The available data on medication adherence among chronic obstructive pulmonary disease (COPD) patients consistently indicates that adherence is a significant problem. This is a particularly distressing finding, considering that pharmacological therapy may be considered the backbone of COPD management in settings where comprehensive rehabilitation services are limited. Despite the importance of this issue and a large data base on how to enhance medication adherence among medical populations, there have been no empirical investigations evaluating the implementation of these strategies with COPD patients. Furthermore, the available literature fails to (a) adequately describe the complete patterns of medication utilization and (b) delineate factors which relate to poor adherence in this population. Accordingly, this application seeks to test the effectiveness of a self- management program to improve adherence which can be conducted by nurses or other clinic staff in settings where comprehensive rehabilitation services are not available. The proposed project will address this issue through a prospective, controlled study in which 230 emphysema and chronic bronchitis patients from an urban university medical center are randomized into either a """"""""usual care"""""""", control group or into a self-management skills training program for improving adherence. The training program is based on self- management procedures for enhancing adherence which have proven efficacious with diverse populations. the latter two issues will be addressed during a two month baseline period which precedes the controlled outcome study. Self-reported and objective measures of adherence will be examined during the two month baseline period and the one year follow-up in the controlled study. A range of possible covariates including demographics, patient characteristics, treatment, and therapeutic outcome variables will also be collected during the baseline phase and at the 6-month and 12-month follow- up visits in the controlled study to evaluate their relationship to the observed adherence levels.
