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

Abstract

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.

Asthma inhaler adherence determinants in adults: systematic review of observational data

“…Adherence was related to higher income in three out of eight reported results [34,40,[53][54][55][57][58][59]; more prescription coverage in one out of four results [34,40,45,59]; lower treatment costs in two out of seven results [47,54,55,61,77]; and lower perceptions of social norms in one out of three results [68,72,77]. Several other variables were identified in fewer than three results and were found to be unrelated to adherence: geographical area [47]; urban location [59]; immigration status [52]; crime rate in area of residence [54]; social modelling [68]; and social support [40,68].…”

“…Several other variables were examined in fewer than three results: lower adherence was linked to inability to get an appointment when needed in one result [61], to patientprovider communication in one out of two results [34,40], and to the time interval being registered with the same prescriber in one result [81], while receiving a prescription from a specialist versus a generalist was unrelated to adherence [59].…”

Measuring Pharmacy Performance in the Area of Medication Adherence: Addressing the Issue of Risk Adjustment

“…7 These findings and findings from other studies of the predictors of medication adherence [8][9][10][11][12][13][14][15][16] suggest a need to risk adjust for patient characteristics while computing adherence-based pharmacy quality scores. Failure to do so may result in comparisons that do not accurately reflect the effect of individual providers and rewards or penalties in pay-for-performance programs or other incentive/disincentive arrangements that may be reflective of the patient pool rather than pharmacy performance.…”

Exploring the relationship between health beliefs and medication adherence in individuals with asthma

“…326 Increasing age was the only demographic variable associated with medication adherence in this study and this has been reported previously in asthma 15,164,327 This contradicts some literature suggesting older age is associated with non-adherence in individuals with chronic conditions. 13 This may be because in asthma, there is generally a younger age group, compared to other chronic conditions such as heart disease, where the mean age is usually significantly older, and this may have influenced the finding.…”

“…It seems predictable that if an individual believes that their doctor can help control their asthma then they are more likely to take their medication prescribed by that doctor, as previously shown in asthma. 326 This finding contributes to the literature as the relationship between doctor locus of control beliefs and medication adherence is rarely investigated. Other facets of the patient-doctor relationship have been found to be important for medication adherence.…”