Psychological and Medical Characteristics Associated with Non-Adherence to Prescribed Daily Inhaled Corticosteroid.

Brett G Toelle,Guy B Marks,Stewart M Dunn

doi:10.3390/jpm10030126

Abstract

Medication non-adherence is associated with sub-optimal asthma control. Identification of medical and psychological characteristics associated with non-adherence is important to enable a targeted and personalized approach when working with patients and for the development of interventions to improve patient outcomes by improving medication adherence. We enrolled adults who had diagnosed asthma and who were prescribed daily inhaled corticosteroid medication. We used published and validated instruments to measure medical characteristics including asthma features, practical asthma knowledge and perceived involvement in care and psychological characteristics including anxiety, depression, optimism, and personality traits, to assess the relationship with medication non-adherence. A total of 126 participants provided data, with 64 (50.8%) of the participants identified as non-adherent. Multivariate analyses showed that younger age, high neuroticism scores and a previous asthma hospital admission were associated with non-adherence. Interestingly, depression was associated with a lower risk of non-adherence. This study showed that a personalized medicine approach would include interventions targeting those who are younger, who have been in hospital for asthma and who rate high on the neuroticism personality trait. Given the availability of effective medications for asthma, better understanding of the characteristics associated with non-adherence is important to enhance optimal self-management.

Highlights

Asthma continues to cause significant morbidity in the community [1] despite wide dissemination of asthma management plans and the availability of effective anti-inflammatory drugs [2,3]
Of the 145 participants who agree to participate and were sent the study materials, 19 (13%) either said that they had mailed back the materials, did not return their materials after multiple contact attempts or actively withdrew from the study
Participants had a mean age of 49 years (19 to 86 years) and the median age at asthma diagnosis was 13.5 years

Summary

Introduction

Asthma continues to cause significant morbidity in the community [1] despite wide dissemination of asthma management plans and the availability of effective anti-inflammatory drugs [2,3]. One of the reasons for the continued high level of morbidity is that adherence to prescribed asthma medication is often sub-optimal, with studies reporting a range of between 30% to 70% adherence [4,5,6]. Studies investigating the factors that influence adherence to prescribed medication are important if we are to reduce the morbidity associated with asthma. The Australian National Asthma Council [7], the Royal Pharmaceutical Society of Great Britain [8] and the World Health Organization [9] have published seminal guidelines to assist health professionals to address the issue of non-adherence. Non-adherence with medication remains a significant barrier to optimal asthma control and is as relevant today as it was when these guidelines were published two decades ago

Objectives

Results

Discussion

Conclusion