Adherence with Twice-daily Dosing of Inhaled Steroids

Abstract

Poor adherence to medication regimens may be contributing to the recent increase in asthma morbidity and mortality. We examined patient characteristics that may influence adherence to twice-daily inhaled steroid regimens. Fifty adults with moderate to severe asthma completed questionnaires examining sociodemographics, asthma severity, and health locus of control. Adherence was electronically monitored for 42 d. Following monitoring, patients' understanding of asthma pathophysiology and the function of inhaled corticosteroids were assessed. Patient beliefs about the effectiveness and convenience of these medications, and their perception of communications with their clinician were measured. Mean adherence was 63% +/- 38%; 54% of subjects recorded at least 70% of the prescribed number of inhaled-steroid actuations. Factors associated with poor adherence were less than 12 yr of formal education (p < 0. 001), poor patient-clinician communication (p < 0.001), household income less than $20,000 (p = 0.002), Spanish as primary language (p = 0.005), and minority status (p = 0.007). In a multiple logistic regression analysis, less than 12 yr of formal education (OR: 6.72; CI: 1.10 to 41.0) and poor patient-clinician communication (OR: 1.2; CI: 1.01 to 1.55) were independently associated with poor adherence. These results emphasize the importance of socioeconomic status and adequate patient-clinician communication for adherence to inhaled-steroid schedules.

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

“…‡ Adjusted for all the variables shown plus the external factors, which include variables for socioeconomic status (i.e., household income, wealth [home ownership and home value], and highest level of education for the head of household); barriers to receiving care (i.e., variables for clinic not open at times needed, difficulty in getting to physician's office, couldn't get a timely appointment, long clinic wait to see physician, and couldn't afford clinical visit) (25); barriers to obtaining medication (i.e., variables representing co-payment amount and patient-reported difficulty affording medication); patient-clinician communication (21); level of social support and stressors (e.g., from family, friends, neighbors, etc.) (26); perceived discrimination (27); and exposure to crime and/or violence (28).…”

“…For internal factors, we further subdivided our variables into the following categories: measures related to perception (18) and knowledge (19) about disease; beliefs (i.e., necessity and concern) about (20), knowledge of (21), and past experience with controller medication; the perceived locus of control over asthma, such as internal, chance, powerful others, and god (22,23); self-efficacy (14); readiness to change (14); depression (24); and the personal importance of physician trust. Past experience with controller medications and the personal importance of physician approval were not previously validated metrics.…”

“…For external factors, we further subdivided our variables into the following categories: household income; wealth (i.e., home ownership and home value); highest level of education for the head of household; barriers to receiving care (e.g., difficulty getting to the doctor's office, difficulty in scheduling an appointment, or unable to afford the clinic visit) (25); medication co-payment and affordability; patient-clinician communication (21); social support and stressors (26); perceived discrimination (27); and exposure to crime and violence (28).…”

Communication During Pediatric Asthma Visits and Self-Reported Asthma Medication Adherence

“…6 However, little is known about the relationship between provider-patient communication during pediatric asthma visits and its association with child-and caregiver-reported control medication adherence. 7,8 Apter et al 7 found that poor patient ratings of patient-provider communication about asthma were related to poor adherence to inhaled steroids. Chambers et al 8 discovered that regular inhaled corticosteroid use was related to whether patients perceived themselves as actively involved in treatment decisions during medical visits.…”

“…A limitation of these previous studies is that they relied on subjective patient reports of medical visit communication rather than objective data, such as audio-tape recordings of the visits. 7,8 Our previous work demonstrated that providers rarely asked for child or caregiver input into the child' s asthma treatment plan during audio-taped pediatric medical visits. 9 This current article examines how certain aspects of provider-patient communication that are recommended by the national asthma guidelines (ie, number of control medication questions the provider asks, the total number of medication questions asked by children, and the provider asking for child and caregiver input into the asthma treatment plan) are associated with child asthma medication adherence 1 month after the audio-taped visit.…”