Understanding respiratory medication persistence in Australian patients with chronic obstructive pulmonary disease

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This is an innovative project, utilising a largely untapped health resource - community pharmacists and their computerised prescription data - to help identify patients with chronic obstructive pulmonary disease (COPD) as evidenced by their use of Spiriva (tiotropium). The project objective is to understand the drivers and barriers of persistence with respiratory medication, specifically Spiriva. A software application that extracts data from the market leading pharmacy dispensing software system in Australia (WiniFRED Dispense; PCA/NU Systems), developed by the research team, will be modified to identify patients with COPD as evidenced by use of Spiriva. Community pharmacies throughout Tasmania will be recruited and will install the application. In one pass through the complete data set the dispensing history will be interrogated and a list of patients (who are aged over 40 years or age is unknown) identified as having received Spiriva in the previous 12-month period will be generated. Patients will be identified as “persistent” (those to whom those to whom Spiriva was dispensed at least nine times in the preceding 12-month period, including at least two units in the past 90 days) or “non-persistent” (those for whom Spiriva was dispensed between one and four times (inclusive) in the preceding six-month period, with nil dispensings in the subsequent 65 days). The participating pharmacist will examine the dispensing information for each patient identified and will be able to exclude patients from being sent an invitation to participate if they believe the patient is aged under 40 years, is residing in an aged care facility, is deceased, is significantly cognitively impaired and would not understand the letter, or would be alarmed excessively by receiving the letter and participating in the project. Patients deemed suitable for inclusion will be sent a letter by the community pharmacist, to invite them to participate, along with patient information sheets and consent forms. All consenting patients will be subsequently sent questionnaires by the researchers, assessing anxiety and depression, illness perception, health-related quality of life, and medication adherence. Half of the patients will participate in qualitative interviews addressing patient characteristics, diagnosis, treatment choice, day-to-day management, fulfillment, and persistence with therapy. Project deliverables will include utilising key dispensing information to identify key barriers and predictors of poor persistence to Spiriva, and the development of belief/behaviour maps for identified patients, leading to a clear set of recommendations regarding persistence triggers amongst patient types.

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