña, TAI Study Group, R Agüero Balbín, B Alcázar Navarrete, I Ali García, C Almonacid Sánchez, I Alvaredo Martín, F Álvarez Navascues, D Álvaro Álvarez, R Andujar Espinosa, P Ansola Zubiaurre, M Antolín García, A Arnedillo Muñoz, S Arranz Alonso, M Avilés Ingles, M Badimon Garrido, M Barcena Caamaño, P Barranco Sanz, T Bazús, J Bioque Rivera, E Bollo De Miguel, D Bouza Álvarez, F Bravo Gutiérrez, E Burches Baixauli, V Bustamante Madariaga, C Cabrera López, M Calle Rubio, E Calvo Corbella, A Capelastegu iSaiz, F Carballada Gonzalez, J Carretero Gracia, T Caruana Careaga, F Casas Maldonado, L Cassini Gómez De Cádiz, J Castillo Vizuete, P Cebollero Rivas, E Centeno Etxebarrieta, E Chiner Vives, J Cimas Hernando, C Cisneros Serrano, C Colás Sanz, M Compán Bueno, A Conde Valero, F Contreras Porta, M Corbacho Abelaira, P Cordero Montero, J Costan Galicia, A De Diego Damiá, E De Higes Martínez, J Delgado Romero, C Diego Roza, F DiezF ernández, A Domenech Del Rio, M Domínguez Álvarez, L Domínguez Juncal, J Domínguez Ortega, L Entrenas, M Espinosa De Los MonterosGarde, C Estirado Vera, M Fernández González, E Fernández Robledo, A Fernández Tena, A Fernández Villar, J Figueira Goncalves, X Flor Escriche, J Florido López, C Fluixá Carrascosa, Benimaclet Valencia, J Galdiz Iturri, J Garcia De Pedro, M García Marrón, J GarciaR ivero, B García-Cosío, L García-Giralda Ruíz, A Gil Adrados, J Gil Carbonell, B Gil Marín, M Gimeno Peribáñez, L Ginel Mendoza, J Giner Donaire, R Godoy Mayoral, M Gómez Entrena, E Gómez Torrijos, F González Barcala, M González Gutiérrez, A González López, F González Vargas, J Guallar Ballester, V Gutiérrez Vall De Cabres, M Hernández Fernández De Rojas, S Hernández Flix, J Hueto Pérez De Heredia, J Igea Aznar, M Iglesias Heras, J Ignacio Garcia, P Iriarte Sotés, R Lama Martínez, J Laparra Galíndez, L Lázaro Asegurado, A Levy Naón, M Linares Asensio, E Llorca Martínez, E López De Santa Maria Miro, A López Viña, A Maduenño Car, D Malia Alvarado, A Marin Tapia, N Marina Malanda, C Martín Serrano, J Martín Villasclaras, J Martínez Carbonell, C Martínez González, E Martínez Moragón, C Martínez Rivera, J Martos Velasco, J Mata Poyo, S Mayoralas Alises, J Medina Gallardo, C Melero, P Mengibar Vallejo, S Merlos Navarro, A Miranda Páez, J Molina Paris, F Morante Vélez, A Moreno Ancillo, M Mosteiro Añón, J Olaguíbel Rivera, F Ortega Ruiz, J Ortiz De Saracho Bobo, O Pascual Gil, J Pascual Lledó, A Pedro Pijoan, M Peiró Fábregas, C Pellicer Císcar, I Pérez Camo, G Pérez Chica, L Pérez De Llano, A Pérez Rodríguez, R Piedra Castro, V Plaza Moral, L Puente Maestu, A Pueyo Bastida, J Querol Borrás, J Quintano Jiménez, N Quiñones Higuero, S Quirce Gancedo, M Ramón Capilla, D Ramos Barbón, J Ramos González, J Riesco Miranda, M Rivera Ortún, J Rodríguez González, J Rodríguez Hermosa, L Rodriguez Pascual, M Rodríguez Porres, V Roig Figueroa, J Rojas Box, M Román Rodríguez, M Romero Falcón, D Romero Ribate, J Royo Prats, P Rubinstein Aguñín, J Ruiz Hornillos, A Ruz García, Broggi Moises, G Sáez Roca, A Sala Cunill, D Sánchez Berenguer, J Sánchez Nieto, N Sánchez Ruano, F Sanchez-Toril López, E Sanjuán Sanchís, J Sans Torres, P Sanz Sanz, A Sebastian Ariño, J Serra Batlles, J Serrano Pariente, A Sogo Sagardía, M SojoG onzález, J Soto Campos, J Soto Jiménez, A SotoV enegas, J Tárrega Camarasa, M Torrejón Lázaro, J Trigueros Carrero, I Urrutia Landa, A Valero Santiago, A Valido Morales, P Vaquero Lozano, Z Vasquez Gambasica, J Vega Chicote, J Velasco Garrido, A Viejo Casas, M Villanueva Montes, C Villasante Fernández-Montes, G Villegas Sánchez, M Zuil Martín, Vicente Plaza, Concepción Fernández-Rodríguez, Carlos Melero, Borja G Cosío, Luís Manuel Entrenas, Luis Pérez de Llano, Fernando Gutiérrez-Pereyra, Eduard Tarragona, Rosa Palomino, Antolín López-Viña, TAI Study Group, R Agüero Balbín, B Alcázar Navarrete, I Ali García, C Almonacid Sánchez, I Alvaredo Martín, F Álvarez Navascues, D Álvaro Álvarez, R Andujar Espinosa, P Ansola Zubiaurre, M Antolín García, A Arnedillo Muñoz, S Arranz Alonso, M Avilés Ingles, M Badimon Garrido, M Barcena Caamaño, P Barranco Sanz, T Bazús, J Bioque Rivera, E Bollo De Miguel, D Bouza Álvarez, F Bravo Gutiérrez, E Burches Baixauli, V Bustamante Madariaga, C Cabrera López, M Calle Rubio, E Calvo Corbella, A Capelastegu iSaiz, F Carballada Gonzalez, J Carretero Gracia, T Caruana Careaga, F Casas Maldonado, L Cassini Gómez De Cádiz, J Castillo Vizuete, P Cebollero Rivas, E Centeno Etxebarrieta, E Chiner Vives, J Cimas Hernando, C Cisneros Serrano, C Colás Sanz, M Compán Bueno, A Conde Valero, F Contreras Porta, M Corbacho Abelaira, P Cordero Montero, J Costan Galicia, A De Diego Damiá, E De Higes Martínez, J Delgado Romero, C Diego Roza, F DiezF ernández, A Domenech Del Rio, M Domínguez Álvarez, L Domínguez Juncal, J Domínguez Ortega, L Entrenas, M Espinosa De Los MonterosGarde, C Estirado Vera, M Fernández González, E Fernández Robledo, A Fernández Tena, A Fernández Villar, J Figueira Goncalves, X Flor Escriche, J Florido López, C Fluixá Carrascosa, Benimaclet Valencia, J Galdiz Iturri, J Garcia De Pedro, M García Marrón, J GarciaR ivero, B García-Cosío, L García-Giralda Ruíz, A Gil Adrados, J Gil Carbonell, B Gil Marín, M Gimeno Peribáñez, L Ginel Mendoza, J Giner Donaire, R Godoy Mayoral, M Gómez Entrena, E Gómez Torrijos, F González Barcala, M González Gutiérrez, A González López, F González Vargas, J Guallar Ballester, V Gutiérrez Vall De Cabres, M Hernández Fernández De Rojas, S Hernández Flix, J Hueto Pérez De Heredia, J Igea Aznar, M Iglesias Heras, J Ignacio Garcia, P Iriarte Sotés, R Lama Martínez, J Laparra Galíndez, L Lázaro Asegurado, A Levy Naón, M Linares Asensio, E Llorca Martínez, E López De Santa Maria Miro, A López Viña, A Maduenño Car, D Malia Alvarado, A Marin Tapia, N Marina Malanda, C Martín Serrano, J Martín Villasclaras, J Martínez Carbonell, C Martínez González, E Martínez Moragón, C Martínez Rivera, J Martos Velasco, J Mata Poyo, S Mayoralas Alises, J Medina Gallardo, C Melero, P Mengibar Vallejo, S Merlos Navarro, A Miranda Páez, J Molina Paris, F Morante Vélez, A Moreno Ancillo, M Mosteiro Añón, J Olaguíbel Rivera, F Ortega Ruiz, J Ortiz De Saracho Bobo, O Pascual Gil, J Pascual Lledó, A Pedro Pijoan, M Peiró Fábregas, C Pellicer Císcar, I Pérez Camo, G Pérez Chica, L Pérez De Llano, A Pérez Rodríguez, R Piedra Castro, V Plaza Moral, L Puente Maestu, A Pueyo Bastida, J Querol Borrás, J Quintano Jiménez, N Quiñones Higuero, S Quirce Gancedo, M Ramón Capilla, D Ramos Barbón, J Ramos González, J Riesco Miranda, M Rivera Ortún, J Rodríguez González, J Rodríguez Hermosa, L Rodriguez Pascual, M Rodríguez Porres, V Roig Figueroa, J Rojas Box, M Román Rodríguez, M Romero Falcón, D Romero Ribate, J Royo Prats, P Rubinstein Aguñín, J Ruiz Hornillos, A Ruz García, Broggi Moises, G Sáez Roca, A Sala Cunill, D Sánchez Berenguer, J Sánchez Nieto, N Sánchez Ruano, F Sanchez-Toril López, E Sanjuán Sanchís, J Sans Torres, P Sanz Sanz, A Sebastian Ariño, J Serra Batlles, J Serrano Pariente, A Sogo Sagardía, M SojoG onzález, J Soto Campos, J Soto Jiménez, A SotoV enegas, J Tárrega Camarasa, M Torrejón Lázaro, J Trigueros Carrero, I Urrutia Landa, A Valero Santiago, A Valido Morales, P Vaquero Lozano, Z Vasquez Gambasica, J Vega Chicote, J Velasco Garrido, A Viejo Casas, M Villanueva Montes, C Villasante Fernández-Montes, G Villegas Sánchez, M Zuil Martín

Abstract

Background: To validate the 'Test of Adherence to Inhalers' (TAI), a 12-item questionnaire designed to assess the adherence to inhalers in patients with COPD or asthma.

Methods: A total of 1009 patients with asthma or COPD participated in a cross-sectional multicenter study. Patients with electronic adherence ≥80% were defined as adherents. Construct validity, internal validity, and criterion validity were evaluated. Self-reported adherence was compared with the Morisky-Green questionnaire.

Results: Factor analysis study demonstrated two factors, factor 1 was coincident with TAI patient domain (items 1 to 10) and factor 2 with TAI health-care professional domain (items 11 and 12). The Cronbach's alpha was 0.860 and the test-retest reliability 0.883. TAI scores correlated with electronic adherence (ρ=0.293, p=0.01). According to the best cut-off for 10 items (score 50, area under the ROC curve 0.7), 569 (62.5%) patients were classified as non-adherents. The non-adherence behavior pattern was: erratic 527 (57.9%), deliberate 375 (41.2%), and unwitting 242 (26.6%) patients. As compared to Morisky-Green test, TAI showed better psychometric properties.

Conclusions: The TAI is a reliable and homogeneous questionnaire to identify easily non-adherence and to classify from a clinical perspective the barriers related to the use of inhalers in asthma and COPD.

Keywords: anti-asthmatic agents, administration and dosage; inhalers; medication adherence; medication non-adherence; pulmonary disease, chronic obstructive, drug therapy; questionnaires; validation studies.

Figures

FIG. 1.
FIG. 1.
Flow-chart of the study design and procedures.
FIG. 2.
FIG. 2.
ROC curves for the classification of adherent (AUC=0.7) and non-adherent (AUC=0.6) patients using a cut-off of the 10-items TAI questionnaire of 50 and ≤45, respectively.
FIG. 3.
FIG. 3.
Overall adherent and non-adherent percentages of patients and adherence levels in the self-reported (n=901) and electronic (n=99) adherence groups with the 10-items TAI.

References

    1. Bozek A, and Jarzab J: Adherence to asthma therapy in elderly patients. J Asthma. 2010;47:162–165
    1. Cecere LM, Slatore CG, Uman JE, Evans LE, Udris EM, Bryson CL, and Au DH: Adherence to long-acting inhaled therapies among patients with chronic obstructive pulmonary disease (COPD). COPD. 2012;9:251–258
    1. Boulet LP, Vervloet D, Magar Y, and Foster JM: Adherence: The goal to control asthma. Clin Chest Med. 2012;33:405–417
    1. Vestbo J, Anderson JA, Calverley PM, Celli B, Ferguson GT, Jenkins C, Knobil K, Willits LR, Yates JC, and Jones PW: Adherence to inhaled therapy, mortality and hospital admission in COPD. Thorax. 2009;64:939–943
    1. Klok T, Kaptein AA, Duiverman EJ, and Brand PL: It's the adherence, stupid (that determines asthma control in preschool children)! Eur Respir J. 2014;43:783–791
    1. Melani AS, Bonavia M, Cilenti V, Cinti C, Lodi M, Martucci P, Serra M, Scichilone N, Sestini P, Aliani M, and Neri M; Gruppo Educazionale Associazione Italiana Pneumologi Ospedalieri: Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011;105:930–938
    1. Rau JL: Determinants of patient adherence to aerosol regimen. Respir Care. 2005;50:1346–1356
    1. Morisky DE, Green LW, and Levine DM: Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986; 24: 67–74
    1. Val Jiménez A, Amorós Ballestero G, Martínez Visa P, Fernández Ferré ML, and León Sanromà M: Descriptive study of patient compliance in pharmacologic antihypertensive treatment and validation of the Morisky and Green test. Aten Primaria. 1992;10:767–770
    1. Cohen JL, Mann DM, Wisnivesky JP, Home R, Leventhal H, Musumeci-Szabó TJ, and Halm EA: Assessing the validity of self-reported medication adherence among inner-city asthmatic adults: The Medication Adherence Report Scale for Asthma. Ann Allergy Asthma Immunol. 2009;103:325–331
    1. Singh M, and Kansra S: Adherence issues in asthma. Indian Pediatr. 2006;43:1050–1055
    1. Rand CS: Adherence to asthma therapy in the preschool child. Allergy. 2002;57:48–57
    1. Rand CS, and Wise RA: Measuring adherence to asthma medication regimens. Am J Respir Crit Care Med 1994;149:S69–S78
    1. Dalkey NC: The Delphi Method: An Experimental Study of Group Opinion. Santa Monica, CA: Rand Corporation, 1969
    1. Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2014: Available from: Last access: October/3/14
    1. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2014. Available from: Last access: October/3/14
    1. Burgess SW, Wilson SS, Cooper DM, Sly PD, and Devadason SG: In vitro evaluation of an asthma dosing device: The smart-inhaler. Respir Med. 2006;100:841–845
    1. Nathan RA, Sorkness CA, Kosinski M, Schatz M, Li JT, Marcus P, Murray JJ, and Pendergraft TB: Development of the asthma control test: A survey for assessing asthma control. J Allergy Clin Immunol. 2004;113:59–65
    1. Vega JM, Badia X, Badiola C, López-Viña A, Olaguíbel JM, Picado C, Sastre J, and Dal-Ré R: Validation of the Spanish version of the Asthma Control Test (ACT). J Asthma. 2007;44:867–872
    1. Jones PW, Brusselle G, Dal Negro RW, Ferrer M, Kardos P, Levy ML, Perez T, Soler Cataluña JJ, van der Molen T, Adamek L, and Banik N: Properties of the COPD assessment test in a cross-sectional European study. Eur Respir J. 2011;38:29–35
    1. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, and Wanger J: Standardisation of spirometry. Eur Respir J. 2005;26:319–338
    1. Roca J, Sanchis J, Agusti-Vidal A, Segarra F, Navajas D, Rodriguez-Roisin R, Casan P, and Sans S: Spirometric reference values from a Mediterranean population. Bull Eur Physiopathol Respir. 1986;22:217–224
    1. Rand CS, Wise RA, Nides M, Simmons MS, Bleecker ER, Kusek JW, Li VC, and Tashkin DP: Metered-dose inhaler adherence in a clinical trial. Am Rev Respir Dis. 1992;146:1559–1564
    1. Kaiser HF: A second-generation Little Jiffy. Psychometrika. 1970;35:401–415
    1. Kaiser HF, and Rice J: Little Jiffy Mark IV. Educ Psychol Meas. 1974;34:111–117
    1. Bartlett M: Tests of significance in factor analysis. Br J Psychol. 1950;3:77–85
    1. Cronbach LJ: Coefficient alpha and the internal structure test. Psychometrika. 1951;16:297
    1. Prieto L, Lamarca R, and Casado A: Assessment of the reliability of clinical findings: The intraclass correlation coefficient. [Article in Spanish]. Med Clin (Barc). 1998;110:142–145
    1. Brooks CM, Richards JM, Kohler CL, Soong SJ, Martin B, Windsor RA, and Bailey WC: Assessing adherence to asthma medication and inhaler regimens: A psychometric analysis of adult self-report scales. Med Care. 1994;32:298–307
    1. Erickson SR, Coombs JH, Kirking DM, and Azimi AR: Compliance from self-reported versus pharmacy claims data with metered-dose inhalers. Ann Pharmacother. 2001;35-997–1003
    1. Hahn SR, Park J, Skinner EP, Yu-Isenberg KS, Weaver MB, Crawford B, and Flowers PW: Development of the ASK-20 adherence barrier survey. Curr Med Res Opin. 2008;24:2127–2138
    1. McHorney CA, Victor Spain C, Alexander CM, and Simmons J: Validity of the adherence estimator in the prediction of 9-month persistence with medications prescribed for chronic diseases: A prospective analysis of data from pharmacy claims. Clin Ther. 2009;31:2584–2607
    1. Nikander K, Pearce LJ, Smith NJ, and Pritchard JN: The impact of electronic monitors on patients' adherence to inhaled medications. In: Dalby RN, Byron PR, Peart J, Suman JD, Farr SJ, and Young PM, editors. Respiratory Drug Delivery 2012. River Grove IL: Davis Healthcare International Publishing, pp. 673–678. Available at: Last access: October/3/14
    1. Baddar S, Jayakrishnan B, and Al-Rawas OA: Asthma control: Importance of compliance and inhaler technique assessments. J Asthma. 2014;51:429–434
    1. Lavorini F, Magnan A, Dubus JC, Voshaar T, Corbetta L, Broeders M, Dekhuijzen R, Sanchis J, Viejo JL, Barnes P, Corrigan C, Levy M, and Crompton GK: Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008;102:593–604
    1. Williams LK, Pladevall M, Xi H, Peterson EL, Joseph C, Lafata JE, Ownby DR, and Johnson CC: Relationship between adherence to inhaled corticosteroids and poor outcomes among adults with asthma. J Allergy Clin Immunol. 2004;114:1288–1293
    1. Cramer JA: A systematic review of adherence with medications for diabetes. Diabetes Care. 2004;27:1218–1224
    1. Kleppe M, Lacroix J, Ham J, and Midden C: The development of the ProMAS: A Probabilistic Medication Adherence Scale. Patient Prefer Adherence. 2015;9:355–367

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever