Optimal cut-off value and clinical usefulness of the Adherence Starts with Knowledge-12 in patients with asthma taking inhaled corticosteroids

Abstract

Background: Non-adherence to inhalation regimens is common in asthmatic patients. The Adherence Starts with Knowledge-12 (ASK-12) survey was developed to detect and address patient-specific barriers to medication adherence. Our objective is to investigate the clinical usefulness of the ASK-12 for assessing and addressing adherence to inhalation therapy in asthma. Methods: The ASK-12 was administered to 138 asthmatic patients. Using pharmacy-refill data, we examined the cut-off value of the ASK-12 to identify patients who were non-adherent to inhalation regimens and identify factors associated with non-adherence. To verify the usefulness of the ASK-12, inhalation regimens were prospectively switched to less-expensive and simpler (once-daily) dosing regimens in eight non-adherent asthmatic patients who reported specific-barriers in "inconvenience of twice-daily inhaler use" and "cost".Results: Valid responses were received from 114 (82.6%) patients. A significant correlation was found between pharmacy-refill rates and the ASK-12 total score (r=−0.55, P<0.0001). The optimal cut-off value of the ASK-12 total score to discriminate non-adherent patients (defined by pharmacy-refill rate <80%) was 23, with 71.4% specificity and 93.3% sensitivity. Using this value, 52 (45.6%) patients were classified as nonadherent. Univariate followed by multivariate analysis identified younger age as a predictor of non-adherence to inhalation regimens (odds ratio, 2.67; 95% CI, −0.95 to −0.06; P=0.027). Switching inhaled medicines in eight patients resulted in significant improvements in both ASK-12 scores and asthma control. Conclusions:The ASK-12 is a brief, practical, and clinically useful measure for assessing and addressing adherence to inhalation regimens in asthma.

Assessment of medication adherence in children and adults with congenital adrenal hyperplasia and the impact of knowledge and self‐management

“…Higher scores indicate more barriers to adherence or greater problems with adherence behaviour. We determined a cut‐off level for non‐adherence to be 22 19 . Less than 22 was categorized as good adherence.…”

Mobile Health App for Japanese Adult Patients With Asthma: Clinical Observational Study

“…In our survey, 61.53% (966/1570) of participants answered that they have stopped taking ICS because 81.1% (784/967) of them had felt better or 81.6% (787/965) of them had improved asthma attacks ( Multimedia Appendix 7 ). Takemura et al [ 28 ] reported that the optimal cut-off value of the ASK-12 total score for discriminating nonadherent patients was 23. The ASK-12 total score and the TBC score in 1569 participants were 28.7 and 4.2, respectively ( Multimedia Appendix 8 ), suggesting that Zensoku-Log users were patients with poor adherence.…”

“…The Adherence Starts with Knowledge 12 (ASK-12) questionnaire for Japanese adults with asthma was used for assessing adherence to asthma medication in our app [ 10 , 27 , 28 ]. For each item of the ASK-12 questionnaire, participants were asked to rate their potential barriers to medication adherence using a 5-point scale (all items are listed in Multimedia Appendix 1 ).…”

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“…4 However, the most widespread approach to ROC analysis, routinely used in a clinical setting, is still the simplest one: several values of some numerical (continuous or discrete) classifier are evaluated as possible "optimal" cutoff for labeling individuals as "diseased" or "nondiseased." [5][6][7][8] The goal is to set up a simple screening test, therefore avoiding performing a more invasive, expensive, or time-consuming "gold standard" test.…”