An Empirical Method to Cluster Objective Nebulizer Adherence Data Among Adults with Cystic Fibrosis

Overview

Journal Patient Prefer Adherence

Date 2017 Apr 11

PMID 28392678

Citations 5

Authors

Zhe H Hoo

Michael J Campbell

Rachael Curley

Martin J Wildman

Affiliations

Soon will be listed here.

Abstract

Background: The purpose of using preventative inhaled treatments in cystic fibrosis is to improve health outcomes. Therefore, understanding the relationship between adherence to treatment and health outcome is crucial. Temporal variability, as well as absolute magnitude of adherence affects health outcomes, and there is likely to be a threshold effect in the relationship between adherence and outcomes. We therefore propose a pragmatic algorithm-based clustering method of objective nebulizer adherence data to better understand this relationship, and potentially, to guide clinical decisions.

Methods To Cluster Adherence Data: This clustering method consists of three related steps. The first step is to split adherence data for the previous 12 months into four 3-monthly sections. The second step is to calculate mean adherence for each section and to score the section based on mean adherence. The third step is to aggregate the individual scores to determine the final cluster ("cluster 1" = very low adherence; "cluster 2" = low adherence; "cluster 3" = moderate adherence; "cluster 4" = high adherence), and taking into account adherence trend as represented by sequential individual scores. The individual scores should be displayed along with the final cluster for clinicians to fully understand the adherence data.

Three Illustrative Cases: We present three cases to illustrate the use of the proposed clustering method.

Conclusion: This pragmatic clustering method can deal with adherence data of variable duration (ie, can be used even if 12 months' worth of data are unavailable) and can cluster adherence data in real time. Empirical support for some of the clustering parameters is not yet available, but the suggested classifications provide a structure to investigate parameters in future prospective datasets in which there are accurate measurements of nebulizer adherence and health outcomes.

Citing Articles

Implementing the use of objective medication adherence data in routine clinical practice via the digital CFHealthHub platform: situation analysis and strategy development using the theoretical domains framework.

Girling C, Packham A, Robinson L, Arden M, Hind D, Wildman M Implement Sci Commun. 2022; 3(1):12.

PMID: 35135620 PMC: 8822811. DOI: 10.1186/s43058-022-00263-9.

Mechanisms of Action of a Web-Based Intervention With Health Professional Support to Increase Adherence to Nebulizer Treatments in Adults With Cystic Fibrosis: Qualitative Interview Study.

Drabble S, OCathain A, Scott A, Arden M, Keating S, Hutchings M J Med Internet Res. 2020; 22(10):e16782.

PMID: 32697197 PMC: 7576463. DOI: 10.2196/16782.

When Is Forgetting Not Forgetting? A Discursive Analysis of Differences in Forgetting Talk Between Adults With Cystic Fibrosis With Different Levels of Adherence to Nebulizer Treatments.

Drabble S, OCathain A, Arden M, Hutchings M, Beever D, Wildman M Qual Health Res. 2019; 29(14):2119-2131.

PMID: 31303116 PMC: 7322938. DOI: 10.1177/1049732319856580.

Understanding patient activation and adherence to nebuliser treatment in adults with cystic fibrosis: responses to the UK version of PAM-13 and a think aloud study.

Gao J, Arden M, Hoo Z, Wildman M BMC Health Serv Res. 2019; 19(1):420.

PMID: 31234848 PMC: 6591841. DOI: 10.1186/s12913-019-4260-5.

A pragmatic behavior-based habit index for adherence to nebulized treatments among adults with cystic fibrosis.

Hoo Z, Wildman M, Campbell M, Walters S, Gardner B Patient Prefer Adherence. 2019; 13:283-294.

PMID: 30863018 PMC: 6388736. DOI: 10.2147/PPA.S186417.

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