Intervention Can Help Decrease Exacerbation Rates, Improve Medication Adherence in COPD

A recent study found that the Service Apothecary Respiratory Advice eHealth intervention could help patients with chronic obstructive pulmonary disease with exacerbation rates and medication adherence.

The Service Apothecary Respiratory Advice (SARA) eHealth intervention could reduce exacerbation rates and increase medication adherence for patients with chronic obstructive pulmonary disease (COPD), according to a study published in the Journal of Medical Internet Research.

The study used the SARA eHealth intervention that was developed by the Service Pharmacy organization. SARA contained comprehensive information about inhalation medication, inhalation instruction videos, informational videos about asthma and COPD, a pollen forecast, and a questionnaire that is given to participants after 15 days in the intervention. A 7-item questionnaire was also developed by the Service Pharmacy organization to assess medication usage.

Participants were offered the usage of SARA during pharmacy visits when they were receiving inhalation medication for asthma, COPD, bronchitis, or other respiratory illnesses. Participants were enrolled in the intervention if they expressed interest. Those who were not interested were deemed control patients as well as those who had received inhalation medication but not offered SARA.

Index date was either the registration date or the last dispensing date before the registration date. Data was collected from January 2015, to September 2020, from 382 Service Pharmacies located in the Netherlands.

Patients were included if they were aged 18 years and older, were registered as a SARA or control patient, time between index date and last medication dispensing date was a maximum of 30 days, the patient needed to have a disease indication of asthma or COPD, and that the patient had to have at least 1 medication dispensing record before the 2-year analysis started.

There were 9452 patients who were included in this study, of which 25.39% were enrolled in SARA, 25.73% were not interested, and 48.88% had not been invited or did not want to participate at that moment. The mean (SD) age of the population was 60.8 (15.0) years, and nearly two-thirds of the participants were female. The mean age of the participants using SARA was lower than of the control group. There were also more men in the control group than in the SARA group.

There were 5955 participants (63.00%) who had had 0 exacerbations in the year before SARA implantation; after the implantation of SARA, 5293 (56.00%) participants had 0 exacerbations. The mean rate of exacerbations was higher after SARA implantation (SARA: 0.73; control: 0.67).

Exacerbation rate over time saw a significant difference between the SARA and control patients, with the mean exacerbation rate increasing over time in both SARA (asthma: 0.07; COPD: 0.03) and control (asthma: 0.17; COPD: 0.12). The patients on SARA had a significantly lower increase in exacerbation rates over time.

The mean proportion of days covered (PDC) was higher in the year after implantation of SARA when compared with the year before for SARA participants (after: 77.26; before 70.53) and control participants (after: 77.77; before: 73.29). The difference in change over time in the group of SARA participants demonstrated increase in medication adherence was significant.

The mean number of participants who had been given antimycotics was higher after implantation of SARA when compared with the year before for SARA participants (6.4% vs 5.4%) and control participants (6.1% vs 4.7%).

There were some limitations to this study. Some data were not originally designed to answer specific research questions due to the study results coming from retrospective pharmacy dispensing data. The pharmacy dispensing data also did not provide information on how often or when medications were used. Calculation of PDC was also limited due to the “at least 1” method used, which does not take medication overuse into account. The interpretation that better medication adherence was a sign of good self-management could also be problematic, as the opposite could be true.

Intensity of support offered by pharmacists was also not known for this study. Demographics were also different between the SARA and control groups, as SARA participants were younger and more often female.

The researchers concluded that their study proved the effectiveness of a multi-component eHealth intervention.

“The results suggest that such an intervention has the potential to decrease exacerbation rates and improve medication adherence. This could subsequently have important clinical implications and lead to better patient outcomes and potentially reduced health care costs,” the authors wrote.


Schnoor K, Versluis A, Bakema R, et al. A pharmacy-based ehealth intervention promoting correct use of medication in patients with asthma and COPD: nonrandomized pre-post study. J Med Internet Res. 2022;24(6):e32396. doi:10.2196/32396