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IPD2.04 Assessing the clinical impact of motivational interviewing on inhaled antibiotic (IA) adherence in CF
Interactive Poster Discussion Sessions / Journal of Cystic Fibrosis 16S1 (2017) S1–S62
technology with personal health coaching, to marry the use of our Machine on Machine Mankind Interface (M.O.M.M.I) to FATHER. Methods: 20 subjects aged 8–51, 55% female, mean (SD) Morisky Adherence Questionnaire 3.4 (2.0),%FEV1 59.5 (37.3), and Pulmonary Exacerbation Score (PES) 6.9 (5.0). Health Coaching, based on Motivational Interviewing principles, was delivered by one Health Coach (JP). At the initial in-clinic 30-minute session the coach and client agreed to weekly discussions regarding findings from the monitoring device; the final 30minute session was also “face to face”. The four intervening sessions lasted approximately 10-minutes, by phone or face-to-face. RedCAP database was informed by the PARI server of the device use, duration of use, use of cleaning, and results of HRQOL testing, pulmonary function, pulmonary exacerbation score (PES). Results: Lung function (spirometry, %FEV1, PES), and Body Mass Index (BMI) improved from baseline in all subjects. For both %FEV1 and PES, 21.4% of subjects improved significantly, assessed by the Reliable Change Index. Conclusion: Successful integration, dispensing and teaching of the eTrack™. The health coaching was successful and required shorter duration than the usual one hour sessions of motivational interviewing. Patients felt increased treatment burden because there was one of actual adherence. Despite the short intervention, effects were seen beyond the demonstration of the usability of the device. IPD2.04 Assessing the clinical impact of motivational interviewing on inhaled antibiotic (IA) adherence in CF C. Addy1,2, K. Mooney1,3, J.E. Moore3,4, A.J. Crossan3, S.J. Hanna3, C. Ryan5, V. Brown1, D.G. Downey1,3. 1Queen’s University Belfast, Centre for Experimental Medicine, Belfast, United Kingdom; 2Northern Ireland Regional Adult CF Centre, Centre for Experimental Medicine, Belfast, United Kingdom; 3 Northern Ireland Regional Adult CF Centre, Belfast City Hospital, Belfast, United Kingdom; 4Queen’s University Belfast, Belfast, United Kingdom; 5Royal College of Surgeons in Ireland (RCSI), Dublin, United Kingdom Objectives: Adherence to treatment is a major challenge in CF. Motivational Interviewing (MI) is a collaborative therapeutic approach to elicit and strengthen motivation for change. Its use is increasing but its clinical impact in CF is unknown. We investigated the impact of MI on IA pick-up and clinical outcomes. Methods: Three MI visits were conducted over 2 months, a phone call at 3 months and clinic visits at 4/6 months. Sessions were recorded for monitoring purposes. Demographics, FEV1, BMI, adherence (IA collection rates) and need for additional antibiotics were collected during the study and for 6 months prior. Treatment Quality and Satisfaction (TQSM Score), self-reported adherence (Morisky Medication Adherence Scale, MMAS-8), sputum Pseudomonas aeruginosa (Psa) density and Quality of Life (QOL) using the Cystic Fibrosis Questionnaire-Revised (CFQ-R) were assessed at each study visit. Results: Patients (22 adults, 14 male) on IA for chronic Psa were enrolled; Mean age 31yrs ( ± SD = 9); Mean FEV1 55% ( ± SD = 19.6). 16 completed the study. There was no significant change in FEV1, BMI, Psa density or additional antibiotic use during the study. Significant variation in TQSM ( p > 0.0001), MMAS-8 ( p = 0.04) and QOL ( p = 0.0017) were seen between study visits. Average IA collection rate was 17.5% (Range 0–83%); 50% did not pick up any IA during the study. Self-reported adherence overestimated IA pick-up. Three participants demonstrated improved pick-up rates – they were significantly younger ( p = 0.04). Conclusion: A short MI intervention does not improve IA pick-up rates or clinical outcomes in an adult population but may be useful for some individuals. Further work is needed to identify individuals who may benefit from MI, develop more individualised adherence interventions and establish the optimal time-frame for intervention. IPD2.05 Demographic and clinical factors associated with objective nebuliser adherence among adults with CF Z.H. Hoo1,2, B. Gardner3, R.E. Curley1,2, M.J. Campbell1, M.J. Wildman1,2. 1 Design, Trials & Statistics, ScHARR, University of Sheffield, Sheffield, United Kingdom; 2Sheffield Adult CF Centre, Northern General Hospital,
S59
Sheffield, United Kingdom; 3King’s College London, Department of Psychology Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom Background: Technology now enables automatic capture of nebuliser adherence data for centre-comparison to drive quality improvement. Casemix adjustments are needed to appropriately compare nebuliser adherence. Previous studies in this area have looked at adherence measured with medication possession ratio (Quittner AL et al. Chest 2014;146:142–51) but not objective adherence measured with chipped nebulisers. Aim: To explore the relationship between objective adherence and casemix factors Methods: This is a retrospective analysis of adherence data measured in 2015 with I-neb nebulisers in the Sheffield Adult CF centre. Adherence was calculated as “normative adherence” (Hoo ZH et al. Patient Prefer Adherence 2016;10:887–900). Demographic data were obtained from electronic patient record. Socioeconomic deprivation was determined using postcodes (Taylor-Robinson DC et al. Lancet Respir Med 2013;1:121–8). Mann-Whitney and Kruskal-Wallis tests were used to test whether adherence levels were different among different sub-groups of adults. Adults on ivacaftor or with previous lung transplantation were excluded. Results: 104 adults were included in this analysis. Adherence did not differ significantly according to gender (males: median 45.9%; females: median 39.4%; p = 0.215) or baseline FEV1 (FEV1 ≥70%: median 44.2%; FEV1 40–69%: median 44.6%; FEV1 < 40%: median 41.1%; p = 0.792). Adults aged 19–25 years had the lowest adherence.
Age groups:
≤18 years (n = 17)
58.7% Normative (14.0% – adherence in 87.5%) 2015, median (IQR)
19–25 years 26–34 years ≥35 years (n = 33) (n = 32) (n = 22)
KruskalWallis p-value
21.9% (14.6% – 54.9%)
0.030
46.2% (24.5% – 92.2%)
49.2% (26.4% – 62.6%)
[Adherence levels according to different age groups]
The most affluent quintile had higher adherence, but this was not statistically significant.
Deprivation quintiles:
1 i.e. most affluent (n = 15)
2 (n = 10)
3 (n = 29)
4 (n = 26)
5 i.e. most deprived (n = 24)
KruskalWallis p-value
Normative 69.6% 31.1% 39.4% 40.4% 31.3% 0.260 adherence (48.0% – (11.7% – (18.8% – (20.8% – (16.6% – in 2015, 92.8%) 85.9%) 60.4%) 60.4%) 96.1%) median (IQR)
[Adherence levels according to deprivation status]
Conclusion: When comparing adherence between centres, it is important to adjust for age differences. The small number of adults in the most affluent quintile may have limited the power to detect differences in adherence. IPD2.06 Development of a regional monitoring system for Inhaled Antibiotic collection as a measure of adherence C. Addy1,2, K. Mooney1,2, J.E. Moore2,3, A.J. Crossan2, S.J. Hanna2, C. Ryan4, V. Brown1, D.G. Downey1,2. 1Queen’s University Belfast, Centre for Experimental Medicine, Belfast, United Kingdom; 2Northern Ireland Regional Adult CF Centre, Belfast City Hospital, Belfast, United Kingdom; 3Queen’s University Belfast, Belfast, United Kingdom; 4Royal College of Surgeons in Ireland (RCSI), Belfast, United Kingdom Objectives: Adherence to therapy is one of the greatest challenges in CF Care. Medication possession ratios can help measure adherence. In
technology with personal health coaching, to marry the use of our Machine on Machine Mankind Interface (M.O.M.M.I) to FATHER. Methods: 20 subjects aged 8–51, 55% female, mean (SD) Morisky Adherence Questionnaire 3.4 (2.0),%FEV1 59.5 (37.3), and Pulmonary Exacerbation Score (PES) 6.9 (5.0). Health Coaching, based on Motivational Interviewing principles, was delivered by one Health Coach (JP). At the initial in-clinic 30-minute session the coach and client agreed to weekly discussions regarding findings from the monitoring device; the final 30minute session was also “face to face”. The four intervening sessions lasted approximately 10-minutes, by phone or face-to-face. RedCAP database was informed by the PARI server of the device use, duration of use, use of cleaning, and results of HRQOL testing, pulmonary function, pulmonary exacerbation score (PES). Results: Lung function (spirometry, %FEV1, PES), and Body Mass Index (BMI) improved from baseline in all subjects. For both %FEV1 and PES, 21.4% of subjects improved significantly, assessed by the Reliable Change Index. Conclusion: Successful integration, dispensing and teaching of the eTrack™. The health coaching was successful and required shorter duration than the usual one hour sessions of motivational interviewing. Patients felt increased treatment burden because there was one of actual adherence. Despite the short intervention, effects were seen beyond the demonstration of the usability of the device. IPD2.04 Assessing the clinical impact of motivational interviewing on inhaled antibiotic (IA) adherence in CF C. Addy1,2, K. Mooney1,3, J.E. Moore3,4, A.J. Crossan3, S.J. Hanna3, C. Ryan5, V. Brown1, D.G. Downey1,3. 1Queen’s University Belfast, Centre for Experimental Medicine, Belfast, United Kingdom; 2Northern Ireland Regional Adult CF Centre, Centre for Experimental Medicine, Belfast, United Kingdom; 3 Northern Ireland Regional Adult CF Centre, Belfast City Hospital, Belfast, United Kingdom; 4Queen’s University Belfast, Belfast, United Kingdom; 5Royal College of Surgeons in Ireland (RCSI), Dublin, United Kingdom Objectives: Adherence to treatment is a major challenge in CF. Motivational Interviewing (MI) is a collaborative therapeutic approach to elicit and strengthen motivation for change. Its use is increasing but its clinical impact in CF is unknown. We investigated the impact of MI on IA pick-up and clinical outcomes. Methods: Three MI visits were conducted over 2 months, a phone call at 3 months and clinic visits at 4/6 months. Sessions were recorded for monitoring purposes. Demographics, FEV1, BMI, adherence (IA collection rates) and need for additional antibiotics were collected during the study and for 6 months prior. Treatment Quality and Satisfaction (TQSM Score), self-reported adherence (Morisky Medication Adherence Scale, MMAS-8), sputum Pseudomonas aeruginosa (Psa) density and Quality of Life (QOL) using the Cystic Fibrosis Questionnaire-Revised (CFQ-R) were assessed at each study visit. Results: Patients (22 adults, 14 male) on IA for chronic Psa were enrolled; Mean age 31yrs ( ± SD = 9); Mean FEV1 55% ( ± SD = 19.6). 16 completed the study. There was no significant change in FEV1, BMI, Psa density or additional antibiotic use during the study. Significant variation in TQSM ( p > 0.0001), MMAS-8 ( p = 0.04) and QOL ( p = 0.0017) were seen between study visits. Average IA collection rate was 17.5% (Range 0–83%); 50% did not pick up any IA during the study. Self-reported adherence overestimated IA pick-up. Three participants demonstrated improved pick-up rates – they were significantly younger ( p = 0.04). Conclusion: A short MI intervention does not improve IA pick-up rates or clinical outcomes in an adult population but may be useful for some individuals. Further work is needed to identify individuals who may benefit from MI, develop more individualised adherence interventions and establish the optimal time-frame for intervention. IPD2.05 Demographic and clinical factors associated with objective nebuliser adherence among adults with CF Z.H. Hoo1,2, B. Gardner3, R.E. Curley1,2, M.J. Campbell1, M.J. Wildman1,2. 1 Design, Trials & Statistics, ScHARR, University of Sheffield, Sheffield, United Kingdom; 2Sheffield Adult CF Centre, Northern General Hospital,
S59
Sheffield, United Kingdom; 3King’s College London, Department of Psychology Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom Background: Technology now enables automatic capture of nebuliser adherence data for centre-comparison to drive quality improvement. Casemix adjustments are needed to appropriately compare nebuliser adherence. Previous studies in this area have looked at adherence measured with medication possession ratio (Quittner AL et al. Chest 2014;146:142–51) but not objective adherence measured with chipped nebulisers. Aim: To explore the relationship between objective adherence and casemix factors Methods: This is a retrospective analysis of adherence data measured in 2015 with I-neb nebulisers in the Sheffield Adult CF centre. Adherence was calculated as “normative adherence” (Hoo ZH et al. Patient Prefer Adherence 2016;10:887–900). Demographic data were obtained from electronic patient record. Socioeconomic deprivation was determined using postcodes (Taylor-Robinson DC et al. Lancet Respir Med 2013;1:121–8). Mann-Whitney and Kruskal-Wallis tests were used to test whether adherence levels were different among different sub-groups of adults. Adults on ivacaftor or with previous lung transplantation were excluded. Results: 104 adults were included in this analysis. Adherence did not differ significantly according to gender (males: median 45.9%; females: median 39.4%; p = 0.215) or baseline FEV1 (FEV1 ≥70%: median 44.2%; FEV1 40–69%: median 44.6%; FEV1 < 40%: median 41.1%; p = 0.792). Adults aged 19–25 years had the lowest adherence.
Age groups:
≤18 years (n = 17)
58.7% Normative (14.0% – adherence in 87.5%) 2015, median (IQR)
19–25 years 26–34 years ≥35 years (n = 33) (n = 32) (n = 22)
KruskalWallis p-value
21.9% (14.6% – 54.9%)
0.030
46.2% (24.5% – 92.2%)
49.2% (26.4% – 62.6%)
[Adherence levels according to different age groups]
The most affluent quintile had higher adherence, but this was not statistically significant.
Deprivation quintiles:
1 i.e. most affluent (n = 15)
2 (n = 10)
3 (n = 29)
4 (n = 26)
5 i.e. most deprived (n = 24)
KruskalWallis p-value
Normative 69.6% 31.1% 39.4% 40.4% 31.3% 0.260 adherence (48.0% – (11.7% – (18.8% – (20.8% – (16.6% – in 2015, 92.8%) 85.9%) 60.4%) 60.4%) 96.1%) median (IQR)
[Adherence levels according to deprivation status]
Conclusion: When comparing adherence between centres, it is important to adjust for age differences. The small number of adults in the most affluent quintile may have limited the power to detect differences in adherence. IPD2.06 Development of a regional monitoring system for Inhaled Antibiotic collection as a measure of adherence C. Addy1,2, K. Mooney1,2, J.E. Moore2,3, A.J. Crossan2, S.J. Hanna2, C. Ryan4, V. Brown1, D.G. Downey1,2. 1Queen’s University Belfast, Centre for Experimental Medicine, Belfast, United Kingdom; 2Northern Ireland Regional Adult CF Centre, Belfast City Hospital, Belfast, United Kingdom; 3Queen’s University Belfast, Belfast, United Kingdom; 4Royal College of Surgeons in Ireland (RCSI), Belfast, United Kingdom Objectives: Adherence to therapy is one of the greatest challenges in CF Care. Medication possession ratios can help measure adherence. In