Fulvio Braido. Il corretto utilizzo dei devices erogatori quale fattore critico per il successo terapeutico

Transcript

1 Fulvio Braido Il corretto utilizzo dei devices erogatori quale fattore critico per il successo terapeutico

2 CHRONIC DISEASES MANAGEMENT DIAGNOSIS SYMPTOMS FUNCTIONAL PARAMETERS CONTROL DISEASES MANAGEMENT & TREATMENT COMORBIDITIES PROs Patient Reported Outcomes CONTROL QoL Quality of Life ADHERENCE To Treatment

3 15.1%

4 Carls et al JOEM 2012

5 Carls et al JOEM 2012

6 Costs of asthma Annual costs 17.7 billion European Lung White Book 2003

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8 Possible Avoidance REASONS for NON-ADHERENCE Switching to Different Formulary High Number of Daily Doses Complexity of Treatment Regimen Side Effects Patient Education Difficult Access to HCS Cost/Reimbursent Chronicity Patient Cognitive Features Patient Psycho Characters Impact on Adherence

9 2013 PAP

10 PAP Respiratory diseases management Perception and experience of the disease, adherence and attitudes towards the device PUBLIC PERCEPTION EXTENSIVE SURVEY

11 The methodology used Type of investigation: ad hoc quantitative Detection mode: Reference population: Sample: personal interviews (C.A.P.I. system) 30 minutes structured questionnaire men and women aged 15 years and over resident in the whole national territory interviews representative of the sample according to the main socio-demographic parameters Survey: from May 22 nd to June 7 th, 2012

12 PAP Sample demographic characteristics N of patients: 2008 AGE < >64 TOWN SIZE LITTLE < inhab. 59 MEDIUM inhab. 16 BIG > inhab. 25

13 Socio-economic condition EDUCATION JOB DIPLOMA WORKING EMPLOYEE 18 DEGREE 9 50 ELEMENTARY- SECONDARY TRADER, CRAFSTMAN 8 TECHNICIAN 6 WORKER 5 ENTREPRENEUR, FREELANCE PROFESSIONAL 5 TEACHER 2 SOCIO-ECONOMIC CATEGORY MIDDLE MANAGER 2 EXECUTIVE MANAGER 1 Medium-high High Low Medium FARMER 1 NOT WORKING 53 RETIRED HOUSEWIFE 12 Mediumlow STUDENT 10 UNEMPLOYED 6 N of patients: 2008

14 AWARENESS OF RESPIRATORY DISEASES diabetes Have you recently heard of any of the following diseases? 61 migraine artrosis hypertension ASTHMA osteoporosis 48 colitis hepatitis ASMA celiac disease BPCO 38 glaucoma 31 BPCO 14 PAP

15 La conoscenza delle malattie respiratorie Di recente Le è capitato di sentir parlare di qualcuna delle seguenti malattie? LIVELLO DI AWARENESS diabete emicrania artrosi ipertensione asma osteoporosi colite epatite celiachia glaucoma BPCO Rispondenti (totale campione): % Presso il general public la conoscenza delle malattie respiratorie croniche presenta consistenti discontinuità. Da un lato si è sentito parlare molto di asma, mentre la BPCO rimane un patologia ancora misconosciuta. Awareness per classi di età ASMA BPCO

16 La conoscenza delle malattie respiratorie Quanto direbbe di conoscere le seguenti malattie respiratorie croniche? GRADO DI CONSAPEVOLEZZA ASMA % 42 Livello medio-alto 13 BPCO Molto Abbastanza Poco Per niente Non sa Rispondenti: Sebbene l asma possa contare su un awareness piuttosto diffusa, le persone interpellate segnalano significative carenze informative (ancora più pesanti per la BPCO).

17 KNOWLEDGE ABOUT DRUGS USED According to you, the most used drugs to treat... are: ASTHMA COPD % Inhaled through a device Pills Mouth dissolving tablets Syrups Drops Sachets to be mixed with water Doesn t know \ Doesn t answer respondents: (have heard of the disease) PAP The knowledge of treatments based on devices is not universal. Doubts emerge more frequently for COPD.

18 Il vissuto delle malattie respiratorie IMPATTO SOCIALE DELLA PATOLOGIA Non conoscono persone malate di asma / BPCO Soffrono di asma / BPCO Hanno familiari che soffrono che soffrono di asma / BPCO famiglie interessate dalla patologia 13 Le malattie respiratorie croniche rappresentano a tutti gli effetti un problema sociale: oltre 3 milioni di famiglie devono confrontarsi con tali patologie. Rispondenti (totale campione): Conoscono / frequentano persone che soffrono di asma / BPCO % Scarsa consapevolezza diffusa, sintomatologia composita, complessità dei percorsi diagnostici: tali fattori sembrano influire sul riconoscimento della BPCO. sufferers ASMA BPCO 10 3 familiari malati sufferers familiari malati

19 USE OF THE INHALER DEVICE Respondents: suffer from asthma/copd USE OF THE INHALER DEVICE (%) 65 Patients currently using it % The use of device is less extended than we might expect. The percentage of abandoners is significant Patients who never used it Patients who used it in the past It should be noticed an intermittent use of the device: in most cases it is used as needed. PAP

20 PERCEPTION OF DEVICE EFFECTIVENESS I think that taking a brug by means of a device has a more rapid effect 9 3 I think that a drug taken by means of a device acts in a more precise way I agree I disagree I don't know I think that a drug taken by means of a device is more effective I agree I disagree I don't know I think that a drug taken by means of a device has a more prolonged effect over time I agree I disagree I don't know I agree I disagree I don't know

21 Gli atteggiamenti nei confronti del device Quanto è d'accordo con la seguente affermazione? Assumere un farmaco con l erogatore mi sembra più pratico e comodo ACCORDO 79 % Mi sento assolutamente in grado di far funzionare un erogatore ACCORDO 79 SENSAZIONE DI PRATICITA' del tutto d accordo parzialmente d accordo parzialmente in disaccordo del tutto in disaccordo non sa del tutto d accordo parzialmente d accordo parzialmente in disaccordo del tutto in disaccordo non sa Con l erogatore diventa più facile seguire una cura ACCORDO 73 Mi sembra complicato dover utilizzare l erogatore nella vita di ogni giorno, nella routine quotidiana DISACCORDO 57 del tutto d accordo parzialmente d accordo parzialmente in disaccordo del tutto in disaccordo non sa del tutto d accordo parzialmente d accordo parzialmente in disaccordo del tutto in disaccordo non sa Rispondenti: totale campione

22 USE OF THE DEVICE I think that taking a drug by means of a device is the best solution in case of respiratory diseases I think that taking a drug by means of a device could be a good solution for many other diseases I agree I disagree I don't know I agree I disagree I don't know I think that only less serious disorders can be treated with drugs taken by means of a device Using the device I would have the impression of following a mild treatment I agree I disagree I don't know I agree I disagree I don't know

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24 PROBLEMS WITH THE INHALER DEVICE Respondents: device users When you have been prescribed the treatment based on the assumption of inhaled drugs, has the physician explained to you how the inhaler % device should be used? Yes, exhaustively No, he hasn t explained anything Yes, in a generic way Yes, quite exhaustively 89% PAP In the great majority of cases patients undergoing inhalation therapy say to have received from the physician a sufficiently detailed explanation of how to use the device.

25 Respiratory medicine 2007 Only 21% of patients were able to correctly use a pmdi after reading the package insert and Only 52% of patients correctly used a pmdi after receiving instruction

26 Laube et al.erj 2011

27 van der Palen et al, ERJ 1999

28 WILLINGNESS TO CHANGE If I had to change my device, I would like to be told exactly how it works PAP I agree I disagree I don't know

29 WILLINGNESS TO CHANGE I would be willing to change the device I usually use if the physician told me PAP I agree I disagree I don't know

30 WILLINGNESS TO CHANGE If I had to change the drug, I would rather maintain the same type of device 12 7 PAP 81 I agree I disagree I don't know

31 Arch Intern Med. Published online December 31, 2012

32 Arch Intern Med. Published online December 31, 2012

33 Respiratory Medicine 2010 Outcome of asthma treatment during study year 2 for patients whose inhaled corticosteroid device was switched without an accompanying consultation (switched cohort) and matched controls

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37 LIVELLO DI ACCORDO Gli atteggiamenti nei confronti del device MOTIVI DI ADESIONE DRIVERS FONDAMENTALI VANTAGGI MARGINALI OPPORTUNITA PROSPETTICHE IMPORTANZA LATENTE

38 LIVELLO DI ACCORDO Gli atteggiamenti nei confronti del device BARRIERE PROBLEMI MARGINALI CRITICITA FONDAMENTALI RESISTENZE CIRCOSCRITTE IMPORTANZA LATENTE

39 COSTS ADHERENCE Implementation Strategies Media Campaigns MD students Education Interactions HCS CME-Meetings Opinion Leaders Scientific Societies HC Blogs Blogs Internet Social Networks Patient Organizations EFFECTIVENESS patient/physician partnership Patient Education

40 Charles et al. JACI 2007

41 Garbutt et al. Arch.Ped.Adolesc.Med.2010

42 LATE BREAKING NEWS

43 Possible Avoidance REASONS for NON-ADHERENCE Switching to Different Formulary High Number of Daily Doses Complexity of Treatment Regimen Side Effects Patient Education Difficult Access to HCS Cost/Reimbursent Chronicity Patient Cognitive Features Patient Psycho Characters Impact on Adherence

44 TAKE HOME MESSAGES Adherence is a moral responsability It s mandatory to support the Patients in any way to be adherent (No Switching to Different Formulary) The wisest investement is in Education

45 Fulvio Braido Il corretto utilizzo dei devices erogatori quale fattore critico per il successo terapeutico