Modifiable barriers to adherence to inhaled steroids among adults with asthma: It's not just black and white

Apter, Andrea J.; Boston, Ray; George, Maureen; Norfleet, A.Lorraine; TenHave, Thomas R.; Coyne, James C.; Birck, Kathleen; Reisine, Susan; Cucchiara, Andrew J.; Feldman, Harold I.

doi:10.1067/mai.2003.1479

Cited by 246 publications

(204 citation statements)

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“…1,2 However, adherence to ICS medication tends to be quite low, especially among older adults, among whom only 40 % use ICS medications as prescribed by their physicians. [2][3][4][5] Sub-optimal adherence to ICS among older adults is a major public health concern because of the large number of individuals affected and the particular vulnerability of this population to poor outcomes. Asthma affects up to 9 % of the US population over the age of 65 years.…”

Section: Introductionmentioning

confidence: 99%

Strategies Used by Older Adults with Asthma for Adherence to Inhaled Corticosteroids

et al. 2014

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BACKGROUND: Older adults with asthma have low levels of adherence to their prescribed inhaled corticosteroids (ICS). While prior research has identified demographic and cognitive factors associated with ICS adherence among elderly asthmatics, little is known about the strategies that older adults use to achieve daily use of their medications. Identifying such strategies could provide clinicians with useful advice for patients when counseling their patients about ICS adherence. OBJECTIVE: To identify medication use strategies associated with good ICS adherence in older adults. PARTICIPANTS: English-speaking and Spanishspeaking adults ages 60 years and older with moderate or severe asthma were recruited from primary care and pulmonary practices in New York City, NY, and Chicago, IL. Patients with chronic obstructive pulmonary disease, other chronic lung diseases or a smoking history of greater than 10 pack-years were excluded. MAIN MEASURES: Medication adherence was assessed with the Medication Adherence Rating Scale (MARS). Medication use strategies were assessed via open-ended questioning. "Good adherence" was defined as a mean MARS score of 4.5 or greater. KEY RESULTS: The rate of good adherence to ICS was 37 %. We identified six general categories of medication adherence strategies: keeping the medication in a usual location (44.2 %), integrating medication use with a daily routine (32.6 %), taking the medication at a specific time (21.7 %), taking the medication with other medications (13.4 %), using the medication only when needed (13.4 %), and using other reminders (11.9 %). The good adherence rate was greater among individuals who kept their ICS medication in the bathroom (adjusted odds ration [AOR] 3.05, 95 % CI 1.03-9.02, p=0.04) or integrated its use into a daily routine (AOR 3.77, p=0.002). CONCLUSIONS: Keeping ICS medications in the bathroom and integrating them into daily routines are strategies associated with good ICS adherence. Clinicians concerned with adherence should consider recommending these strategies to their older asthmatic patients, although additional research is needed to determine whether such advice would improve adherence behaviors.

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Section: Introductionmentioning

confidence: 99%

Strategies Used by Older Adults with Asthma for Adherence to Inhaled Corticosteroids

et al. 2014

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“…Poor adherence to ICS medication is associated with increased asthmarelated emergency department visits and hospitalizations and an increased need for oral corticosteroids (1,4). Differences in medication adherence by race-ethnicity exist and have been noted in several studies (2,(5)(6)(7)(8). This may be the result of external factors, such as income, possession of commercial health insurance (5), psychosocial stressors (e.g., residential crime rates) (2,9), and characteristics of the facility where care is provided (6).…”

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confidence: 99%

Race-Ethnic Differences in Factors Associated with Inhaled Steroid Adherence Among Adults with Asthma

2009

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Rationale: Adherence to inhaled corticosteroid (ICS) medication is known to be low overall, but tends to be lower among AfricanAmerican patients when compared with white patients. Objectives: To understand the factors that contribute to ICS adherence among African-American and white adults with asthma. Methods: Eligible individuals had a prior diagnosis of asthma, one or more ICS prescriptions, and were members of a large health maintenance organization in southeast Michigan. Individuals were sent a survey that included questions about internal factors (e.g., patient beliefs, knowledge, and motivation) and external factors (e.g., socioeconomic status, barriers to care, social support, and stressors) potentially related to ICS adherence. Adherence was calculated using electronic prescription and fill data. Stepwise regression was used to identify factors associated with adherence before and after stratifying by race-ethnicity. Measurements and Main Results: Surveys were returned by 1,006 (56.3%) of 1,787 eligible patients. Adjusting for internal factors, but not external factors, diminished the relationship between raceethnicity and ICS adherence. Among African-American patients, readiness to take ICS medication was the only internal or external factor significantly associated with ICS adherence; it explained 5.6% of the variance in adherence. Among white patients, perceived ICS necessity, ICS knowledge, doctors being perceived as the source of asthma control, and readiness to take medication were the internal factors associated with ICS adherence; these accounted for 19.8% of the variance in adherence. Conclusions: Factors associated with ICS adherence appear to differ between African-American and white patients, suggesting that group-specific approaches are needed to improve adherence.

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“…8,9 Studies have suggested a link between parental beliefs about medications and their child's adherence to asthma treatment. [10][11][12][13][14] Child adherence was revealed to decrease as parental concerns about medications exceeded their belief in the necessity of the medications. 10 Parental concerns about asthma medications were linked to increased CAM use.…”

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Complementary and Alternative Medicine Use and Adherence With Pediatric Asthma Treatment

Philp¹,

Maselli

Pachter

et al. 2012

Pediatrics

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BACKGROUND AND OBJECTIVE: Complementary and alternative medicine (CAM) use for pediatric asthma is increasing. The authors of previous studies linked CAM use with decreased adherence to conventional asthma medicines; however, these studies were limited by cross-sectional design. Our objective was to assess the effect of starting CAM on pediatric adherence with daily asthma medications. METHODS: We used a retrospective cohort study design. Telephone surveys were administered to caregivers of patients with asthma annually from 2004 to 2007. Dependent variables were percent missed doses per week and a previously validated “Medication Adherence Scale score.” Independent variables included demographic factors, caregiver perception of asthma control, and initiation of CAM for asthma. We used multivariate linear regression to assess the relationship between medication adherence and previous initiation of CAM. RESULTS: From our longitudinal data set of 1322 patients, we focused on 187 children prescribed daily medications for all 3 years of our study. Patients had high rates of adherence. The mean percent missed asthma daily controller medication doses per week was 7.7% (SD = 14.2%). Medication Adherence Scale scores (range: 4–20, with lower scores reflecting higher adherence) had an overall mean of 7.5 (SD = 2.9). In multivariate analyses, controlling for demographic factors and asthma severity, initiation of CAM use was not associated with subsequent adherence (P > .05). CONCLUSIONS: The data from this study suggest that CAM use is not necessarily “competitive” with conventional asthma therapies; families may incorporate different health belief systems simultaneously in their asthma management. As CAM use becomes more prevalent, it is important for physicians to ask about CAM use in a nonjudgmental fashion.

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Modifiable barriers to adherence to inhaled steroids among adults with asthma: It's not just black and white

Cited by 246 publications

References 18 publications

Strategies Used by Older Adults with Asthma for Adherence to Inhaled Corticosteroids

Strategies Used by Older Adults with Asthma for Adherence to Inhaled Corticosteroids

Race-Ethnic Differences in Factors Associated with Inhaled Steroid Adherence Among Adults with Asthma

Complementary and Alternative Medicine Use and Adherence With Pediatric Asthma Treatment

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