Patients with asthma who do not fill their inhaled corticosteroids: A study of primary nonadherence

Williams, L. Keoki; Joseph, Christine L.M.; Peterson, Edward L.; Wells, Karen; Wang, Mingqun; Chowdhry, Vimal K.; Walsh, Matthew; Campbell, Jan; Rańd, Cynthia S.; Apter, Andrea J.; Lanfear, David E.; Tunceli, Kaan; Pladevall, Manel

doi:10.1016/j.jaci.2007.08.020

Cited by 144 publications

(102 citation statements)

References 26 publications

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“…Adherence was calculated in a manner similar to that in our previous studies, using automated data from electronic prescriptions (DrFirst Inc., Rockville, MD) and pharmacy claims (3). Briefly, we linked electronic prescription information with fill information from pharmacy claims data to estimate the number of days that a given fill of an ICS would last (i.e., days supplied).…”

Section: Calculating Ics Adherencementioning

confidence: 99%

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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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Section: Calculating Ics Adherencementioning

confidence: 99%

“…Inhaled corticosteroid (ICS) medication is the most consistently effective long-term control therapy for persistent asthma, yet patient adherence to ICS treatment is low (1)(2)(3)(4). Poor adherence to ICS medication is associated with increased asthmarelated emergency department visits and hospitalizations and an increased need for oral corticosteroids (1,4).…”

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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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“…Underuse of controller medications may be due to provider underdiagnosis or undertreatment of asthma, or patient medication nonadherence (9). Poor adherence to ICSs has been estimated to account for up to 60% of asthma-related hospitalizations (10)(11)(12)(13)(14). Furthermore, it has been suggested that optimal asthma control entails adherence rates to medication treatment more than 75% of the time (15).…”

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confidence: 99%

Primary Adherence to Controller Medications for Asthma Is Poor

Butler

et al. 2015

Annals ATS

104

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Rationale: Few previous studies have evaluated primary adherence (whether a new prescription is filled within 30 d) to controller medications in individuals with persistent asthma.Objective: To compare adherence to the major controller medication regimens for asthma.Methods: This was a retrospective cohort study of enrollees from five large health plans. We used electronic medical data on patients of all ages with asthma who had experienced an asthma-related exacerbation in the prior 12 months. We studied adherence measures including proportion of days covered and primary adherence (first prescription filled within 30 d).Measurements and Main Results: Our population included 69,652 subjects who had probable persistent asthma and were prescribed inhaled corticosteroids (ICSs), leukotriene antagonists (LTRAs), or ICS/long-acting b-agonists (ICS/LABAs). The mean age was 37 years and 58% were female. We found that 14-20% of subjects who were prescribed controller medicines for the first time did not fill their prescriptions. The mean proportion of days covered was 19% for ICS, 30% for LTRA, and 25% for ICS/LABA over 12 months. Using multivariate logistic regression, subjects prescribed LTRA were less likely to be primary adherent than subjects prescribed ICS (odds ratio, 0.82; 95% confidence interval, 0.74-0.92) or ICS/LABA (odds ratio, 0.88; 95% confidence interval, 0.80-0.97). Black and Latino patients were less likely to fill the prescription compared with white patients.Conclusions: Adherence to controller medications for asthma is poor. In this insured population, primary adherence to ICSs was better than to LTRAs and ICS/LABAs. Adherence as measured by proportion of days covered was better for LTRAs and ICS/LABAs than for ICSs.

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“…However, patients may over-report adherence when they use selfreports or diary cards [92][93][94][95][96] due to memory bias and willingness to please physicians and health-care professionals. Patient self-reports have higher adherence rates compared with electronic device monitoring, canister weighing, and medication-dispensing records obtained from pharmacies.…”

Section: Patient Self-reports or Diary Cardsmentioning

confidence: 99%

Patient Education and Adherence to Aerosol Therapy

Ari

2015

Respir Care

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SummaryNonadherence to prescribed medications results in disease instability and poor clinical control, with increases in hospital admissions, emergency room visits, school/work absenteeism, morbidity, and mortality. Poor patient adherence to therapy can be due to lack of cognition, competence, or contrivance. Patients who have not been trained or fail to understand use of drug and device combinations (cognition) often do not have the ability to use an aerosol device correctly (competence). Many patients have the competence to use the device correctly and know why they should RESPIRATORY CARE • JUNE 2015 VOL 60 NO 6 941 use the device in the way they were taught; however, they still contrive to use it in an ineffective and suboptimal manner that reduces its efficiency and effectiveness. Ensuring effective aerosol therapy and optimizing its role in disease management involve not only delivery of aerosolized medications to the lungs, but also understanding why, when, and how to use the medications, competence to use the device, motivation to adhere to therapy, and not contriving to use the device in a way that will prevent effective drug delivery. This paper explains some of the problems with patient education and adherence to aerosol therapy and suggests strategies to evaluate, monitor, and improve patient adherence effectively in primary care. Factors affecting patient adherence to prescribed medications, effective educational interventions, and strategies to promote patient adherence to aerosol therapy are also discussed.

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Patients with asthma who do not fill their inhaled corticosteroids: A study of primary nonadherence

Cited by 144 publications

References 26 publications

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

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

Primary Adherence to Controller Medications for Asthma Is Poor

Patient Education and Adherence to Aerosol Therapy

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