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Measurement of Inhaled Corticosteroid Adherence in Inner-City, Minority Children with Persistent Asthma by Parental Report and Integrated Dose Counter  [PDF]
Marina Reznik,Philip O. Ozuah
Journal of Allergy , 2012, DOI: 10.1155/2012/570850
Abstract: Parents often overreport adherence to asthma treatment regimens making accurate assessment of medication adherence in clinical practice difficult. This study was conducted to compare two adherence assessment methods clinicians may choose from when assessing patient inhaled corticosteroid (ICS) adherence: parental report and dose counter measurements of metered-dose inhaler (MDI) actuation. Participants included children ( ) with persistent asthma and their parents ( ). At enrollment, children received a new, marked ICS at the dose prescribed by their physician. Thirty days following enrollment, we measured ICS adherence by parental report and objectively, with a dose counter. Parental report overestimated ICS adherence when compared to dose counter. We found a statistically significant overall difference between parental report and objectively measured adherence. A dose counter that most ICS inhalers are equipped with may be a more reliable alternative measure of ICS adherence in a clinical practice setting. 1. Introduction Asthma disproportionately burdens low-income African-American and Hispanic children residing in inner cities such as the Bronx, New York [1]. The Bronx, which is predominately Hispanic, is the New York City (NYC) borough with the highest overall rates of asthma hospitalizations, deaths, and prevalence among children and adults [2]. Daily use of inhaled corticosteroid (ICS) medications, the most effective long-term therapy available for patients with persistent asthma, controls symptoms and reduces asthma morbidity [3]. However, adherence to ICS is about 50% for children with asthma [4–7]. Poor adherence to ICS medications contributes to asthma morbidity and has been associated with increased health-care use and decreased treatment effectiveness [3]. Improving adherence in clinical practice setting is difficult because health-care providers do not know if patients are adherent without the use of objective monitoring [8]. Electronic devices attached to inhalers record date and time of medication use and provide objective documentation of adherence [9]. However, these devices are costly [10] and prone to mechanical failure [11, 12], making them impractical for office or clinic practices. In turn, many pediatricians rely on parental report of ICS adherence to guide asthma management in children with persistent asthma [13]. Subjective measures are easily administered and cost-effective, yet often provide overestimated adherence data that may result in unnecessary escalation of treatment [9]. National guidelines recommend that clinicians
A short-term educational program improved physicians’ adherence to guidelines for COPD and asthma in Shanghai
Xiaocong Fang, Shanqun Li, Lei Gao, Naiqing Zhao, Xiangdong Wang, Chunxue Bai
Clinical and Translational Medicine , 2012, DOI: 10.1186/2001-1326-1-13
Abstract: A prescription survey was performed in a random sample of 100 COPD and asthma outpatients to assess their pharmacological therapy. Then, an educational program was conducted in young pulmonary physicians from 83 hospitals in Shanghai. The training course was divided into 7 sessions of 2?hours delivered over 4?days from July 2010 to August 2011. Three months later, all of the participants were asked to take a written examination to assess the efficiency of training.Prescription survey among the patients indicated the prescriptions are not consistent with the recommendations of current GOLD and GINA guidelines. The mainly existing issue is the overuse of inhaled glucocorticosteroid. For the educational program, 161 pulmonary physicians have attended the training course, and 110 clinicians finished the tests with an attendance rate of 68.3%. Although most of the clinicians recognized the increasing burden of COPD and asthma, they do not know well about the core elements of guidelines and their clinical practice is not fully in agreement with current recommendations. Through crossover comparison, our results suggested clinicians’ knowledge of the guidelines was improved after training.We concluded that application of continuous educational programs among physicians might promote their adherence to guidelines, and by that improve the quality of healthcare.Chronic obstructive pulmonary disease (COPD) and asthma are both chronic respiratory diseases characterized by the impairment of lung function, and they are also complex multi-component diseases accompanied with mental and physical co-morbidities [1,2]. In recent years, there has been increasing evidences suggesting that COPD and asthma are imposing enormous burden on patients, healthcare professionals and society in terms of morbidity, mortality, healthcare resources utilization and expense worldwide [3], especially in developing countries [4-9].Despite these striking statistics, the management of COPD and asthma is fa
Failure to refill essential prescription medications for asthma among pediatric Medicaid beneficiaries with persistent asthma
Vaidya V,Gupte R,Balkrishnan R
Patient Preference and Adherence , 2013,
Abstract: Varun Vaidya,1 Renuka Gupte,2 Rajesh Balkrishnan31Pharmacy Health Care Administration, Department of Pharmacy Practice, University of Toledo College of Pharmacy, Toledo, OH, USA; 2Private Practice, Sylvania, OH, USA; 3Department of Clinical, Social and Administrative Sciences, Pharmacy, The University of Michigan, Ann Arbor, MI, USAAbstract: The problem of patients not taking medications as prescribed, also known as "lack of medication adherence," is widely discussed as an issue related to suboptimal outcomes and excess health care expenditure. Although medication adherence is defined as patients not taking medications as prescribed, there are two elements to it: first, those who fail to follow the medication regimen by skipping a dose or not following the instructions, resulting in poor adherence with prescribed medicines; and, second, the patient who does not take the medication at all or stops after the initial fill. The existing literature contains a lot of studies on the first element, but very little is known about those who stop taking their medication after the initial fill or do not take it at all. In this study, our focus is on identifying patients who fail to refill a prescription for essential medicines, such as asthma-controlling drugs. Using Medicaid claims datasets, this study analyzed a pediatric population diagnosed with persistent asthma that discontinued an essential controlling medication after the initial fill. We found that more than half of this population did not continue their medication after the first fill. While there might be many reasons behind the failure to refill such medications, our data indicate that race/ethnicity, comorbid illness, and type of Medicaid plan are potentially associated with such behavior. Future research is warranted to understand this issue further and identify specific factors causing such behavior, such that strategies may be formulated by which poor adherence can be minimized.Keywords: medication adherence, asthma, Medicaid, controller medication, prescription refill
Promoting Medication Adherence to Asthma  [PDF]
Weerapong Lilitwat, Yuttiwat Vorakunthada
Health (Health) , 2018, DOI: 10.4236/health.2017.101002
Abstract: Promoting adherence to asthma treatment is an essential aspect of clinical practice. Approximately 60% of asthmatic patients are non-adherent to asthma regimen, resulting in adverse outcomes and higher costs of care. Non-adherence could be intentional (perceptions of asthma severity, self-manage therapy, fear of side-effects) or non-intentional (forgetful, cost, and misunderstandings). Adherence can be evaluated by patient’s reporting, dose counter, electronic metered dose inhaler but using pharmacy records is a more cost-effective method. The most successful strategies to improve patients’ adherence is to utilize the principle of patient-centered collaborative care and effective communication. Keys of communication skills consist of establishing a relationship, listening, collaborating on the treatment plan, time management, and implementing effective follow-up interventions. Interventions to improve adherence include providing reinforcement for patients’ efforts to change, providing feedback on progress, tailoring education to patients’ needs and circumstances and follow-up. Evaluation of health literacy is mandatory for prioritizing information from most to least critical, speaking slowly, avoiding medical jargon, and spending minimal extra time during each visit. Communication technology including texting or interactive voice response is another new strategy that can increase adherence.
Failure to refill essential prescription medications for asthma among pediatric Medicaid beneficiaries with persistent asthma
Vaidya V, Gupte R, Balkrishnan R
Patient Preference and Adherence , 2013, DOI: http://dx.doi.org/10.2147/PPA.S37811
Abstract: ilure to refill essential prescription medications for asthma among pediatric Medicaid beneficiaries with persistent asthma Original Research (624) Total Article Views Authors: Vaidya V, Gupte R, Balkrishnan R Published Date January 2013 Volume 2013:7 Pages 21 - 26 DOI: http://dx.doi.org/10.2147/PPA.S37811 Received: 06 September 2012 Accepted: 09 October 2012 Published: 09 January 2013 Varun Vaidya,1 Renuka Gupte,2 Rajesh Balkrishnan3 1Pharmacy Health Care Administration, Department of Pharmacy Practice, University of Toledo College of Pharmacy, Toledo, OH, USA; 2Private Practice, Sylvania, OH, USA; 3Department of Clinical, Social and Administrative Sciences, Pharmacy, The University of Michigan, Ann Arbor, MI, USA Abstract: The problem of patients not taking medications as prescribed, also known as "lack of medication adherence," is widely discussed as an issue related to suboptimal outcomes and excess health care expenditure. Although medication adherence is defined as patients not taking medications as prescribed, there are two elements to it: first, those who fail to follow the medication regimen by skipping a dose or not following the instructions, resulting in poor adherence with prescribed medicines; and, second, the patient who does not take the medication at all or stops after the initial fill. The existing literature contains a lot of studies on the first element, but very little is known about those who stop taking their medication after the initial fill or do not take it at all. In this study, our focus is on identifying patients who fail to refill a prescription for essential medicines, such as asthma-controlling drugs. Using Medicaid claims datasets, this study analyzed a pediatric population diagnosed with persistent asthma that discontinued an essential controlling medication after the initial fill. We found that more than half of this population did not continue their medication after the first fill. While there might be many reasons behind the failure to refill such medications, our data indicate that race/ethnicity, comorbid illness, and type of Medicaid plan are potentially associated with such behavior. Future research is warranted to understand this issue further and identify specific factors causing such behavior, such that strategies may be formulated by which poor adherence can be minimized.
Adherence with Preventive Medication in Childhood Asthma  [PDF]
Scott Burgess,Peter Sly,Sunalene Devadason
Pulmonary Medicine , 2011, DOI: 10.1155/2011/973849
Abstract: Suboptimal adherence with preventive medication is common and often unrecognised as a cause of poor asthma control. A number of risk factors for nonadherence have emerged from well-conducted studies. Unfortunately, patient report a physician's estimation of adherence and knowledge of these risk factors may not assist in determining whether non-adherence is a significant factor. Electronic monitoring devices are likely to be more frequently used to remind patients to take medication, as a strategy to motivate patients to maintain adherence, and a tool to evaluate adherence in subjects with poor disease control. The aim of this paper is to review non-adherence with preventive medication in childhood asthma, its impact on asthma control, methods of evaluating non-adherence, risk factors for suboptimal adherence, and strategies to enhance adherence. 1. Introduction The aim of this paper is to review non-adherence with preventive medication in childhood asthma and its impact on asthma control. Methods of evaluating non-adherence and risk factors for sub-optimal adherence will be reviewed. Finally, the latest evidence for strategies to enhance adherence will be summarised. 2. Compliance, Adherence, and Concordance “Compliance” describes the degree to which a patient takes a medication as it has been prescribed [1]. Compliance has largely been replaced by the term “adherence,” which has fewer negative connotations [1]. It has been argued that both terms reflect a paternalistic model of care rather than a partnership. However, the alternative “concordance”, which has been coined to reflect a therapeutic decision that incorporates the common goals of the physician and patient [1], has not been widely accepted. 3. Management of Asthma and Preventive Medication Preventive medication is the corner stone of treatment for children with frequent intermittent or persistent asthma [2]. Preventive medication is taken on regular basis and has been shown to decrease inflammation within the lung and to improve disease outcomes [3]. 4. Importance of Adherence with Preventive Medication Non-adherence takes many forms, and the extent to which a patient is adherent with different asthma-related tasks may vary [4]. Patients may fail to attend appointments, fill prescriptions, miss doses of medication, or fail to use their inhalation device correctly. The incorrect use of an asthma device may be accidental (reflecting competence) or deliberate (contrivance) [5]. The impact of non-adherence depends upon the severity of the condition and the effectiveness of the treatment.
Efficacy Evaluation of Different Treatment Regimens with Fluticasone Propionate in Mild Persistent Asthma
Bilan Nemat,M. Shoaran,Asvadi Atabak
Research Journal of Biological Sciences , 2012,
Abstract: Asthma is a chronic airway disorder and prevalence of asthma symptoms in children is about 1-30% and is increasing in many countries. Inhaled Corticosteroids (ICS) are one of the basic therapeutic agents for asthma and their daily frequency is one of the most important factors in the patient adherence to therapy. This study was designed to compare the effect of different frequencies of Fluticasone Propionate on the treatment of mild persistent asthma. This study is a randomized clinical trial on 100 patients with mild persistent asthma at the age of 2-14 years-old receiving Fluticasone Propionate 1 puff twice daily for first 3 months and then 2 puffs once daily for next 3 months are compared to 150 asthmatic patients with the same age range and severity of disease but receiving 1 puff twice daily for 6 months. There was no significant meaningful difference in therapeutic effects of Fluticasone Propionate between two studied groups but adherence to therapy was better in once-daily administered group. Considering the lack of significant difference between two groups and increased parental adherence in first group, the lower frequencies of spray administration after a partial improvement is suggested.
Efficacy Evaluation of Different Treatment Regimens with Fluticasone Propionate in Mild Persistent Asthma
Bilan Nemat,M. Shoaran,Asvadi Atabak
Research Journal of Biological Sciences , 2008,
Abstract: Asthma is a chronic airway disorder and prevalence of asthma symptoms in children is about 1-30% and is increasing in many countries. Inhaled Corticosteroids (ICS) are one of the basic therapeutic agents for asthma and their daily frequency is one of the most important factors in the patient adherence to therapy. This study was designed to compare the effect of different frequencies of Fluticasone Propionate on the treatment of mild persistent asthma. This study is a randomized clinical trial on 100 patients with mild persistent asthma at the age of 2-14 years-old receiving Fluticasone Propionate 1 puff twice daily for first 3 months and then 2 puffs once daily for next 3 months are compared to 150 asthmatic patients with the same age range and severity of disease but receiving 1 puff twice daily for 6 months. There was no significant meaningful difference in therapeutic effects of Fluticasone Propionate between two studied groups but adherence to therapy was better in once-daily administered group. Considering the lack of significant difference between two groups and increased parental adherence in first group, the lower frequencies of spray administration after a partial improvement is suggested.
A Survey of Pediatricians’ Knowledge on Asthma Management in Children
Mohammad Gharagozlou,Hengameh Abdollahpour,Zahra Moinfar,Mohammad Hassan Bemanian
Iranian Journal Of Allergy, Asthma and Immunology , 2008,
Abstract: Asthma is one of the most common acute and chronic conditions in children, and the pediatricians are expected to provide an important role for asthma care in this age group, however there is no published information describing the different aspects of their practices about children asthma in Iran. This study was done to characterize the knowledge of the Iranian pediatricians about the diagnosis, treatment and education of asthma in children. Validated questionnaires were completed by 193 pediatricians from different parts of Iran during the International Congress of Pediatrics in Tehran. A total of 193 returned questionnaires (96.5%) were eligible for the survey and analysis. About 49% of the respondents were male and 18% were sub-specialists. Wheezing was the most common mentioned symptoms in taking asthma into consideration. About 40% of these physicians had no plan for doing spirometry in eligible children and 35.2% of them did not have familiarity with peak flowmeter. Also about 17.6% of them paid no regular visits to their asthmatic patients. Only 29% of the respondents indicated that they would prescribe inhaled corticosteroids for a 6-year-old child with moderate persistent asthma and 73.3% of them would prescribe inhaled bronchodilator (Salbutamol) for an acute asthmatic attack as the first drug, while 17.1% of them used epinephrine injection for this purpose. About 42.2% of the respondents did not consider any education or action plan for their patients and only 60.6% of them had access to standard guidelines and educational programs. The results show that there are numerous aspects of children asthma management in Iran which are not consistent with standardized guidelines and recommendations. This survey and the attained information suggest areas for interventions to improve the pediatricians' knowledge about asthma and the disease management.
Impact of Asthma Educational Intervention on Self-Care Management of Bronchial Asthma among Adult Asthmatics  [PDF]
Varalakshmi Manchana, Rajinder Kaur Mahal
Open Journal of Nursing (OJN) , 2014, DOI: 10.4236/ojn.2014.411080
Abstract: Asthma is one of the most common chronic diseases worldwide [1]. Despite advancement in science and technology and pharmacological revolutions, worldwide asthma prevalence is uncontrolled, morbidity and mortality from asthma. The most common reasons are non adherence to treatment, poor knowledge and skills in disease management [2]. Aim: The study aims to assess the impact of Asthma Education on self care management among Bronchial asthma patients. Objectives: 1) to assess the knowledge on self care management of Bronchial asthma; 2) to develop and administer the Asthma educational intervention on self care management of asthma; 3) to evaluate the impact of Asthma educational intervention on patient knowledge levels in comparison of pre and post test scores. Design: Quasi experimental Pre test-post test design was chosen. Methods: Study was done to assess the effectiveness of structured asthma education program on self care management of Bronchial asthma. Thirty patients, meeting the inclusive criteria, were selected by simple random sampling, and were tested for their knowledge levels on identification of asthma triggers, and warning signs, adherence to specified drugs, diet and breathing exercises. Based on the patient needs, structured education program was developed, validated and administered. Two weeks after administering structured asthma education, post-test was conducted. The Pre-test and Post-test scores were compared to evaluate the effectiveness of the Asthma education. Results: There was significant enhancement on knowledge levels on four areas of assessment and education. After asthma education the knowledge levels on disease process raised from minimum of 10% in the pre test to 77.50% in the post test. The knowledge scores on asthma triggers and warning signs enhanced 12% to 72%. The area of self monitoring and management records a rise in knowledge levels from 20% minimum scoring in pre test to 82.5% in the post test. The scores in diet, breathing exercises and adherence to drugs rose from 12.5% to 72.5% after asthma education. Conclusion: The findings reveal that educating patients remarkably increased their knowledge levels, which facilitate their behavioral modification thus enhances their self-care. Effective self care management at home level decreases asthma related morbidity and frequent visit to hospitals.
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