Dijk, L. van (Lise) (2017) Patients in control , the future key in choosing an elegible inhaler device ? : The feasability of shared decision making in the choice of of the inhaler device. thesis, Medicine.
Full text available on request.Abstract
Background Asthma and COPD are well recognized healthcare problems which severely affect patients’ quality of life and society costs. Inhaled therapy delivered by inhaler devices, is the cornerstone of obstructive lung disease management. However, successful inhaled therapy is hardly achieved in daily practise due to frequent incorrect inhaler use, inadequate inhaler adherence and insufficient self-management among asthma and COPD patients. Choosing the most suitable inhaler device is essential in order to master a correct inhaler use and optimize the inhaler adherence. Presently, this inhaler choosing process is challenging due to extensive inhaler options. A more patient-centred approach with involving patient’s inhaler preferences by shared decision making (SDM) could be supportive. However, strong evidence is lacking and SDM in the choice of the inhaler device is still an unclear era to date. Aim The aim of this thesis was to investigate the feasibility of SDM in the choice of the inhaler device in asthma and COPD patients. Method A three-divided study design was conducted. First, inhaler satisfaction and inhaler preferences were investigated by an online, self-developed quantitative questionnaire among Dutch asthma and COPD patients. Second, data from the questionnaire was used to develop an online walk-through system for patients and pharmacists wherein suitable inhaler device options are discussed over objective videos. This system was used in this study to evaluate SDM in a randomized controlled trial (RCT) in twenty pharmacies in the Netherlands. I created this online walk-through system and provided all needed conditions to start the RCT. Last, the implemental potentials of SDM in every day practice was investigated by exploring pharmacists’ opinion regarding SDM with qualitative, semi-structured interviews. Results Quantitative questionnaire: a total of 452 participants completed the survey. On average, participants were satisfied with their inhaler device. However, lower satisfaction was found in the use of the dry-powder single dose inhaler, in female participants and in participants whom experienced less efficiency of their inhaler device, were less confidence in their inhaler use, used their inhaler device <12 months or experienced hand comorbidity of any kind. Furthermore, according to our participants the perfect inhaler device would be easy and quick to use, contains a dose counter and has a feedback mechanism. Development of the experimental intervention: it was possible to create an easy to use, online walk-through system that can facilitate SDM in the pharmacy. Unfortunately, it appeared to be difficult to include enough pharmacies to participate in our study. Quantitative interviews: a total of 6 Dutch pharmacists and pharmacy assistants were interviewed. Results of these interviews demonstrated that despite a supportive attitude regarding SDM in the choice of the inhaler device, its implementation is complicated by the lack of time, restricted policies by healthcare insurances, the great amount of available inhaler devices and the challenges in cooperation between the general practitioner and the pharmacy. Conclusion Due to a broad variation of different inhaler preferences found between age, gender and education levels, it is difficult to predict which inhaler device is best suited for whom. Therefore, an individualized inhaler choice process with involving patient’s inhaler preferences is needed, in which SMD could be providing. However, implementing SDM in daily practice appeared to be challenging due to several deterrent barriers. Further research is needed to find proper and suitable solutions for making SDM common practice.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Daily Supervisor: and Metting, E. and Supervisor: and Kocks, J.W and Groningen Institute for Asthma and COPD in primary care(GRIA |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:01 |
| Last Modified: | 25 Jun 2020 11:01 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2133 |
Actions (login required)
 |
View Item |