Asthma patients' self-reported behaviours toward inhaled corticosteroids

SummaryBackgroundPatient adherence to recommended use of ICS is questionable in asthma, with irregular use or interruptions occurring frequently. Factors explaining discontinuation of controller therapy could orientate interventions. The characteristics of patients with interruptions of inhaled corticosteroids (ICSs), intentional or accidental, were investigated.MethodsAsthma patients regularly prescribed ICS by GPs (Cegedim network) were included. Patients' characteristics and behaviours toward ICS (accidental/intentional interruptions, less frequent use of ICS and change in dosing) were identified from self-report questionnaires, and linked to data prescription database. Interrelations between declared behaviours toward ICS were studied with a Multiple Component Analysis (MCA) and the correlates of ICS interruptions were identified.ResultsDuring the past 3 months, 31.6% of 204 patients (mean age: 53.8 years, females: 59.3%) intentionally interrupted ICS when feeling better, 25.4% forgot ICS and 18.3% deliberately changed the doses. A quarter of patients considered constant use of respiratory medicines as unhealthy. MCA revealed that intentional, accidental interruptions and less frequent use of ICS were closely correlated. Risk of intentional interruption was increased when patients considered constant use of respiratory therapy to be unhealthy (OR=3.36, 95%CI=[1.47–7.66]). Conversely, risk was significantly lower when ICS was associated or combined with another controller (OR=0.24, 95%CI=[0.08–0.73]), compared to ICS in monotherapy. Less frequent interruptions were observed in patients older than 65 (OR=0.35, 95%CI=[0.13–0.89]).ConclusionsOur study suggests that discontinuation of use of controllers is associated with other inadequate behaviours or beliefs about inhaled controllers. Efforts should be targeted at patients' perceptions and behaviours toward controller therapy

A privacy-preserving design for sharing demand-driven patient datasets over permissioned blockchains and P2P secure transfer

Sharing patient datasets curated by health institutions is critical for the advance of monitoring, surveillance and research. However, patient data is sensitive data and it can only be released under certain conditions and with previous explicit consent. Privacy preserving data sharing provides techniques to distribute datasets minimizing the risk of identification of patients. However, the sharing of datasets is typically done without considering the needs or requests of data consumers. Blockchain technologies provide an opportunity to gather those requests and share and assemble datasets using privacy-preserving methods as data and requirements on anonymity match. The architecture and design of such a solution is described, assuming an underlying permissioned blockchain network where providers such as healthcare institutions deal with consent, patient preferences and anonymity guarantees, playing a mediator role to a network of organizations