Patient compliance with assessing and monitoring of asthma

J Asthma. 2009 Dec;46(10):1027-31. Jiang H, Han J, Zhu Z, Xu W, Zheng J, Zhu Y. Department of Pneumology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P.R. China.

Background. The current asthma guidelines encourage use of a diary for assessing and monitoring symptoms and airway function. However, patient compliance and acceptability are usually poor owing to the burden of frequent and prolonged assessment.

Objective. We investigated whether better patient compliance could be ensured if a study was more relevant to patient convenience and had less impact on their daily life.

Methods. A total of 106 patients with symptomatic asthma underwent a fixed-time thrice-daily assessment schedule for a period lasting 2 weeks, and they were assigned to a doctor visit after the assessment. Symptoms and medication use were recorded in a booklet (paper diary) and airway function measured by a portable spirometer (electronic diary).

Results. Of 4,452 expected entries, the paper diary yielded 3,186 compliant entries and the electronic diary yielded 3,557 compliant entries; 71% of patients completed at least 30 compliant entries in the paper diary and 79% in the electronic diary. Use of an electronic device was associated with better compliance compared with paper technique (80.0% vs. 71.7%, p < 0.0001). Patient compliance decreased in the second week compared with the first week of diary keeping for both types of diaries (paper diary: 68.6% vs. 74.8%, p < 0.0001; electronic diary: 76.7% vs. 83.4%, p < 0.0001). The morning compliance was the least good, the afternoon better, and the evening best (paper diary: 68.2% vs. 71.0% vs. 75.9%, p < 0.0001; electronic diary: 77.2% vs. 79.0% vs. 83.9%, p < 0.0001). Among demographics and clinical factors, higher anxiety levels were linked to lower patient compliance.

Conclusion. Good patient compliance and acceptability can be achieved when a study takes into account patient convenience, uses user friendly electronic devices, and is less disruptive to patients' daily life.

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