Impact of an adherence intervention program on medication adherence barriers, asthma control, and productivity/daily activities in patients with asthma.

OBJECTIVE: This study evaluated the impact of an asthma patient intervention program, with a focus on medication adherence on adherence barriers, asthma control, and productivity/daily activities.
METHODS: Patients ≥18 years old who were employed by a large Southeastern public school system, had ≥1 medical claim for asthma, and were taking ≥1 asthma medication were invited to participate in the study. The ASK-20, the Asthma Control Test (ACT), and a productivity questionnaire were administered before and after a 6-month period of intervention that involved the use of baseline ASK-20 results to create patient-specific reports on adherence barriers and talking points for care managers to use during the two outbound telephone calls addressing barriers identified. Patients also received three educational mailings. The ASK-20 is a brief, self-reported instrument developed to identify patient-specific barriers to medication adherence and to improve provider/patient communication about adherence.
RESULTS: Of 112 individuals who enrolled, 87 completed the program (77.7%). Participants' mean age was 48.2 years (SD = 10.5), and most were female (86.2%) and white (64.4%). The mean number of years with asthma was 17.5 (SD = 14.7); approximately one third (36.8%) of participants had had asthma for >20 years. The intervention was associated with a significant reduction in the number of adherence barriers (3.8 to 2.8; p = .0021) as well as improvement in asthma control as reflected in an increase in the percentage of participants with controlled asthma defined as having an ACT score > 19 (50.0% to 64.6%; p = .0285). Significant reductions in the mean number of days that housework or schoolwork was limited by asthma (p = .0059) and the mean number of days that family, social, or recreational activities were missed or limited because of asthma (p = .0185) were also observed. The majority of the participants (95%) rated the program as being good, very good, or excellent.
CONCLUSION: Programs incorporating a clinical assessment tool such as the ASK-20 for identifying a broad range of risk factors for nonadherence and for developing patient-specific intervention may reduce adherence barriers and improved disease control and ability to perform daily activities in patients with asthma.