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Asthma Preventer Non-adherence: A psychological perspective

Asthma Preventer Non-adherence: A psychological perspective. New Zealand Respiratory Conference September 2013 Dr Kate Perry, Lead Health Psychology Specialist. Asthma Preventer Non-adherence. Common Between 30-70% of occasions (Bender et al., 1997 ) Likely an underestimate

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Asthma Preventer Non-adherence: A psychological perspective

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  1. Asthma Preventer Non-adherence: A psychological perspective New Zealand Respiratory Conference September 2013Dr Kate Perry, Lead Health Psychology Specialist

  2. Asthma Preventer Non-adherence • 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)

  3. "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)

  4. 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)

  5. 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)

  6. Patient Reasons for Medication Non-adherence Unintentional non-adherence Practical barriers Intentional non-adherence Perceptual barriers

  7. Unintentional Reasons for Medication Non-adherence Practical reasons for not taking medication Resource and ability limitations non-adherence Perceptual barriers Unintentional non-adherence Practical barriers

  8. ‘Practical’ Interventions • Overcoming resource limitations • Access • Reducing cost • Delivery • Overcoming ability limitations • Dexterity and technique • Demonstration and instruction • Health literacy • Memory • Aids and devises • Establishing routine

  9. Patient Reasons for Medication Non-adherence Conscious decision not to take medication Motivations and beliefs non-adherence Perceptual barriers Intentional non-adherence Perceptual barriers

  10. Intentional Reasons for Medication Non-adherence

  11. ‘Perceptual’ Interventions • 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

  12. Summary • Reasons for non-adherence vary • Unintentional and intentional • In consultation • Elicit reasons from patient • Offer solutions that are tailored • Practical • Perceptual

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