Page 152 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Chapter 9
non-medical costs such as days out of work or the impact of asthma on daily work performance [32;33] and as a result the calculation of total costs might be partially underestimated. Nevertheless, the strong associations between adherence to the internet system and each category of medical consumption reassure the impact of higher adherence to treatment in improving outcomes.
The reduction in costs in our study was primarily related to fewer visits to health care professionals, and only weakly to a reduction in emergency visits and severe asthma exacerbations. This was not an unexpected finding. The original study [6] was designed to continuously taper the prednisone dose, potentially leading to a destabilization of the disease. However, for safety reasons, the study nurse could interfere in case of a developing exacerbation, and prevent the patient to have unscheduled visits to their health care professionals or hospital. It is to be expected that without this interference, the exacerbation rate amongst non-adherent patients would have been much higher.
It is likely that a virtuous circle was created in this study: the patient’s adherence to the internet-management led to lower prednisone consumption and better outcomes which reinforced the adherence to the internet system and continuation with the trial. In addition, it is plausible that high adherence to the internet tool is an indication of high adherence to medications and other treatments in general. Together, all these positive effects explain why patients with higher level of adherence to the internet system required fewer appointments with health specialists and generated lower costs.
Implications
The results from the present study have some valuable implications, particularly in the management of patients with complex treatment regimens. Non- adherence in patients with chronic diseases is a difficult problem to be solved [34;35]. Real time interaction using an internet-feedback system can improve the situation. In this study we show that the use of an internet-based tool may be an efficient way to measure the level of adherence to a complex treatment regimen. Patients with low adherence to the internet management can this way be detected, have the chance to be coached more intensively through the system and consecutively improve their health.
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