The Global Usability Score Short-Form for the simplified assessment of dry powder inhalers (DPIs) usability

  • Massimiliano Povero | m.povero@adreshe.com AdRes Health Economics and Outcome Resources, Turin, Italy.
  • Paola Turco Research and Clinical Governance, Verona, Italy.
  • Luca Bonadiman National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology, Verona, Italy.
  • Roberto W. Dal Negro National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology, Verona, Italy.

Abstract

Background: The choice of the Dry Powder Inhaler (DPI) to prescribe is a critical issue. The estimation of DPIs usability depends on the objective assessment of several indices related to both subjective and objective determinants. The Global Usability Score (GUS) Questionnaire is a comprehensive tool usable for checking, comparing, and ranking inhalers’ usability objectively in real life, but it takes some time to fill.
Aim: The aim of this study was to favour the quicker check of DPIs usability in clinical practice by means of a simplified short-form GUS (S-GUS) Questionnaire, while maintaining the high specificity and sensitivity of the original, extended version of the Questionnaire (O-GUS questionnaire).
Methods: The usability of the six most prescribed DPIs was assessed in 222 patients with persistent airway obstruction and needing long-term inhalation treatments. LASSO regression and multicollinearity test were used to select the subset of questions of the O-GUS questionnaire, with the highest information power. Each item was then scored using the corresponding coefficient in the linear regression (normalized at 50 as the O-GUS score). Agreement between the original and the short-form questionnaire was evaluated using the Cohen’s kappa statistic (κ). The overall S-GUS values obtained for each DPI were then compared to those from the O-GUS, in the same patients, using a Bayesian indirect comparison (IC) model.
Results: After the statistical selection of the items mostly contributing to the overall score, the novel S-GUS questionnaire consists of twelve items only. Nine items are related to patients’ opinion before DPIs handling, and three to the nurse’s assessment after DPIs practicality. O-GUS and S-GUS score were strongly correlated (R2=0.9843, p<0.0001) and the usability score calculated for each DPI by means of the O- and of S- GUS overlapped almost completely (κ=84.5%, 95% CI 81.3% to 89.2%). Furthermore, S-GUS was much faster to complete than O-GUS (mean time 6.1 vs 23.4 minutes, p<0.001). Estimates of S-GUS, obtained from the IC model, allowed to propose a simple classification of usability: “good” by GUS values >25; “pretty good” by values ≤25≥15, and “insufficient” by values <15.
Conclusions: The S-GUS proves as much specific and suitable as the extended O-GUS questionnaire in measuring DPIs usability, while maintaining the same high sensitivity. As the time required for its use is quite shorter, S-GUS is also particularly suitable and helpful in current clinical practice.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

References

Newman SP, Busse WW. Evolution of dry powder inhaler design, formulation, and performance. Respir Med 2002;96: 93-304.

Wieshammer S, Dreyhaupt J. Dry powder inhalers: which factors determine the frequency of handling errors? Respiratio. 2008;75:18-25. DOI: https://doi.org/10.1159/000109374

Chapman KR, Fogarty CM, Peckitt C, Lassen C, Jadayel D, Dederichs J, et al. Delivery characteristics and patients’ handling of two single-dose dry powder inhalers used in COPD. Int J Chron Obstruct Pulmon Dis 2011;6:353-6.

Barrons R, Pegram A, Borrens A. Inhaler device selection: special considerations in elderly patients with chronic obstructive pulmonary disease. Am J Health Syst Pharm 2011;1221-32. DOI: https://doi.org/10.2146/ajhp100452

Barry PW, O’Callagnan C. The influence of inhaler selection on efficacy of asthma therapies. Adv Drug Deliv Res 2003;55:879-923. DOI: https://doi.org/10.1016/S0169-409X(03)00083-8

Gustafsson P, Taylor A, Zanen P, Chrystyn H. Can patients use all dry powder inhalers equally well? Int J Clin Pract Suppl 2005;59:13-18. DOI: https://doi.org/10.1111/j.1368-504X.2005.00722.x

Melani AS. Inhalatory therapy training: a priority challenge for the physician. Acta Biomed 2007;78:233-45.

Thomas M, Williams AE. Are outcomes the same with all dry powder inhalers? Int J Clin Pract Suppl 2005;149:33-5. DOI: https://doi.org/10.1111/j.1368-504X.2005.00726.x

Chrystyn H. Do patients show the same level of adherence with all dry powder inhalers? Int J Clin Pract Suppl 2005;149:19-25. DOI: https://doi.org/10.1111/j.1368-504X.2005.00723.x

Franks M, Briggs P. Use of a cognitive ergonomics approach to compare usability of a multidose dry powder inhaler and a capsule dry powder inhaler: an open label, randomized, controlled study. Clin Ther 2004;26:1791-9. DOI: https://doi.org/10.1016/j.clinthera.2004.11011

Virchow JC, Crompton GK, Dal Negro R, Pedersen S, Magnan A, Seidenberg J, et al. Importance of inhaler devices in the management of airway disease. Respir Med 2008;102:10-9. DOI: https://doi.org/10.1016/j.rmed.2007.07.031

Lenney J, Innes JA, Crompton GK. Inappropriate inhaler use: assessment of use and patient preference of seven inhalation devices. EDICI. Respir Med 2000;94:496-500. DOI: https://doi.org/10.1053/rmed.1999.0767

Anderson P. Patient preference for and satisfaction with inhaler devices. Eur Respir Rev 2005;96:109-16. DOI: https://doi.org/10.1183/09059180.05.00009606

Tordera PM, Viejo JL, Sanchis J, Badia X, Cobos N, Picado C, et al. Assessment of patient satisfaction and preferences with inhalers in asthma with the FSI-10 Questionnaire. Arch Broncopneumol 2008;44:346-52. DOI: https://doi.org/10.1016/S1579-2129(08)60060-9

Schulte M, Osseiran K, Betz R, Wenker M, Brand P, Meyer T, et al. Handling of and preferences for available dry powder inhaler systems by patients with asthma and COPD. J Aerosol Med Pulm Drug Deliv 2008;21:321-8. DOI: https://doi.org/10.1089/jamp.2007.0634

Hodder R, Price D. Patient preferences for inhaler devices in chronic obstructive pulmonary disease: experience with Respimat Soft Mist Inhaler. Int J Chron Obstruct Pulmon Dis 2009;4:381-90. DOI: https://doi.org/10.2147/COPD.S3391

van der Polen J, Ginko T, Kroker A, van der Valk P, Goosens M, Padullés L, et al. Preference, satisfaction an errors with two dry powder inhalers in patients with COPD. Expert Opin Drug Deliv 2013;10:1023-31. DOI: https://doi.org/10.1517/17425247.2013.808186

Hantulik P, Wittig K, Henschel Y, Ochse J, Vahteristo M, Rytila P. Usage and usability of one powder inhaler compared to other inhalers at therapy start: an open, non-interventional observational study in Poland and Germany. Pneumol Allergol Pol 2015;83:365-77. DOI: https://doi.org/10.5603/PiAP.2015.0059

Kozma CM, Slaton TL, Monz BU, Hodder R, Reese PR. Development and validation of a patient satisfaction and preference questionnaire for inhalation devices. Treat Respir Med 2005;4:41-52. DOI: https://doi.org/10.2165/00151829-200504010-00005

Rajan SK, Gogtay JA. Ease-of-use, preference, confidence, and satisfaction with Revolizer, a novel dry powder inhaler, in an Indian population. Lung India 2014;31:366-37. DOI: https://doi.org/10.4103/0970-2113.142122

Zervas E, Samitas K, Gaga M. Assessment of satisfaction with different dry powder inhalation devices in Greek patients with COPD and asthma: the ANASA study. Int J Chron Obstruct Pulmon Dis 2016;11:1845-55. DOI: https://doi.org/10.2147/COPD.S113870

Dal Negro RW, Turco P, Povero M. The Global Usability Score: A novel comprehensive tool for assessing, ranking, and compare usability of inhalers in patients requiring airway treatments. Pulm Respir Med 2017;7:2.

Dal Negro RW, Povero M. Usability and cost-of-usability of three Dry powder inhalers (DPIs) in patients with Chronic Obstructive Pulmonary Disease (COPD): may these variables influence the health technology assessment of DPIs? Chronic Obstr Pulm Dis 2016;1:2-12. DOI: https://doi.org/10.21767/2572-5548.100012

Dal Negro RW, Turco P, Povero M. Patients’ usability of seven most used dry-powder inhalers in COPD. Multidiscip Respir Med 2019;14:30. DOI: https://doi.org/10.1186/s40248-019-0192-5

Tibshirani R. Regression Shrinkage and Selection via Lasso. J R Statist Soc B 1996;58:267-88. DOI: https://doi.org/10.1111/j.2517-6161.1996.tb02080.x

Altman DG, Andersen PK. Bootstrap investigation of the stability of a Cox regression model. Stat Med 1989;8:771-83. DOI: https://doi.org/10.1002/sim.4780080702

Derksen S, Keselman HJ. Backward, forward and stepwise automated subset selection algorithm: Frequency of obtaining authentic and noise variables. Brit J Math Stat Psychol 1992;45:265-82. DOI: https://doi.org/10.1111/j.2044-8317.1992.tb00992.x

Sheather SJ. A modern approach to regression with R. New York, NY; Springer; 2009. DOI: https://doi.org/10.1007/978-0-387-09608-7

Dias S, Sutton AJ, Ades AE, Welton NJ. Evidence synthesis for decision making 2: A generalized linear modeling framework for pairwise and network meta-analysis of randomized controlled trials. Med Decis Making 2013;33:607-17. DOI: https://doi.org/10.1177/0272989X12458724

Salanti G, Ades AE, Ioannidis PA. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol 2011;64:163-71. DOI: https://doi.org/10.1016/j.jclinepi.2010.03.016

David J, Spiegelhalter, NGB, Bradley PC, van der Linde A. Bayesian measures of model complexity and fit. J R Statist Soc B 2002;64:583-639. DOI: https://doi.org/10.1111/1467-9868.00353

Self TH, Arnold LB, Csosnowski LM, Swanson JM, Swanson H. Inadequate skill of health care professionals in using asthma inhalation devices. J Asthma 2007;44:593-8. DOI: https://doi.org/10.1080/02770900701554334

Published
2020-07-21
Info
Issue
Section
Original Research Articles
Keywords:
inhalation devices, dry powder inhalers, usability, global usability score, GUS, GUS short-form, bronchial asthma, COPD
Statistics
  • Abstract views: 609

  • PDF: 93
  • HTML: 0
How to Cite
Povero, M., Turco, P., Bonadiman, L., & Dal Negro, R. W. (2020). The Global Usability Score Short-Form for the simplified assessment of dry powder inhalers (DPIs) usability. Multidisciplinary Respiratory Medicine, 15. https://doi.org/10.4081/mrm.2020.659

Most read articles by the same author(s)