General Practitioner Use of Generically Substitutable Inhaler Devices and the Impact of Training on Device Mastery and M
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ORIGINAL RESEARCH
General Practitioner Use of Generically Substitutable Inhaler Devices and the Impact of Training on Device Mastery and Maintenance of Correct Inhaler Technique Biljana Cvetkovski
. Charlotte Hespe . Rachel Tan .
Vicky Kritikos . Elizabeth Azzi . Sinthia Bosnic-Anticevich
Received: July 15, 2020 Ó The Author(s) 2020
ABSTRACT Introduction: Generic substitution of inhaler devices is a relatively new phenomenon. The best patient outcomes associated with generic substitution occur when prescribers obtain consent from their patients to prescribe a generic inhaler and also teach their patient how to correctly use the new device. To date, no prospective observational study has assessed the level of training required for general practitioners (GPs) to demonstrate correct inhaler technique using two dry powder inhaler devices delivering fixed-dose combination budesonide/formoterol therapy. This study aims to Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12933002. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s41030020-00131-8) contains supplementary material, which is available to authorized users. B. Cvetkovski (&) R. Tan V. Kritikos E. Azzi S. Bosnic-Anticevich Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia e-mail: [email protected] C. Hespe School of Medicine, The University of Notre Dame Australia, Sydney, Australia S. Bosnic-Anticevich Sydney Local Health District, Sydney, Australia
(1) determine the level of training required for GPs to master and maintain correct IT when using two different dry powder inhalers that are able to be substituted in clinical practice and (2) determine the number and types of errors made by GPs on each device and inhaler device preference at each training visit. Method: A randomized, parallel-group crossover study design was used to compare the inhaler technique of participants with a SpiromaxÒ placebo device and a TurbuhalerÒ placebo device. This study consisted of two visits with each participant over a period of 4 ± 1 weeks (visit 1 and visit 2). A total of six levels of assessment and five levels of training were implemented as required. Level 1, no instruction; level 2, following use of written instruction; level 3, following viewing of instructional video; level 4, expert tuition from the researcher; level 5/level 6, repeats of expert tuition from the researcher when required. Participants progressed through each level and stopped at the point at which they demonstrated device mastery. At each level, trained researchers assessed the inhaler technique of the participants. Participants were also surveyed about their previous inhaler use and training. Results: In total, 228 GPs participated in this study by demonstrating their ability to use a TurbuhalerÒ and a SpiromaxÒ device. There was no significant difference between the proportion of participants who demonstra
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