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Ishisaka Y, Ankam J, Feldman J, Busse P, Wisnivesky JP, Federman AD. Asthma Beliefs and Overuse of Short-Acting Beta-adrenergic Receptor Agonists Among Older Adults. J Asthma 2024:1-14. [PMID: 39258932 DOI: 10.1080/02770903.2024.2403742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 09/02/2024] [Accepted: 09/09/2024] [Indexed: 09/12/2024]
Abstract
Objective Short-acting Beta-adrenergic Receptor Agonists (SABA) carry a risk of worse asthma outcomes when overused. Beliefs about asthma controller medications are associated with medication-taking behaviors in older adults, but the association of medication beliefs with SABA use has not been previously examined. We aimed to investigate the association of asthma and controller medication beliefs with SABA use among older patients with asthma.Methods We performed a cross-sectional analysis of data on adults ≥ 60 years with moderate to severe asthma in New York City, NY (n = 234). SABA overuse was defined as the average of ≥1 inhalation per day and controller medication adherence as ≥80% of expected inhalations, measured electronically. Illness and medication beliefs were measured using the Brief-Illness Perception Questionnaire and Beliefs about Medications Questionnaire, respectively. The associations of medication-taking behaviors with beliefs were examined in multivariable logistic regression models.Results The mean age was 67.6 ± 6.5 years, 84% were female, 26% were Black and 53% were Hispanic. 35% of participants overused SABA and 21% had adequate controller medication adherence. Overuse of SABA was not significantly associated with controller medication beliefs (Necessity: odds ratio [OR] 1.04, 95% confidence interval [CI] [0.97-1.12], p = 0.28, Concerns: OR 0.95 [95% CI 0.88, 1.03], p = 0.23) or asthma beliefs (OR 1.06 [95% CI 0.99, 1.15], p = 0.11). SABA overuse was also not significantly associated with controller medication adherence (OR 2.20 [95% CI 0.88, 5.51], p = 0.09).Conclusions SABA overuse was common among older adults with asthma and was not significantly associated with asthma controller medication or illness beliefs.
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Affiliation(s)
- Yoshiko Ishisaka
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Morningside West, New York, NY
| | - Jyoti Ankam
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jonathan Feldman
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Paula Busse
- Department of Medicine, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Pattock AM, Locke ER, Hebert PL, Simpson T, Battaglia C, Trivedi RB, Swenson ER, Edelman J, Fan VS. Predictors of Patient-reported and Pharmacy Refill Measures of Maintenance Inhaler Adherence in Veterans with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2024; 21:384-392. [PMID: 37774091 DOI: 10.1513/annalsats.202211-975oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 09/29/2023] [Indexed: 10/01/2023] Open
Abstract
Rationale: Suboptimal adherence to inhaled medications in patients with chronic obstructive pulmonary disease (COPD) remains a challenge. Objectives: To examine the sociodemographic and clinical characteristics and medication beliefs associated with adherence measured by self-report and pharmacy data. Methods: A cross-sectional analysis of data from a prospective observational cohort study of patients with COPD was completed. Participants underwent spirometry and completed questionnaires regarding sociodemographic data, inhaler use, dyspnea, social support, psychological and medical comorbidities, and medication beliefs (Beliefs about Medicines Questionnaire [BMQ]). Self-reported adherence to inhaled medications was measured with the Adherence to Refills and Medications Scale (ARMS), and pharmacy-based adherence was calculated from administrative data using the ReComp score. Multivariable linear regression was used to examine the sociodemographic, clinical, and medication-belief factors associated with both adherence measures. Results: Among 269 participants with ARMS and ReComp data, adherence was the same for each measure (38.3%), but only 18% of participants were adherent by both measures. In multivariable adjusted analysis, a 10-year increase in age (β = 0.54; 95% confidence interval, 0.14-0.94) and the number of maintenance inhalers used (β = 0.53; 0.04-1.02) were associated with increased adherence by self-report. Improved ReComp adherence was associated with chronic prednisone use (β = 0.18; 0.04-0.31) and the number of maintenance inhalers used (β = 0.11; 0.05-0.17). In adjusted analyses examining patient beliefs about medications, increases in the COPD-specific BMQ concerns score (β = -0.10; -0.17 to -0.02) were associated with reduced self-reported adherence. No significant associations between ReComp adherence and BMQ score were found in adjusted analyses. Conclusions: Adherence to inhaled COPD medications was poor as measured by self-report or pharmacy refill data. There were notable differences in factors associated with adherence based on the method of adherence measurement. Older age, chronic prednisone use, the number of prescribed maintenance inhalers used, and patient beliefs about medication safety were associated with adherence. Overall, fewer variables were associated with adherence as measured based on pharmacy refills. Pharmacy refill-based and self-reported adherence may measure distinct aspects of adherence and may be affected by different factors. These results also underscore the importance of addressing patient beliefs when developing interventions to improve medication adherence.
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Affiliation(s)
| | - Emily R Locke
- Center of Innovation for Veteran-Centered and Value-Driven Care and
| | - Paul L Hebert
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
- Center of Innovation for Veteran-Centered and Value-Driven Care and
| | - Tracy Simpson
- Center of Excellence in Substance Addiction Treatment and Education (CESATE), VA Puget Sound Health Care System, Seattle, Washington
- Department of Psychiatry, University of Washington School of Medicine, Seattle, Washington
| | - Catherine Battaglia
- Center of Innovation for Veteran-Centered and Value-Driven Care, Eastern Colorado VA Health Care System, Aurora, Colorado
- Department of Health System Management and Policy, Colorado School of Public Health, Aurora, Colorado
| | - Ranak B Trivedi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California; and
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Erik R Swenson
- Department of Medicine and
- Center of Innovation for Veteran-Centered and Value-Driven Care and
| | - Jeff Edelman
- Department of Medicine and
- Center of Innovation for Veteran-Centered and Value-Driven Care and
| | - Vincent S Fan
- Department of Medicine and
- Center of Innovation for Veteran-Centered and Value-Driven Care and
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Dong R, Sun S, Sun Y, Wang Y, Zhang X. The association of depressive symptoms and medication adherence in asthma patients: The mediation effect of medication beliefs. Res Social Adm Pharm 2024; 20:335-344. [PMID: 38110324 DOI: 10.1016/j.sapharm.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND The significant role of depression in influencing medication beliefs, which are pivotal cognitive factors that strongly influence medication adherence, has been established. Poor adherence to asthma-controlled medication poses an significant barrier to achieving optimal asthma management. OBJECTIVE To explore the potential mediating effects of medication beliefs on the relationship between depressive symptoms and medication adherence in patients with asthma. METHODS Demographic and clinical characteristics, depressive symptoms, medication adherence, and medication beliefs were collected using questionnaires. Structural equation modeling, was utilized to model medication beliefs as mediators in the relationship between depressive symptoms and medication adherence. Bootstrapping was performed to analyze the mediation- and contrast-specific indirect effects of the two medication beliefs. RESULTS Among the patients who participated in the study, 29.6 % with depressive symptoms were more prone to poor adherence and exhibited skepticism toward asthma medications. Depression had a direct effect (direct effect = -0.275, 95%CI: -0.369 to -0.190) and an indirect effect on adherence mediated by medication beliefs (indirect effect = -0.168, 95%CI: -0.224 to -0.121). The specific mediation effect of concern belief was stronger than that of necessity belief (difference = -0.076, 95%CI: -0.132 to -0.029). CONCLUSION Depressive symptoms have a direct impact on medication adherence as well as an indirect effect mediated by beliefs about medication, particularly concerns belief.
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Affiliation(s)
- Ruiying Dong
- The First Affiliated Hospital of China Medical University, China
| | - Shanwen Sun
- The First Affiliated Hospital of China Medical University, China
| | - Yajun Sun
- The First Affiliated Hospital of China Medical University, China
| | - Yali Wang
- The First Affiliated Hospital of China Medical University, China
| | - Xiaochun Zhang
- The First Affiliated Hospital of China Medical University, China.
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Lam SSW, Chen J, Wu JT, Lee CF, Ragavendran N, Ong MEH, Tan NC, Loo CM, Matchar DB, Koh MS. Association of quality-of-care indicators with asthma outcomes: A retrospective observational study for asthma care in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:497-509. [PMID: 38920201 DOI: 10.47102/annals-acadmedsg.2023151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Introduction Asthma guidelines have advocated for the use of quality-of-care indicators (QCIs) in asthma management. To improve asthma care, it is important to identify effective QCIs that are actionable. This study aimed to evaluate the effect of the presence of 3 QCIs: asthma education, Asthma Control Test (ACT) and spirometry testing on the time to severe exacerbation (TTSE). Method Data collected from the SingHealth COPD and Asthma Data Mart (SCDM), including asthma patients managed in 9 SingHealth polyclinics and Singapore General Hospital from January 2015 to December 2020, were analysed. Patients receiving Global Initiative for Asthma (GINA) Steps 3-5 treatment, with at least 1 QCI recorded, and at least 1 severe exacerbation within 1 year before the first QCI record, were included. Data were analysed using multivariate Cox regression and quasi-Poisson regression models. Results A total of 3849 patients in the registry fulfilled the criteria. Patients with records of asthma education or ACT assessment have a lower adjusted hazard ratio (HR) for TTSE (adjusted HR=0.88, P=0.023; adjusted HR=0.83, P<0.001). Adjusted HR associated with spirometry is higher (adjusted HR=1.22, P=0.026). No QCI was significantly associated with emergency department (ED)/inpatient visits. Only asthma education and ACT showed a decrease in the number of exacerbations for multivariate analysis (asthma education estimate: -0.181, P<0.001; ACT estimate: -0.169, P<0.001). No QCI was significant for the number of exacerbations associated with ED/inpatient visits. Conclusion Our study suggests that the perfor-mance of asthma education and ACT was associated with increased TTSE and decreased number of exacerbations, underscoring the importance of ensuring quality care in clinical practice.
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Affiliation(s)
- Sean Shao Wei Lam
- Duke-NUS Medical School, National University of Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore
- Health Services Research Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore
- Lee Kong Chian School of Business, Singapore Management University, Singapore
| | - Jingwei Chen
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Jun Tian Wu
- Duke-NUS Medical School, National University of Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore
- Health Services Research Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore
| | - Chun Fan Lee
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Narayanan Ragavendran
- Duke-NUS Medical School, National University of Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore
- Health Services Research Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore
| | - Marcus Eng Hock Ong
- Duke-NUS Medical School, National University of Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore
- Health Services Research Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore
| | - Ngiap Chuan Tan
- Duke-NUS Medical School, National University of Singapore, Singapore
- SingHealth Polyclinics, SingHealth, Singapore
| | - Chian Min Loo
- Duke-NUS Medical School, National University of Singapore, Singapore
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - David Bruce Matchar
- Duke-NUS Medical School, National University of Singapore, Singapore
- Department of Internal Medicine (General Internal Medicine), Duke University Medical School, Durham, North Carolina, US
| | - Mariko Siyue Koh
- Duke-NUS Medical School, National University of Singapore, Singapore
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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Fan Q, Ong ASE, Koh MS, Doshi K. The mediating role of trust in physician and self-efficacy in understanding medication adherence in severe asthma. Respir Med 2021; 190:106673. [PMID: 34768073 DOI: 10.1016/j.rmed.2021.106673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/20/2021] [Accepted: 10/30/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the relationships between beliefs about medication, trust in physician, self-efficacy, and medication adherence in severe asthma patients. METHODS A sample of 117 patients with a diagnosis of Severe Asthma on Step 4 or 5 of GINA assessment of control treatment ladder completed a one-time survey, including the shortened Medication Adherence Report Scale (MARS-5), Beliefs about Medicines Questionnaire (BMQ), Trust in Physician Scale (TIPS), and Self-Efficacy in Taking Medication (SEAMS). RESULTS Our study found that medication adherence was associated with trust in physician (p = 0.033); factor one of beliefs about medication - Necessity of taking medication (BMQ1-Necessity: p = 0.025); and two factors of self-efficacy in taking medication (SEAMS1-Difficulty: p = 0.001; SEAMS2-Uncertain: p = 0.005). Furthermore, two factors of self-efficacy and trust in physician together significantly mediated the relationship between beliefs about medication and medication adherence in a serial multiple mediator model. CONCLUSIONS Beliefs about medication are fundamental in affecting asthma patients' trust in physician and self-efficacy, which in turn impact medication adherence. CLINICAL IMPLICATIONS Interventions being developed to improve medication adherence may benefit from emphasizing on asthma patients' concerns about overuse and harm of medication. In addition, education program targeting to improve provider-patient relationship could help with patients' confidence in taking medication.
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Affiliation(s)
- Qianqian Fan
- School of Education, Zhengzhou University, Zhengzhou, China; Department of Psychology, Singapore General Hospital, Singapore
| | | | - Mariko Siyue Koh
- Duke-NUS Medical School, Singapore; Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
| | - Kinjal Doshi
- Department of Psychology, Singapore General Hospital, Singapore
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Jensen FF, Håkansson KEJ, Overgaard Nielsen B, Weinreich UM, Ulrik CS. Self-reported vs. objectively assessed adherence to inhaled corticosteroids in asthma. Asthma Res Pract 2021; 7:7. [PMID: 34059120 PMCID: PMC8166004 DOI: 10.1186/s40733-021-00072-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Adherence to inhaled corticosteroids (ICS) in asthma is vital for disease control. However, obtaining reliable and clinically useful measures of adherence remains a major challenge. We investigated the association between patient-reported adherence and objectively measured adherence based on filled prescriptions with inhaled corticosteroids in adults with asthma. METHODS In total, 178 patients with asthma were asked to self-assess adherence during routine visits at a respiratory outpatient clinic. Self-assessment was performed using Foster score ("How many days in a 7-day week do you take your medication as prescribed?", with the answer divided by 7). Objective adherence was calculated as medication possession ratio (MPR). Bivariate and multivariable linear regression, adjusted for age, sex, FEV1, GINA treatment step, excessive use of SABA, and history of exacerbations were used for analyses. RESULTS Of the included patients, 87.6% reported a Foster score of 100%, while the mean ICS MPR was 54.0% (SD 25%). Complex regimens such as twice-daily dosing or dual inhaler-use were associated with lower adherence (p = 0.015 and p < 0.001, respectively). Foster score was predictive of ICS MPR, with an absolute 32% increase in MPR between patients reporting Foster scores of 0 and 100% (95% CI 13-50%, p < 0.001). Female sex predicted higher ICS MPR (p = 0.019). Previous asthma-related hospitalization(s) predicted lower ICS MPR (p = 0.039). CONCLUSION Although a weak association was found between Foster score and ICS MPR, findings do not support the use of Foster score, and by that self-reported adherence, as a reliable marker of controller adherence in asthma due to significant mismatch between patient-reported adherence and MPR. Future studies should address the complex interplay between patient-reported and objectively assessed adherence to controller medication in asthma.
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Affiliation(s)
- Frodi Fridason Jensen
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
| | - Kjell E J Håkansson
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark.
| | | | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
- The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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