Feasibility study for supporting medication adherence for adults with cystic fibrosis: mixed-methods process evaluation.

Autor:	Hind D; Clincal Trials Research Unit, University of Sheffield, Sheffield, UK d.hind@sheffield.ac.uk., Drabble SJ; School of Health and Related Research, University of Sheffield, Sheffield, UK., Arden MA; Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK., Mandefield L; Department of Health Sciences, University of York, York, UK., Waterhouse S; Clincal Trials Research Unit, University of Sheffield, Sheffield, UK., Maguire C; Clincal Trials Research Unit, University of Sheffield, Sheffield, UK., Cantrill H; Clincal Trials Research Unit, University of Sheffield, Sheffield, UK., Robinson L; Clincal Trials Research Unit, University of Sheffield, Sheffield, UK., Beever D; Clincal Trials Research Unit, University of Sheffield, Sheffield, UK., Scott A; Clincal Trials Research Unit, University of Sheffield, Sheffield, UK., Keating S; Clincal Trials Research Unit, University of Sheffield, Sheffield, UK., Hutchings M; Sheffield Adult Cystic Fibrosis Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, Sheffield, UK., Bradley J; Wellcome-Wolfson Institute For Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK., Nightingale J; Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK., Allenby MI; Wessex Adult Cystic Fibrosis Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK., Dewar J; Wolfson Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK., Whelan P; Health eResearch Centre - Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK., Ainsworth J; Health eResearch Centre - Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK., Walters SJ; School of Health and Related Research, University of Sheffield, Sheffield, UK., Wildman MJ; School of Health and Related Research, University of Sheffield, Sheffield, UK.; Sheffield Adult Cystic Fibrosis Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, Sheffield, UK., O'Cathain A; School of Health and Related Research, University of Sheffield, Sheffield, UK.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2020 Oct 27; Vol. 10 (10), pp. e039089. Date of Electronic Publication: 2020 Oct 27.
DOI:	10.1136/bmjopen-2020-039089
Abstrakt:	Objectives: To undertake a process evaluation of an adherence support intervention for people with cystic fibrosis (PWCF), to assess its feasibility and acceptability. Setting: Two UK cystic fibrosis (CF) units. Participants: Fourteen adult PWCF; three professionals delivering adherence support ('interventionists'); five multi-disciplinary CF team members. Interventions: Nebuliser with data recording and transfer capability, linked to a software platform, and strategies to support adherence to nebulised treatments facilitated by interventionists over 5 months (± 1 month). Primary and Secondary Measures: Feasibility and acceptability of the intervention, assessed through semistructured interviews, questionnaires, fidelity assessments and click analytics. Results: Interventionists were complimentary about the intervention and training. Key barriers to intervention feasibility and acceptability were identified. Interventionists had difficulty finding clinic space and time in normal working hours to conduct review visits. As a result, fewer than expected intervention visits were conducted and interviews indicated this may explain low adherence in some intervention arm participants. Adherence levels appeared to be >100% for some patients, due to inaccurate prescription data, particularly in patients with complex treatment regimens. Flatlines in adherence data at the start of the study were linked to device connectivity problems. Content and delivery quality fidelity were 100% and 60%-92%, respectively, indicating that interventionists needed to focus more on intervention 'active ingredients' during sessions. Conclusions: The process evaluation led to 14 key changes to intervention procedures to overcome barriers to intervention success. With the identified changes, it is feasible and acceptable to support medication adherence with this intervention. Trial Registration Number: ISRCTN13076797; Results. Competing Interests: Competing interests: MJW received funding from Zambon and support from Philips Respironics for the early intervention development work. This has not had any direct influence on the feasibility study reported here. In addition, MJW has worked with Pari to carry out studies using the e-track. This has not had any direct influence on the feasibility study reported here. The University of Manchester software team received funding from Pari to create a medication reporting component within the CFHealthHub software. This has not had any direct influence on the feasibility study reported here. (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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