Increasing Adherence to Treatment Regimens

Rates of nonadherence among asthmatic patients typically range from 30% to 70%. On average, patients take only about half of their medication. Other aspects of decreased regimen compliance include poor technique of inhaler use, irregular peak flow meter use, and avoidance of allergens. An estimated $6.2 billion was spent on asthma care in 1990. $3 billion resulted from emergency room visits and hospitalizations. Only 5% of the asthmatic population accounted for 70% of these total emergency services. Clearly, any program that would affect this 5% would greatly reduce asthma health care costs while improving the quality of patients' lives.

There are several factors that influence patient adherence to asthma treatment regimens. Asthma is different from most chronic illnesses in that patient compliance decreases with increased severity. Patients who understand their disease as significant, however, are more compliant with regular medical therapy. Loss of faith in medical regimens is also noted to reduce adherence. Failure of one medical regimen will create skepticism towards successive therapies. Finally, it is no surprise that medication regimens that are difficult to administer further reduce compliance.

At the heart of improving patient compliance is the doctor-patient relationship. The following are several possible methods for improving patient adherence to medical regimens.

Trust - Patients who like and trust their caregiver trust the treatments they prescribe. An environment that is warm, friendly, and approachable helps open lines of communication. This trust in-turn, allow patients to reveal concerns and reluctance regarding therapies.

Communication - Open communication allows the caregiver to allay the fears a patient may have regarding their medical therapy. Many studies have indicated that patients do not comply with regular medication use for fear that they "may get used to the medication" making it ineffectual. Or that the side affect profile may be disproportionately concerning. Frequently, patients crosscheck medical opinion with "lay" sources that may be inaccurate.

Patient education - Trust and open communication will allow for better education of the disease process. As noted, patients who better understand how and why they undergo their symptoms of wheezing and shortness of breath are far more likely to appropriately take their medications.

Self-management - Creating self-management knowledge and skills will give the patient an element of control in their own care. When patients have an understanding of how to modify their regimens, they are far more likely to do so successfully and avoid emergency room use or hospitalizations. This process should include:

• Writing out action plans in clear language for when symptoms worsen.
• Expressing willingness to modify treatment plans based on patient concerns.
• Negotiating to meet concerns such as cost or side effect profile.
• Changing dosing schedules to meet lifestyle concern, or reducing the number of medications.

"Difficult" to control patients require more time and effort from multiple sources such as physician, nurse, home outreach programs, individualized education and care, weekly, bimonthly telephone contact. The additional time and monetary costs in this group are probably easily offset directly by reduction in admissions and other emergency services.

Bibliography
1) Bender, B, Milgrom H and Rand C. Nonadherence in asthmatic patients: is there a solution to the problem? Ann Allergy Asthma Immunol 1997;79:177-86.
2) Osman, L.M., How do patients' views about medication affect their self-management in asthma? Patient Education and Counseling 1997;32:S43-S49.
3) Clark, N.M., Nothwehr, F. Self-management of asthma by adult patients. Patient Education and Counseling 1997;32:S5-S20.