IMPROVING ADHERENCE AMONG ADULT ASTHMATICS: IDENTIFYING A ROLE FOR ACTIVE PATIENT ENGAGEMENT

Purpose: To determine whether modifiable risk factors, relating specifically to patient-physician communication (e.g., the use of shared decision making), predict variation in adherence to controller medication among adult asthmatic patients. 

Method: Adult patients with a previous diagnosis of asthma were approached via telephone to participate in a brief online survey. The survey instrument asks for information about current treatment, adherence to controller therapy (Adult Asthma Adherence Questionnaire), previous exposure to shared decision making (CollaboRATE) and the patient’s willingness to engage in their asthma treatment decision making processes (Problem Solving Decision Making Scale). Demographic characteristics (e.g., age, income, education and comorbidities) were also obtained.

Result: Currently data are available for 50 patients; a response rate of 55%. (Data collection for the full sample [n=150] will be complete in July 2016) The vast majority of participants stated a preference to actively engage in at least some aspects of their treatment decision making process. Patient preferences for an active role centred on (a) determining the acceptability of various treatment risks and (b) making the final treatment decision. The extent to which physicians made efforts to engage patients in the decision making process appears highly variable. While all participants had received some sort of teaching about their inhaler medication, less than 40% had heard of an action plan and less than 20% currently possessed an asthma action plan. An action plan is a written guide for managing asthma symptoms. Of the 80% of respondents being prescribed controllers, only 38% self-reported being adherent to their asthma medication. Concern about medication side-effects was frequently identified as a barrier to treatment adherence.

Conclusion:  Despite a desire to engage in certain aspects of the treatment decision-making process, asthma patients appear not to be playing as active a role as they would like. Suboptimal communication between physicians and their patients may result in undue fears or uncertainties about medication and subsequent poor adherence. Further analyses of these data (using multivariable logistic regression) will test the hypothesis that adherence is associated with having been actively involved in the decision making process. The results of this work will guide strategies to improve patient-physician communication geared toward increasing treatment adherence and asthma control.