P209 Impact of Patient Satisfaction with Their Maintenance Inhaler on Treatment Compliance and Health Outcomes in Chronic Obstructive Pulmonary Disease: An Analysis of Real-World Clinical Practise in Europe

Introduction and objective Compliance with prescribed treatment is often suboptimal in patients with chronic obstructive pulmonary disease (COPD). This analysis examined the relationships between inhaler satisfaction, compliance and health outcomes. Methods Data were analysed from a large, cross-sectional survey of real-world clinical practise conducted in five European countries. Respiratory specialists and primary care physicians provided information on six consecutive patients with COPD (aged ≥40 years with history of smoking). The same patients were then asked to voluntarily complete a self-assessment form. Physicians scored patient compliance with prescribing instructions (5-point Likert scale: 1=‘not at all compliant’; 5=‘fully compliant’) and patients rated overall satisfaction with their maintenance inhaler (7point Likert scale: 1=‘not at all satisfied’; 7=‘very satisfied’). Health outcomes assessments included exacerbations, the modified Medical Research Council dyspnoea scale, the EuroQoL (EQ-5D) instrument and the Jenkins Sleep Questionnaire. Sequential regression was used to analyze the relationship between inhaler attributes and overall satisfaction. Least-squares regression and additive models were used to analyze the relationships between inhaler satisfaction, compliance and health outcomes. Results Data were included for 1443 patients for whom self-completed and matched physician-completed record forms were available. The majority of patients (71.8%) were male; mean age was 65.2 years. Very few patients (0.7%) were ‘not at all compliant’ with their physician’s prescribing instructions, whilst 33.3% were ‘fully compliant’. Most patients (75.1%) were more satisfied with their inhaler than not; 6.6% were ‘very satisfied’. Key attributes influencing satisfaction related to durability, ergonomics and ease of use. There was a significant association between inhaler satisfaction and compliance (χ2 − df=89.7; p<0.001). Other factors related to greater compliance, though to a lesser degree, were fewer maintenance drugs (χ2 − df=17.7; p<0.001) and male gender (χ2 − df=2.9; p<0.05). Severity of breathlessness, age and ethnicity were not significantly associated with compliance (p>0.05). Higher compliance scores were significantly associated with better health outcomes (Table). There was also a direct association between inhaler satisfaction and better health outcomes (exacerbations and EQ-5D, p<0.001). Abstract P209 Table 1 Association with health outcomes N R 2 p-value Relationship between health outcomes and increasing compliance score Fewer exacerbations in past 12 monthsa 1403 0.037 <0.001 Fewer exacerbations managed through hospitalisation in past 12 monthsa 1084 0.025 <0.001 Lower mMRC dyspnoea scale scorea 1419 0.031 <0.0001 Higher EQ-5D scoreb 1422 0.035 <0.0001 Lower Jenkins Sleep Indexb 1402 0.064 <0.0001 Relationship between health outcomes and increasing inhaler satisfaction Fewer exacerbations in past 12 monthsa 944 0.032 <0.001 Higher EQ-5D scoreb 959 0.030 <0.001 a Physician-reported; bpatient-reported Coefficient of determination (R2) derived from generalised additive models EQ-5D, EuroQoL-5 dimensions; mMRC, modified Medical Research Council Conclusions Inhaler satisfaction appears to be significantly associated with COPD treatment compliance, and patients with greater compliance experience better health outcomes, including less frequent exacerbations.