Evaluation of asthma medication adherence rates and strategies to improve adherence in the underserved population at a Federally Qualified Health Center.

Abstract

Adherence with asthma medications is less than optimal, measuring approximately 30-50%. Several factors have been shown to contribute to medication non-adherence including low-socioeconomic status, low literacy, medication cost, access to care, and language barriers. Community Health Clinic Ole has attempted to reduce medication adherence barriers associated with cost, access to care, and language by 1) allowing medications to be obtained from the clinic at a reduced cost via the 340B drug pricing program and patient assistance programs, and 2) providing one-on-one consultations from bilingual Spanish-speaking clinicians. Limited evidence is available regarding chronic disease-state medication adherence among Spanish-speaking individuals presenting to a Federally Qualified Health Center (FQHC). The purpose of this study is to assess asthma medication adherence and determine predictors of non-adherence in the underserved population at an FQHC. Adult patients with a diagnosis of persistent asthma receiving medication refills from clinic between October 1, 2011 and October 31, 2012 were identified (N=121). Individuals with intermittent or seasonal asthma only, exercise-induced asthma only, or mixed asthma/COPD; individuals who have not picked up at least one fill of inhaled corticosteroid in the past one-year; and individuals without active prescriptions for asthma controller medications were excluded. Medication adherence was assessed by using the medication possession ratio (MPR) for asthma controller medications (e.g. inhaled corticosteroids, long-acting beta-2 agonists, leukotriene modifiers, and theophylline). Patients were categorized into two adherence groups: medium-high (MPR≥0.5) and low (MPR<0.5). Approximately one-third of individuals were identified with medium-high adherence to asthma medications, of which only 8.3% of individuals were found to be fully adherent (MPR≥0.8). The majority of individuals (66.1%) were identified with low adherence, despite efforts to reduce medication adherence barriers associated with drug cost, access to care, and language. Patients with low adherence were younger (39.3 vs. 45.4 yo; P<0.012), had fewer medication refills (2.1 vs. 5.3; P<0.001), had fewer primary care provider (PCP) visits (3.4 vs. 5.0; P<0.05), lower baseline Asthma Control Test (ACT) scores (13.1 vs. 17.3; P<0.001), and lower asthma medication ratios (AMR) (0.7 vs. 0.9; P<0.001) than patients with medium-high adherence. No significant differences in MPR rates were found between Hispanics and non-Hispanics. The average MPR in both groups was 0.55. Our findings demonstrate that asthma medication adherence remains poor among all underserved patients despite improved access to care via reduced medication pricing and the provision of Spanish-speaking medication consultations at refill pick-ups. Poor adherence rates remained common among both the Non-Hispanic and Hispanic, younger, and lower-socioeconomic patients in our study. Future studies may wish to explore whether providing a service that encompasses healthcare team support, optimal medication counseling, and utilization of patient-centered communication strategies improves asthma medication adherence in the Hispanic population.