Better use of inhaled medication in asthma and COPD through training, preparation and counselling:the On TRACk study protocol for a cluster randomised controlled trial

Introduction About 70% of patients with asthma and/or chronic obstructive pulmonary disease (COPD) use their inhaled medication incorrectly, leading to reduced disease control, higher healthcare use and costs. Adequate guidance from the pharmacy team from first dispense onwards can benefit patients in the long run. We propose an intervention ('On TRACk') to improve medication adherence and inhaler technique of adult patients with asthma and/or COPD. This intervention focuses on training pharmacy technicians (PTs) in patient-centred communication and inhalation instruction skills. In addition, patients are actively involved in refill consultations at the pharmacy. The aim of this study is to improve inhaler technique and better inhaled medication adherence among patients with asthma and/or COPD. This paper describes the study protocol. Methods and analysis A cluster randomised controlled trial (RCT) with an intervention and control group of 15 pharmacies each will be conducted. Per intervention pharmacy, two PTs will be trained online. Each PT will include five patients who will prepare their second and third dispense counselling sessions by selecting three topics they wish to discuss. Pharmacies in the control cluster provide usual care. In total, 300 patients (150 per group) will be included. Up to 12 months after inclusion, patients complete 3-monthly follow-up questionnaires. Both a process evaluation and a cost-effectiveness analysis will be performed alongside the trial. Trial effectiveness on the patient level will be evaluated after the 12-month follow-up period. Patient data will be collected through questionnaires and pharmacy refill data. Patients' inhaler technique will be visually assessed by PTs. Semistructured interviews with PTs and patients will be conducted regarding implementation and fidelity. Direct and indirect health costs will be collected to assess cost-effectiveness. The primary outcome is adherence to inhalation maintenance medication measured with pharmacy refill data. Secondary outcomes are inhaler technique, persistence, patients' attitudes towards medication, self-efficacy in medication use and communication with their PTs. Ethics and dissemination The study was approved by the Vrije Universiteit Amsterdam Ethics Committee (number: 2020.358). Results will be presented at (inter)national conferences and published in peer-reviewed journals. If proven to be (cost-)effective, the intervention should be considered for reimbursement and implementation in Dutch community pharmacies

The impact of trust in healthcare and medication, and beliefs about medication on medication adherence in a Dutch medication-using population

INTRODUCTION: Trust in healthcare and medication, defined as feelings of reassurance and confidence in the healthcare system or medication, may be a key prerequisite before engaging in the use of medication. However, earlier studies have focussed on beliefs about medication rather than trust as predictors of medication adherence. This study therefore aims to simultaneously explore the relationship of trust in healthcare, medication and beliefs about medication, with medication adherence.METHODS: In a cross-sectional study, an online questionnaire was sent out to 1500 members of the Dutch Health Care Consumer Panel of Nivel in November 2018. Respondents were asked to grade their level of trust in healthcare and medication (scale 1-10). The Beliefs About Medicines Questionnaire (BMQ) for general and specific medication beliefs was used to address beliefs, the Medication Adherence Report Scale (MARS-5) to measure medication adherence. Data were analysed using structural equation modelling (SEM) with a backward stepwise approach. Out of 753 people that completed the questionnaire, 407 people used prescription medication and were included in the analyses.RESULTS: A positive association between trust in medication and medication adherence was found (0.044, p &lt; 0.05). BMQ subscales Overuse (-0.083, p &lt; 0.05), Necessity (0.075, p &lt; 0.05) and Concerns (-0.134, p &lt; 0.01) related with medication adherence. BMQ subscale Harm did not relate to medication adherence.CONCLUSION: Trust in medication and beliefs about medication were both individually associated with medication adherence. Healthcare providers should therefore not only focus on patients' medication beliefs, but also on strengthening patients' trust in medication to improve medication adherence.</p

Influencing Factors of Online Health Information Seeking in Selected European Countries: Analysis of Country Specifics

Patients’ participation in healthcare requires comprehensive health knowledge and can benefit from online health information seeking behaviours (O-HISB). The internet is a particularly vital source for seeking health-related information in many regions of the world. Therefore, we take a European cross-country comparative perspective on O-HISB. We aim to compare the importance of personal, health(care)-related, and cognitive determinants of using the internet for health-related purposes in four European countries. We conducted online surveys among the German, Swiss, Dutch, and Austrian public and described patterns of health information seeking online. The internet seemed to be a widely used source of health information in the four selected European countries. The explanation patterns of personal, health(care)-related, and cognitive factors differ by country and between selecting the internet as a source of health information and the frequency of online use. Using online media appeared to be more common for women and for current health problems. Respondents’ willingness and competencies are essential for online health information seeking. To prevent the increase of social and health-related disparities, there is an urgent need to support underprivileged population groups and increase motivations and eHealth literacy to use the internet for health-related purposes

Sick for Information? : Information Needs and Media Use of the Dutch Public During the Covid-19 Pandemic

During a pandemic outbreak, timely and accurate information that matches the information needs of the public is vital to inform the public. In April 2020, 977 individuals completed a questionnaire that measured the Dutch public’s health information needs and media consumption during the early stages of the coronavirus outbreak. Results show that respondents sought information about prevention of contamination, (the severity of) symptoms, treatment, and vaccination. News outlets, both online and offline, were the most preferred sources for information. Older people were more likely to search for information in traditional media, such as on TV, in newspapers, and on the radio. Younger people more often used news websites to find information. Respondents with lower levels of education obtained information via TV more frequently than respondents with higher levels of education, who in turn used newspapers more frequently. This study, guided by the Risk Information Seeking and Processing (RISP) model, was conducted during the early stages of the pandemic in the Netherlands to provide information that public health officials and governments can use to optimise information provision during pandemics. Presently, news media have the highest degree of coverage and impact and should thus be used first to convey reliable information

The effects of persuasive messages on cancer patients’ attitudes, norms and intention to express concerns

Objective: To examine whether the use of persuasive messages in which cancer patients’ attitudes and perceived social norms were either simultaneously or exclusively targeted can positively change patients’ attitudes, perceived social norms and the intention to express concerns in consultations. Methods: Two online experiments were conducted. The first experiment had a pre-test and post-test measurements design with 4 conditions (attitudes message, social norms message, combined message, control message). The second experiment had a pre-test and post-test measurements design with 2 conditions (message and no message group). Results: The results of the first study showed small positive changes for patients who could potentially change, but there were no differences in effects between conditions. A second study was conducted to determine whether these effects could be attributed to exposure to the message or to the pre-test questionnaire. There were no differences between the conditions. Conclusion: The results indicate that paying attention to the expression of concerns by patients might increase patients’ intention to express further concerns. Practice implications: Providers might be able to support patients’ in their sharing of concerns through simple communication strategies such as explicitly mentioning that the expression of concerns is possible during a consultation

Patients’ convergence of mass and interpersonal communication on an online forum: Hybrid methods analysis

Background: Patients are increasingly taking an active role in their health. In doing so, they combine both mass and interpersonal media to gratify their cognitive and affective needs (ie, convergence). Owing to methodological challenges when studying convergence, a detailed view of how patients are using different types of media for needs fulfillment is lacking. Objective: The aim of this study was to obtain insight into the frequency of reported convergence, how convergence affects what posters write online, motives for posting, and the needs posters are trying to fulfill. Methods: Using a hybrid method of content analysis and supervised machine learning, this study used naturally available data to fill this research gap. We analyzed opening posts (N=1708) of an online forum targeting cancer patients and their relatives (Kanker.nl). Results: Nearly one-third of the forum opening posts contained signs of convergence in mass or interpersonal media. Posts containing mass media references disclosed less personal information and were more geared toward community enhancement and sharing experiences compared to posts without convergence. Furthermore, compared to posts without signs of convergence, posts that included interpersonal media references disclosed more personal information, and posters were more likely to ask for the experiences of fellow users to fulfill their needs. Within posts containing signs of convergence, posts including interpersonal media references reported fewer shortages of information, disclosed more information about the disease, and were more active in seeking other posters’ experiences compared to posts containing mass media references. Conclusions: The current study highlights the intertwining of media platforms for patients. The insights of this study can be used to adapt the health care system toward a new type of health information–seeking behavior in which one medium is not trusted to fulfill all needs. Instead, providers should incorporate the intertwinement of sources by providing patients with reliable websites and forums through which they can fulfill their needs