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Asthma Beliefs Are Associated with Medication Adherence in Older Asthmatics

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Abstract

BACKGROUND

Empirical research and health policies on asthma have focused on children and young adults, even though asthma morbidity and mortality are higher among older asthmatics.

OBJECTIVE

To explore the relationship of asthma-related beliefs and self-reported controller medication adherence in older asthmatics.

DESIGN

An observational study of asthma beliefs and self-management among older adults.

PARTICIPANTS

Asthmatics ages ≥60 years (N = 324, mean age 67.4 ± 6.8, 28 % white, 32 % black, 30 % Hispanic) were recruited from primary care practices in New York City and Chicago.

MAIN MEASURES

Self-reported controller medication adherence was assessed using the Medication Adherence Report Scale. Based on the Common Sense Model of Self-Regulation, patients were asked if they believe they only have asthma with symptoms, their physician can cure their asthma, and if their asthma will persist. Beliefs on the benefit, necessity and concerns of treatment use were also assessed. Multivariate logistic regression was used to examine the association of beliefs with self-reported medication adherence.

KEY RESULTS

The majority (57.0 %) of patients reported poor adherence. Poor self-reported adherence was more common among those with erroneous beliefs about asthma illness and treatments, including the “no symptoms, no asthma” belief (58.7 % vs. 31.7 %, respectively, p < 0.001), “will not always have asthma” belief (34.8 % vs. 12.5 %, p < 0.001), and the “MD can cure asthma” belief (21.7 % vs. 9.6 %, p = 0.01). Adjusting for illness beliefs, treatment beliefs and demographics, patients with a “no symptoms, no asthma” belief had lower odds of having good self-reported adherence (odds ratio [OR] 0.45, 95 % confidence interval [CI] 0.23-0.86), as did those with negative beliefs about the benefits (OR 0.73, 95 % CI 0.57-0.94) and necessity (OR 0.89, 95 % CI 0.83-0.96) of treatment.

CONCLUSIONS

Illness and treatment beliefs have a strong influence on self-reported medication adherence in older asthmatics. Interventions to improve medication adherence in older asthmatics by modifying illness and treatment beliefs warrant study.

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Abbreviations

NIA:

National Institute on Aging

CSM:

Common Sense Model of Self Regulation

FQHC:

Federally Qualified Health Center

COPD:

Chronic Obstructive Pulmonary Disease

ICS:

Inhaled Corticosteroids

LTI:

Leukotriene Inhibitors

MARS:

Medication Adherence Report Scale

B-IPQ:

Brief Illness Perceptions Questionnaire

BMQ:

Beliefs about Medications Questionnaire

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Acknowledgments

Contributors

The authors would like to thank Fernando Caday, Jose Morillo-Rodriguez, Diego F. Chiluisa, Catherine Mariduena, Rachel O’Conor, Annie Boyd and Liliana Aguayo for their help with coordinating interviews and collecting data.

Funders

The project described was supported by Award Number R01HL096612 from the National Heart, Lung, And Blood Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, And Blood Institute or the National Institutes of Health.

Prior Presentations

Anastasia Sofianou presented an earlier version of the manuscript as a poster at the Society for Behavioral Medicine’s 33rd Annual Meeting in New Orleans, LA, in April 2012.

Conflict of Interest

Dr. Juan P. Wisnivesky is a member of the research board of EHE International, has received lecture honorarium from Novartis Pharmaceutical, and was awarded a research grant from GlaxoSmithKline to conduct a study on COPD. To the best of our knowledge, no other conflict of interest, financial or other, exists.

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Correspondence to Alex D. Federman MD, MPH.

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Sofianou, A., Martynenko, M., Wolf, M.S. et al. Asthma Beliefs Are Associated with Medication Adherence in Older Asthmatics. J GEN INTERN MED 28, 67–73 (2013). https://doi.org/10.1007/s11606-012-2160-z

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  • DOI: https://doi.org/10.1007/s11606-012-2160-z

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