How can adherence to asthma medication be enhanced? Triangulation of key asthma stakeholders' perspectives

Abstract

Asthma medication adherence is a complex process and successful interventions aimed at its improvement would benefit from: (a) making an effort to understand patients' experiences and negotiate the treatment regimen, rather than imposing recommendations; (b) considering treatment as a shared responsibility involving the patient, the healthcare professional(s), and the patients' social networks; and,

Understanding patients' perceptions of asthma control: a qualitative study

“…Insufficient information on the "what to" and "how to" communicate with asthmatic patients has been identified previously for explaining the poor uptake of self-management plans and guideline use by primary care professionals [31]. The timing of discussions around adherence also seems to be critical factor [32]. Furthermore, effective collaboration between healthcare professionals and patients with asthma was found to be hampered by failure of the healthcare professionals to elicit, and the patient to disclose, health beliefs inconsistent with Western medicine or those that are simply inaccurate [33].…”

<p>Understanding Patient Perspectives on Medication Adherence in Asthma: A Targeted Review of Qualitative Studies</p>

“…Patients often questioned their diagnosis due to lack of a clear diagnosis from their physician, denial on their part, or distrust of the medical community. 18,24,[32][33][34][35]42 Lingner et al 33 engaged adult patients (20-77 years old) in focus group discussions and noted that patients reported a lack of consensus across physicians (primary care vs specialists) on the diagnosis of asthma. Murdoch et al 42 conducted face-toface interviews with patients (17-80 years old) and noted that patients believed there is uncertainty in medical knowledge.…”

“…Interestingly, for many patients, doubts about the accuracy of their diagnosis may have been based on them not wanting to acknowledge that they had a chronic disease requiring longterm (potentially life-long) treatment. 18,35,42 Skepticism about the accuracy of asthma diagnosis was harbored by patients across age groups. McDonald et al 24 reported that the absence of a diagnosis, a protracted diagnosis, or a missed diagnosis was a concern for many older patients (≥55 years old), with some patients expressing frustration with repeated attempts to confirm their diagnosis.…”

“…You never know" 34 Perceived concerns about side effects "I had to take steroids, which has made me gain weight, which has sort of kept me from exercising" 40 Perceived medication affordability "My physician told me to take my medication in the mornings and in the evenings, but I take it every two days because that's a lot of money" 34 well; however, when exacerbations occurred or symptoms became pronounced, patients reverted to their asthma medication. 24,28,[30][31][32][33][34][35] This took the form of overuse of reliever inhalers, 39 as-needed use of maintenance medication, 24,26,30,35 or both. 31,32 Despite having experienced asthma attacks or exacerbations, many patients felt that their daily life and daily functioning were relatively unaffected by asthma.…”

“…Unstructured medication use was also observed, wherein the maintenance inhaler was not used consistently, with an increase in asthma symptoms triggering the intake of asthma medication. 32 Similarly, Peláez et al 35 described asthma as "a disease experienced along a continuum," where symptom-free intervals led to patients neglecting the importance of daily preventive medication. 35 McDonald et al 24 described intentional nonadherence whereby treatment was self-titrated according to patients' perceived needs and symptoms.…”