Zia A, Brassart A, Thomas S, et al. Patient-Centric Structural Determinants of Adherence Rates Among Asthma Populations: Exploring the Potential of Patient Activation and Encouragement Tool TRUSTR to Improve Adherence

Abstract

Background: Lack of adherence with prescribed medications among the asthma populations exacerbates health outcomes and increases social and economic costs. Objectives: The proposed study aims to model patient-centric structural determinants of adherence rates among asthma patients and explore the potential of mobile health apps such as the TRUSTR platform to improve adherence using its power of monetary and non-monetary chatbotting and non-monetary nudges. Following specific hypotheses are tested: (1) Patient attributes, such as their age and medical condition, have significant effect on their adherence with the prescribed treatment plans. (2) Behavioral nudging with rewards and engagement via mobile health apps will increase adherence rates. Methods: The patient population (N= 37 359) consists of commercially insured patients with asthma who have been identified from administrative claims in the HealthCore Integrated Research Database (HIRD) between April 1, 2018 and March 31, 2019. Two Structural Equation Models (SEMs) are estimated to quantify direct, indirect and total effect sizes of age and medical condition on proportion of days covered (PDC) and medical possession ratio (MPR), mediated by patient medical and pharmacy visits. Fourteen additional SEMs were estimated to lateralize TRUSTR findings and conduct sensitivity analysis. Results: HIRD data reveal mean adherence rate of 59% (standard deviation (SD) 29%) for PDC and 58% for MPR (SD 36%). Key structural findings from SEMs derived from the HIRD dataset indicate that each additional year in the age of the patient has a positive total effect on the adherence rate. Patients with poor medical condition are likely to have lower adherence rate, but this direct effect is countered by mediating variables. Further, each additional reward and higher engagement with a mobile app is likely to have a positive total effect on increasing the adherence rate. Conclusions: HIRD data reveal mean adherence rate of 59% (SD 29%), providing the evidence for the opportunity to increase adherence rate by around 40%. Statistical modeling results reveal structural determinants, such as the opportunity to nudge, are higher among younger patients, as they have higher probability of being non-adherent. Methodologically, lateralization approach demonstrates the potential to capture real-world evidence beyond clinical data and merge it with clinical data.

Factors affecting adherence to intranasal treatment for allergic rhinitis: A qualitative study

“…Nudge‐based interventions influence behavior without limiting an individual's freedom of choice. Existing examples in the management of chronic diseases such as diabetes mellitus and asthma include use of short message service (SMS) reminders, monetary and non‐monetary rewards, mobile application‐based interventions, and low‐technology reminders to place in the home 19,20 . In the context of AR, Wang et al demonstrated the value of daily SMS in increasing self‐reported adherence to INCS and clinic attendance; patients in the SMS group were less likely to forget to use their AR medications 8 .…”

“…Existing examples in the management of chronic diseases such as diabetes mellitus and asthma include use of short message service (SMS) reminders, monetary and non‐monetary rewards, mobile application‐based interventions, and low‐technology reminders to place in the home. 19 , 20 In the context of AR, Wang et al demonstrated the value of daily SMS in increasing self‐reported adherence to INCS and clinic attendance; patients in the SMS group were less likely to forget to use their AR medications. 8 Such interventions should be employed in the treatment of AR to improve adherence to treatment given the high prevalence of the disease and potential for development or worsening of asthma and chronic rhinosinusitis.…”