May 2001 • Volume 7 • Number 5
You can help asthma patients adhere to their therapy regimens
BY DENNIS CONNAUGHTON
Artwork from AAFp Video CME program, "Allergic Rhinitis and Asthma: A Clinical Practice Update"Studies show that a scant 50 percent of asthma patients adhere to the daily therapy regimens their doctors prescribe. The rest fail to follow through for a variety of social, economic and psychological reasons.
But physicians can play a big role in turning those statistics around and improving patient outcomes, said speakers at the annual meeting of the American Academy of Allergy, Asthma and Immunology held this March in New Orleans.
"If you want to improve patient adherence to taking asthma medication, you as physicians must make the patient the only thing you are interested in when you see the patient in your office." This was the advice of FP Stuart Stoloff, M.D., clinical associate professor of family and community medicine at the University of Nevada School of Medicine in Reno.
Stoloff dramatized his point, putting on a skit with Carol Jones, R.N., an asthma nurse clinician at Rush-Presbyterian-St. Luke's Medical Center in Chicago. In their dialogue, the patient gave vague answers to general questions from the physician, and the physician seemed bent on getting the conversation over with and the patient out the door.
"We have really good medications for asthma, but they won't do any good unless the physician connects with the patient," Stoloff said. "Just giving people medicine is not enough. You have to develop and strengthen a positive relationship that fosters trust."
Predicting adherence
Various factors may help physicians predict which patients are likely to adhere to a prescribed medication regimen, said Cynthia Rand, Ph.D., associate professor of medicine at Johns Hopkins University School of Medicine in Baltimore.
Among those factors are the characteristics of the therapy itself, such as the dosing frequency, side effects, cost and route of administration. There is usually a decline in adherence with a dosing frequency of more than twice a day, she said.
"Is there something unique about asthma that makes adherence a problem?" asked Frederick Leickly, M.D., clinical associate professor of pediatrics at Indiana University in Indianapolis. "Yes, probably," was Leickly's own answer. He cited the nature of the disease and its therapy as key factors. Leickly reviewed ways to monitor adherence, including self-reporting, physician estimates, prescription filling, pill counting, body-fluid analysis and electronic monitors.
Educating, motivating
If a physician suspects the patient is not adhering to a treatment regimen, the physician should provide ongoing asthma education to the patient, bring the patient back in the near future for follow-up care, simplify the treatment plan and provide motivation to stick to the regimen. So said Bruce Bender, Ph.D., head of pediatric behavioral health at the National Jewish Medical and Research Center in Denver.
"It takes a lot of energy on your part to improve your patient's adherence to therapy," added Don Bukstein, M.D., assistant clinical professor of pediatrics and family practice at the University of Wisconsin in Madison. "But if you educate and motivate your patient, you can change his or her behavior."
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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