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MY SUMR. Alex Ryu Mentor: Andrea Apter, MD, MSc Asthma Brief  Affects 34.1 million Americans, 300M world  Inflammation of airway, comes in “attacks”

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Presentation on theme: "MY SUMR. Alex Ryu Mentor: Andrea Apter, MD, MSc Asthma Brief  Affects 34.1 million Americans, 300M world  Inflammation of airway, comes in “attacks”"— Presentation transcript:

1 MY SUMR

2 Alex Ryu Mentor: Andrea Apter, MD, MSc

3 Asthma Brief  Affects 34.1 million Americans, 300M world  Inflammation of airway, comes in “attacks”  217,000 ER visits/yr  2007 national cost: $19.7 billion, $15B direct  Treated with:  Preventative inhaled corticosteroids (ICS’s)  Emergency inhaler – albuterol  Prednisone – frequently after ER  Lots of side effects, use briefly

4 The Context  Racial disparity in asthma morbidity exists  Medications are underused by all populations  Even when provided!  Asymptomatic nature of asthma  Ability to self-manage key for adherence  Education alone fails  Want to design an individualized intervention to improve adherence  Monitoring is necessary, but problematic

5 The Issue of Adherence  Poor adherence can be mistaken for poor efficacy of medication  Leads to a cycle of increasing dosages and complexity without improved health  Monitors for common asthma meds do not exist  Patients might incorrectly recall usage habits  Drug instructions communicated poorly  Methods of measuring drug container ineffective

6 Make Your Own Monitor  Need monitors for Advair and Flovent – two main prescribed ICS’s – preventative  Flovent exists, need to design one for Advair  Daniel Bogen, MD, PhD  Magnet sensor, basic software  Download at each visit

7 Advair 100: ~$190/month Advair 250: ~$230/month Advair 500: ~$315/month Flovent 110: ~$160/month Flovent 220:~$180/month

8 Diskus Adherence Logger (DAL) Bogen, Apter JACI 2004;114:863.

9 Early Investigation  Focus groups – Influences on adherence  Latino and African American patients  Identified barriers to adherence  Piloted Problem Solving intervention (PS)  Ancillary staff at outpatient visit  Designed to help reduce barriers to adherence

10 Study Design  RCT, participants receive either Attention Control (AC) or Problem-Solving (PS) intervention  Same length, education previously found ineffective  Meet 8 times, around participants’ schedules  Do spirometry, ask questions, do intervention, download adherence data  Cost-free  Questions regarding other relevant issues  Where get meds, reading ability, depression, etc…

11 Independent Variables (A few)  Self-Efficacy  Social Support  Depression  Cost of medication  Knowledge of asthma and medication use

12 Dependent Variables  Adherence  Asthma-Related Quality of Life (QOL)  Asthmatic Control

13 Specific Aims  Determine whether PS improves adherence over AC  Test whether PS improves pulmonary function over AC  Determine whether PS improves asthma- related QOL over AC

14 Exploratory Aims  Examine whether patients’ knowledge of and attitude toward ICS mediate PS, adherence  Examine whether social and environmental interactions mediate PS, adherence  Estimate financial impact of intervention

15 Hypothesis  PS will improve adherence over AC  PS will improve FEV1 over AC  PS will improve asthma-related QOL more than AC

16 Recruitment  Recruit from UPHS clinics + Episcopal Hospital + VA + Woodland Av – mostly minority  Chart searches  Contact over phone or in person  Screen  Enroll

17 Eligibility Criteria  ≥ 18 years of age  Currently prescribed a either Advair or Flovent  Pre-bronchodilator FEV1 <80%  Post-bronchodilator FEV1 increase by 12%  No pulmonary htn, or other disease that impairs asthma-related lung measurements  No cognitive or mental impairments

18 What I did…  Recruitment  Charts – Epic, Mediview  Screening appointments  Compiled participant copay receipts  Administrative tasks  Monitors  Clinical research ≈ PAPER

19 Status  Finally enrolled 400 th participant – unparalleled sample size for this type of study  5 years in the making  Continuing to follow with visits  Some preliminary analyses, most data still frozen until study complete  Have baseline adherence, questionnaires  Database of copay receipts for later analysis  Dan Polsky PhD, MPP, Sean McElligott

20 Limitations  Much of secondary data is self-reported  Potential effects of “attention-factor”  Differing reimbursement patterns  Difficulty with scheduling and retention

21 Lots of Time + Lots of Money=…  Better characterization of impoverished minority patients with moderate/severe asthma  A better understanding of treatment plans to improve ICS adherence  Insights into the numerous social and societal barriers that deter adherence * Ideally, a set of treatment guidelines that will shrink the national financial burden of asthma through improved adherence

22 Lessons  Recruitment takes patience  Good health is more than not having a cough  Appreciation for complex logistics

23 A HUGE Thanks to:  Dr. Andrea Apter  Laura Garcia, MPH  Rodalyn Gonzalez and Chantel Priolo  Participants  Joanne Levy, MBA MCP  Shanta Layton  LDI and SUMR  HUP


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