Impact of positive and negative beliefs about inhaled corticosteroids on adherence in inner-city asthmatic patients
Impact of positive and negative beliefs about inhaled corticosteroids on adherence in inner-city asthmatic patients
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DOI：
10.1016/s1081-1206(10)60141-x
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发表时间：
2009-07-01
影响因子：
5.9
通讯作者：
Halm, Ethan A.
中科院分区：
文献类型：
--
作者：
Ponieman, Diego;Wisnivesky, Juan P.;Halm, Ethan A.
Background: Daily inhaled corticosteroid (ICS) use is the cornerstone of asthma management, although it is often suboptimal, especially in inner-city populations.Objective: To assess the impact of potentially modifiable medication beliefs on adherence with ICS therapy across time.Methods: Asthma history, medication beliefs, and ICS therapy adherence were determined in a prospective, observational cohort. Medication beliefs were based on self-regulation and self-efficacy theory. Self-reported adherence with ICS therapy was assessed using the Medication Adherence Reporting Scale, a validated 10-item instrument, at baseline and at 1 and 3 months. Repeated-measures multivariable regression identified beliefs independently associated with adherence across time after adjusting for age, sex, race, and asthma severity.Results: The 261 patients were low-income minorities with high rates of asthma hospitalization, emergency department visits, intubation, and oral corticosteroid use. Adherence with ICS therapy was stable across time, with 70% of patients saying that they used ICS all or most of the time when asymptomatic. Most patients (82%) thought it was important to use ICS when asymptomatic, although 49% worried about side effects and 37% worried about becoming addicted. Although 82% felt confident in using ICS, 7% felt that their regimen was hard to follow. In multivariable analyses, the odds of adherence increased for those who felt that using, ICS when asymptomatic was important (odds ratio [OR], 4.15) and for those who were confident in using ICS (OR, 2.23) and decreased by worries about side effects (OR, 0.52) or feeling the regimen was hard to follow (OR, 0.48).Conclusions: Several positive and negative beliefs about ICS were associated with adherence. Eliciting and addressing these potentially modifiable beliefs may help improve adherence and outcomes. Ann Allergy Asthma Immunol. 2009; 103:38-42.
