Validation of The Asthma Adherence Management Model (AAMM)
Saturday, March 3, 2018
South Hall A2 (Convention Center)
Andrew G. Weinstein, MD FAAAAI, Deborah A. Gentile, MD, Anil Singh, David P. Skoner, MD, Jennifer Maiolo, Rihab Sharara, Kiet Ma, Tariq Cheema, Erica Butler, Allison Kong
RATIONALE: AAMM postulates that to improve adherence one should apply together: objective monitoring, identification of barriers; enhanced communication skills to deliver barrier-specific adherence strategies (JACIIP 2013)

METHODS: 40 asthma patients mean 45 yrs ( 25 F) were placed into an 3 month prospective nested study of the Asthma Adherence Pathway WebApp (AAP). Treatment (Tx) and Control (C) physicians (allergist/pulmonologists) utilized Dulera 100/200 following NHLBI guidelines. Tx and C subjects had poor asthma control at entry, defined by Asthma Control Questionnaire (ACQ) >1.0. ACQ-was measured at entry and 3 mo for Tx and C subjects. Tx subjects only 1) completed the AAAP identifying adherence barriers; 2) monitored monthly for Dulera adherence (DA) by SmartInhaler. Tx adherence was determined by the mean of 4 measures over 3-months. Tx physicians were trained in Motivational Interviewing using AAP strategies to promote DA. C subjects were not monitored for DA.

RESULTS: Treatment DA 81%. Mean baseline ACQ for Treatment (ACQ MTx=1.86, SD=0.92, N=19) and Control (ACQMC =1.59, SD=0.84, N=20) subjects did not differ. (t(37)=-0.94, p=0.35). A repeated-measures ANOVA using a within-subjects (Study Entry vs. Study End) and a between-subjects (Treatment vs. Control) factors was performed on the ACQ outcome. The time*group interaction was significant (F(1,37)=4.26, p=0.046) indicating The Tx showed greater improvement (0.75 ACQ units) than C (0.19 ACQ units). Tx had 13 subjects achieve Minimal Important Difference (defined as an improvement of greater than or equal to 0.5 units on the ACQ), compared to C 6 subjects, χ2(1)=5.76, p=.016.

CONCLUSIONS: Improvement in ACQ and high DA validates AAMM.