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Asthma Preventer Non-adherence: A psychological perspective
New Zealand Respiratory Conference September 2013
Dr Kate Perry, Lead Health Psychology Specialist
© 2011 Atlantis Healthcare | Commercial in Confidence
• 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
© 2011 Atlantis Healthcare | Commercial in Confidence
Intentional Reasons for Medication Non-adherence
© 2011 Atlantis Healthcare | Commercial in Confidence
• 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