Interventions to improve adherence to inhaled steroids for asthma

Normansell, Rebecca; Kew, Kayleigh M; Stovold, Elizabeth

doi:10.1002/14651858.cd012226.pub2

Cited by 119 publications

(113 citation statements)

References 112 publications

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“…Methods of adherence reporting also varied between studies, which limited direct comparisons between studies. The average adherence of the studies which reported percentage adherence in our review was 48%, which reflects the typical rates reported in asthma adherence literature [84,85] (usually estimated to be ∼50%). Whilst this supports the generalisability of our findings to most asthma populations, they may not be applicable to populations with very poor adherence.…”

Section: Limitationssupporting

confidence: 77%

Treatment perceptions in patients with asthma: Synthesis of factors influencing adherence

Lycett¹,

Wildman²,

Raebel³

et al. 2018

Respiratory Medicine

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Background: Non-adherence to asthma treatment is a contributing factor for poorly controlled asthma. Aim: The aim of this systematic review is to explore patients' perceptions of their inhaled asthma treatment, and how these relate to adherence, using both qualitative and quantitative data. Methods: Pre-determined search terms and inclusion criteria were used to search electronic databases (The Cochrane Library, MEDLINE, EMBASE and PsycINFO). Two researchers screened titles and abstracts using the Rayyan web app and data were extracted in relation to psychological components (beliefs about, and attitudes towards, medicines) and adherence. Results: Of 1638 papers, 36 met the inclusion criteria. Key themes were: Perceived need for treatment -all 12 studies using the BMQ to measure patients' perceived need for treatment found that patients' beliefs about their necessity for treatment were associated with adherence-; Concerns about treatment -immediate and longterm side effects (58%), worries about safety (19%), and potential addiction to asthma medication (31%)-; and Perceived social stigma -22% of studies reported that embarrassment contributed to poor adherence. Conclusions: Acknowledging and addressing patient treatment beliefs and perceptual barriers to adherence is integral to designing adherence interventions for asthma patients. Further research is needed to better our understanding of the relationship between treatment perceptions and adherence.

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Section: Limitationssupporting

confidence: 77%

Treatment perceptions in patients with asthma: Synthesis of factors influencing adherence

Lycett¹,

Wildman²,

Raebel³

et al. 2018

Respiratory Medicine

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“…This suggests that we cannot assume interventions will be effective in young adults and require formal evaluations. Similarly, there is evidence from a systematic review that education, electronic trackers/reminders, and simplified regimens result in better medication adherence among asthmatic patients than control interventions (31). Interventions can also positively influence social outcomes.…”

Section: Discussionmentioning

confidence: 99%

Associations with Wellbeing and Medication Adherence in Young Adults Receiving Kidney Replacement Therapy

Hamilton

Caskey

Casula

et al. 2018

CJASN

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Background and objectives Young adults receiving kidney replacement therapy (KRT) have impaired quality of life and may exhibit low medication adherence. We tested the hypothesis that wellbeing and medication adherence are associated with psychosocial factors.Design, setting, participants, & measurements We conducted a cross-sectional online survey for young adults on KRT. Additional clinical information was obtained from the UK Renal Registry. We compared outcomes by treatment modality using age-and sex-adjusted regression models, having applied survey weights to account for response bias by sex, ethnicity, and socioeconomic status. We used multivariable linear regression to examine psychosocial associations with scores on the Warwick-Edinburgh Mental Wellbeing Scale and the eight-item Morisky Medication Adherence Scale. ResultsWe recruited 976 young adults and 64% responded to the survey; 417 (71%) with transplants and 173 (29%) on dialysis. Wellbeing was positively associated with extraversion, openness, independence, and social support, and negatively associated with neuroticism, negative body image, stigma, psychologic morbidity, and dialysis. Higher medication adherence was associated with living with parents, conscientiousness, physician access satisfaction, patient activation, age, and male sex, and lower adherence was associated with comorbidity, dialysis, education, ethnicity, and psychologic morbidity.Conclusions Wellbeing and medication adherence were both associated with psychologic morbidity in young adults. Dialysis treatment is associated with poorer wellbeing and medication adherence.

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“…Our findings are in line with a recent Cochrane review of interventions targeting adherence to inhaled corticosteroids. The review found a significant intervention effect on adherence when compared to usual care [44]. In terms of intervention location, previous research looking at pharmaceutical care activities and resources across Europe also found significant differences between countries [45].…”

Section: Discussionmentioning

confidence: 75%

“…We did not analyse data for asthma control, the most common primary outcome. However, it was felt that a review of data on adherence to asthma medication and subsequent asthma control was covered in a recent Cochrane review, so we did not duplicate this [44]. The guidelines for a small, medium and large effect size (d) do not translate directly into the healthcare realm.…”

Section: Limitations Of Included Studiesmentioning

confidence: 99%

Pharmacists and medication adherence in asthma: a systematic review and meta-analysis

et al. 2018

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The Lancet Asthma Commission highlighted that non-adherence remains a persistent barrier within asthma care. Medical consultations remain pivotal in addressing non-adherence, but interest in additional adherence support from pharmacists is increasing. This systematic review and meta-analysis aims to evaluate how effective pharmacist-led interventions are in improving medication adherence in adults with asthma.Studies were included if they had adult participants with asthma, pharmacist-led or collaborative care interventions, randomised controlled trial designs comparing interventions with usual pharmacist care, and a medication adherence outcome. We analysed adherence data using the standardised mean difference () and the remaining data were synthesised narratively.From 1159 records, 11 were included in the narrative synthesis and nine in the meta-analysis. The meta-analysis for adherence produced a medium effect size of =0.49 (se=0.08, 95% CI 0.35-0.64, p<0.0001) with low statistical heterogeneity.In line with the Perceptions and Practicalities Approach, interventions targeted to address both the perceptions and practicalities that influence individual motivation and ability to adhere were more effective. Contextual factors (country and healthcare setting) were also influential. Our findings suggest that with adequate remuneration and integration into asthma care, pharmacists can help improve adherence in asthma.

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Interventions to improve adherence to inhaled steroids for asthma

Cited by 119 publications

References 112 publications

Treatment perceptions in patients with asthma: Synthesis of factors influencing adherence

Treatment perceptions in patients with asthma: Synthesis of factors influencing adherence

Associations with Wellbeing and Medication Adherence in Young Adults Receiving Kidney Replacement Therapy

Pharmacists and medication adherence in asthma: a systematic review and meta-analysis

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