Lay Health Coaching to Increase Appropriate Inhaler Use in COPD: A Randomized Controlled Trial

Abstract

Purpose: Poor adherence to medications is more prevalent for chronic obstructive pulmonary disease (COPD) than for other chronic conditions and is associated with unfavorable health outcomes. Few interventions have successfully improved adherence for COPD medications; none of these use unlicensed health care personnel. We explored the efficacy of lay health coaches to improve inhaler adherence and technique.

Methods: Within a randomized controlled trial, we recruited English- and Spanish-speaking patients with moderate to severe COPD from urban, public primary care clinics serving a low-income, predominantly African American population. Participants were randomized to receive 9 months of health coaching or usual care. Outcome measures included self-reported adherence to inhaled controller medications in the past 7 days and observed technique for all inhalers. We used generalized linear models, controlling for baseline values and clustering by site.

Results: Baseline adherence and inhaler technique were uniformly poor and did not differ by study arm. At 9 months, health-coached patients reported a greater number of days of adherence compared with usual care patients (6.4 vs 5.5 days; adjusted P = .02) and were more likely to have used their controller inhalers as prescribed for 5 of the last 7 days (90% vs 69%; adjusted P = .008). They were more than 3 times as likely to demonstrate perfect technique for all inhaler devices (24% vs 7%; adjusted P = .01) and mastery of essential steps (40% vs 11%; adjusted P <.001).

Conclusions: Health coaching may provide a scalable model that can improve care for people living with COPD.

Trial registration: ClinicalTrials.gov NCT02234284.

Keywords: chronic illness; chronic obstructive pulmonary disease; health coaching; inhaler technique; inhalers; medication adherence; patient education; practice-based research; primary care; self-management; shared decision making.

© 2020 Annals of Family Medicine, Inc.

Figures

Figure 1

Consolidated standards of reporting trials diagram. COPD = chronic obstructive pulmonary disease. aReasons: 23 lost to follow-up; 1 no inhalers; 4 did not bring inhalers to demonstrate. bReasons: 13 lost to follow-up; 3 no inhalers; 1 did not answer question. cReasons: 8 lost to follow-up; 1 no inhalers; 3 did not bring inhalers to demonstrate. dReasons: 8 lost to follow-up; 1 no inhalers; 2 did not answer question.