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Asthma Preventer Non-adherence: A psychological perspective

New Zealand Respiratory Conference September 2013

Dr Kate Perry, Lead Health Psychology Specialist

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• Common– Between 30-70% of occasions (Bender et al., 1997)– Likely an underestimate• Not prompted to disclose in consultation• Subject to social desirability and recall biases

• Costly– Loss of health benefit (Stern et al., 2006)– Economic cost (Hoskins et al., 2000)• An uncontrolled patient is 3.5 x the cost of a controlled

patient (£381 vs £108)

Asthma Preventer Non-adherence

"Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments”

Haynes et al. (2008)

3

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Myth 1: Non-adherence is related to socio-demographic factors

• Age & gender– Average correlation = 0 (DiMatteo, 2004)

• Education & income – Average correlation < 0.1 (DiMatteo, 2004)

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Myth 2: Non-adherence is related to personality

• Limited evidence for a ‘non-adherent personality type’ (Hevey, 2007)

• Patients are ‘differentially adherent’ (McHorney & Gadraki, 2012)

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Patient Reasons for Medication Non-adherence

Unintentional non-adherencePractical barriers

Intentional non-adherencePerceptual barriers

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Unintentional Reasons for Medication Non-adherence

Unintentional non-adherencePractical barriers

Practical reasons for not taking medication

Resource and ability limitationsnon-adherencePerceptual barriers

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• Overcoming resource limitations– Access

• Reducing cost• Delivery

• Overcoming ability limitations– Dexterity and technique

• Demonstration and instruction• Health literacy

– Memory• Aids and devises• Establishing routine

‘Practical’ Interventions

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Patient Reasons for Medication Non-adherence

Intentional non-adherencePerceptual barriers

Conscious decision not to take medication

Motivations and beliefsnon-adherencePerceptual barriers

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Intentional Reasons for Medication Non-adherence

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• Elicit patient beliefs about asthma– “How long do you think your asthma will last?”– “How serious do you think your asthma is?”– “How much control do you feel you have over your asthma?”

• Elicit patient beliefs about preventer medication– “How necessary do you think your preventer medication is?”– “How concerned are you about taking your preventer medication?”

• Correcting ‘maladaptive’ beliefs – Personalising the information – Use of behaviour change techniques

‘Perceptual’ Interventions

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• Reasons for non-adherence vary– Unintentional and intentional

• In consultation– Elicit reasons from patient– Offer solutions that are tailored • Practical • Perceptual

Summary