Patients’ perspective of barriers and facilitators to taking long-term controller medication for asthma: a novel taxonomy

Abstract

BackgroundAlthough asthma morbidity can be prevented through long-term controller medication, most patients with persistent asthma do not take their daily inhaled corticosteroid. The objective of this study was to gather patients’ insights into barriers and facilitators to taking long-term daily inhaled corticosteroids as basis for future knowledge translation interventions.MethodsWe conducted a collective qualitative case study. We interviewed 24 adults, adolescents, or parents of children, with asthma who had received a prescription of long-term inhaled corticosteroids in the previous year. The one-hour face-to-face interviews revolved around patients’ perceptions of asthma, use of asthma medications, current self-management, prior changes in self-management, as well as patient-physician relationship. We sought barriers and facilitators to optimal asthma management. Interviews were transcribed verbatim and transcripts were analyzed using a thematic approach.ResultsPatients were aged 2–76 years old and 58% were female. Nine patients were followed by an asthma specialist (pulmonologist or allergist), 13 patients by family doctors or pediatricians, and two patients had no regular follow-up. Barriers and facilitators to long-term daily inhaled corticosteroids were classified into the following loci of responsibility and its corresponding domains: (1) patient (cognition; motivation, attitudes and preferences; practical implementation; and parental support); (2) patient-physician interaction (communication and patient-physician relationship); and (3) health care system (resources and services). Patients recognized that several barriers and facilitators fell within their own responsibility. They also underlined the crucial impact (positive or negative) on their adherence of the quality of patient-physician interaction and health care system accessibility.ConclusionsWe identified a close relationship between reported barriers and facilitators to adherence to long-term daily controller medication for asthma within three loci of responsibility. As such, patients’ adherence must be approached as a multi-level phenomenon; moreover, interventions targeting the patient, the patient-physician interaction, and the health care system are recommended. The present study offers a potential taxonomy of barriers and facilitators to adherence to long-term daily inhaled corticosteroids therapy that, once validated, may be used for planning a knowledge translation intervention and may be applicable to other chronic conditions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-015-0044-9) contains supplementary material, which is available to authorized users.

What patients really think about asthma guidelines: barriers to guideline implementation from the patients’ perspective

“…As described by Pelaez et al [21], patients’ adherence to asthma guideline recommended treatment must be considered on several levels; the patients themselves, the doctor-patient relationship and the health care system. We have previously investigated doctors’ knowledge of the AG [12] and here we focus on the patients’ motivation and wishes in the search for relevant barriers to a more successful AG implementation and therefore to effective evidence based treatment of asthma patients.…”

Asthma control in primary care: the results of an observational cross-sectional study in Italy and Spain

“…The reasons for non-adherence are varied and are likely to include insufficient inhaler technique, the complexity of the therapeutic regimens (e.g. multiple daily dosing) as well as patient’s beliefs about therapy, such as fear of adverse effects or the perception that medication should be used in response to symptoms more than on a regular basis [10, 13]. In keeping with the latter observation, in our study a high percentage (>40%) of patients discontinued the treatment when they felt better, suggesting a “symptoms, no asthma” belief.…”

Pathways linking health literacy, health beliefs, and cognition to medication adherence in older adults with asthma

“…5,6 Inhaled corticosteroids, the mainstay of asthma controller medications and asthma management, decrease asthma symptoms and reduce emergency room visits, hospitalizations, and death, 7 yet less than 50% of older adults with asthma use them as prescribed. 8,9 There are various factors associated with underuse of asthma controller medications ranging from barriers to the specific treatment, including complex and costly regimens, 10 patient/provider-level barriers, such as provider perceptions about the time required to complete patient counseling 11,12 and a poor patient-provider relationship, 13 to patient-level barriers including polypharmacy from a combination of chronic conditions 14 and a lack of motivation to manage chronic illnesses. 13 A growing body of research highlights the impact of 3 additional patient-level factors: (1) limitations in health literacy, defined by the Institute of Medicine as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions,” 15 (2) misconceptions about asthma and the medications used to treat it, 16 and (3) impairments in cognition.…”