What are the common barriers to medication adherence among asthma patients?

A modified asthma-specific tool (ASK-12) has been pilot-tested with asthma patients for the first time in community pharmacy settings and finds varied reasons for nonadherence to medication, of which the most common are inconvenience, forgetfulness, and treatment beliefs, according to a study.

Having more barriers and a higher total barriers modified score predict poorer adherence measure with the original ASK-12, confirming the effective use of the tool and that the addition of asthma-specific barriers is functional.

“The use of such a tool (the modified ASK-12) creates a patient-focused approach to asthma adherence improvement and may lead to more effective, targeted counseling in community pharmacy settings,” the researchers said.

A previously developed asthma-specific tool was pilot-tested on a convenience sample of adult patients with persistent asthma. Using a patient survey, the researchers then collected data on demographic characteristics and comorbidities, adherence, asthma control, and asthma management characteristics.

Descriptive and inferential statistics were also used to describe the prevalence of common barriers to asthma medication adherence and examine associations between patient-reported asthma controller adherence and asthma control, therapy adherence barriers, and asthma management characteristics.

Ninety-three patients (mean age 45.4 percent, 66.7 percent female) were included. Majority of the participants (68.8 percent) had poor adherence, with 61.3 percent having controlled asthma. No significant association was observed between adherence and asthma control. [J Pharm Pract 2021;34:515-522]

There was a significant difference in the mean number of barriers between the good and poor adherence groups: 2.0±1.1 and 5.4±2.4, respectively (p<0.0001). The only asthma management characteristic significantly associated with adherence was having an asthma action plan (AAP). Most of the patients with poor adherence did not have an AAP (76.6 percent), while 81.5 percent of those with good adherence did (p<0.0001).

“Evidently, having an AAP was significantly related to adherence, which signals that pharmacists can play an instrumental role in encouraging attainment and use of an AAP to help patients achieve their asthma-related goals,” the researchers said.

Furthermore, current findings indicated that forgetfulness and treatment beliefs were the common barriers to patient-reported asthma controller adherence. This is in line with other studies, where a significant relationship between a “no symptoms, no asthma” belief correlated with poor adherence. [J Gen Intern Med 2013;28:67-73; Chest 2006;129:573-580]

Regarding the efficient use of the tool, a significant association was seen between ASK-12 cutoff adherence point and modified barrier scores: as adherence decreased, barriers increased. The asthma-specific tool was able to identify the most common asthma controller barriers.

In an earlier study, pharmacists used a communication tool with open-ended and probing questions, which were electronically documented and classified into knowledge, beliefs, and practical barriers. It was not clear how much time the multistep process took, but a more structured and time-saving tool might be needed in a busy community pharmacy setting. [Res Social Adm Pharm 2015;11:909-914]

“The proposed tool not only empowers the patient to take an active role in reporting their barriers but is also efficient for pharmacists, since they do not have to spend as much time interviewing patients,” the researchers said.

“Future steps can incorporate materials for pharmacists and patients who address the resolution of specific barriers and further investigate their effectiveness,” they noted.