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CAN INHALER CONFIDENCE PREDICT CORRECT INHALER TECHNIQUE IN PATIENTS?

      TOPIC: Respiratory Care
      TYPE: Original Investigations
      PURPOSE: Traditional asthma and COPD management is reactive and not proactive, which exacerbates emergency room visits and perpetuates a vicious cycle of poor disease management. Incorrect use of inhalers is a major hurdle for disease management and therefore patient education can become an important tool, albeit it being costly and also time-consuming. Perhaps there is a way to target these interventions to patients who would benefit most. The objective of this study is to establish whether patient's self-reported confidence is a good predictor of correct inhaler technique, in order to better-target education interventions to those with low confidence.
      METHODS: Adults (18+) with asthma or COPD were included in this study where they received either Brief Intervention (BI), Teach-to-Goal (TTG) or Virtual Teach-to-Goal (V-TTG). Inhaler misuse was categorized as getting less than, or equal to, 75% of the steps correct. Participants self-reported their confidence levels using a Likert scale ranging from 1(Not confident) to 5 (Very Confident). All analysis was conducted using STATA 15 (College Station, Texas: StataCorp LP).
      RESULTS: Our study group consisted of predominately Black (92.55), women (66.46%), with an average age of 51.31 (S.D. 14.3). As a whole, the average confidence score pre-intervention were: BI- 3.75, TTG- 4.10, V-TTG- 4.08 and inhaler misuse was common: BI- 94.83%, TTG- 89.34%, V-TTG- 90.14%. A binary logistic regression showed that the participant being confident had no significance in decreasing the odds of inhaler misuse compared to the participant being not confident. An ordinal logistic regression of confidence levels versus inhaler misuse found no internal or external factor which increased, or decreased, the odds of a participant being confident in their inhaler use. Post educational intervention, there was ongoing inhaler misuse: BI- 72.41%, TTG- 21.31%, V-TTG- 26.76% and no significant change in confidence by intervention: BI- +0.75, TTG- + 0.55, V-TTG- +0.6, which was assessed using one-way ANOVA testing.
      CONCLUSIONS: Patients are over-confident when it comes to gauging their ability to use their inhalers correctly. Therefore, self-reported confidence scores are not a valuable tool in optimizing inhaler technique education among patients. Additionally, there is no factor that predicts patients' confidence of using their inhaler.
      CLINICAL IMPLICATIONS: Simply inquiring whether patients are confident in their inhaler technique is insufficient and inhaler education must be assessed at every patient interaction. Furthermore, since there is no significant variable predicting patient's confidence, all patients must be taken as a blank slate and inhaler education should be taught across the board at each individual encounter.
      DISCLOSURES: subject matter expert relationship with Vizient Please note: $1001 - $5000 by Valerie Press, source=Web Response, value=Honoraria
      Consultant relationship with Humana Please note: $5001 - $20000 by Valerie Press, source=Web Response, value=Consulting fee
      No relevant relationships by Paulina Zajac, source=Web Response