Technophobia is not the most significant patient-reported barrier to accepting a digital adherence package: an analysis of the MAGNIFY trial.

Introduction
COPD exacerbations lead to increased mortality and disease progression. Maintenance inhaled therapies can reduce exacerbation risk amongst COPD patients, but non-adherence reportedly ranges from 20-60% in this population. The ongoing cluster randomised trial (MAGNIFY) is investigating the use of digital adherence support as a solution to this problem, but there is little evidence regarding patients’ willingness to accept such devices.
Aims and objectives
To explore patient-reported barriers to accepting a technological adherence package.
Methods
COPD patients were screened for eligibility for the UK-based MAGNIFY trial (Price et al 2021 doi:10.2147/POR.S302809), with main inclusion criteria being aged 40 years or above, with ≥2 moderate/severe exacerbations in the last two years and with ≤50% adherence to mono/dual therapy. Eligible patients received a phone call from a pharmacist who conducted a remote patient review and
invited them to use the digital support package, comprising an Ultibro Breezhaler and adherence support technology (Propeller Health). Patients unwilling/unable to accept the package were asked to provide reasons.
Results
87 participating practices had a total COPD list size of 33211 patients, of which 1833 patients met the trial eligibility criteria. Pharmacists excluded 541 patients following electronic medical record review, and were unable to contact a further 111 patients. Of the 1181 patients contacted, 73 were clinically unsuitable for the adherence package. Of the remaining 1108 patients, 395 (36%) were
unwilling/unable to accept the adherence package; reasons included: no smartphone/incompatible phone (n=273), unwilling to change inhaler (n=71), unwilling to use the support package (n=19), life events (n=12), partially sighted (n=2), no reason (n=18). Patient demographics are reported in Table
1.
Conclusions
The main reasons for not accepting the adherence package were due to lacking a compatible smartphone or not wanting to change inhaler, rather than unwillingness to use technology. Though this is data from a single trial, the patients are from multiple diverse practices. The data suggest that technophobia may not be the most important barrier to patients accepting digital adherence support. A quarter of invited patients did not have a smartphone, highlighting the need for future implementation to ensure equitable access to digital support.