Backing Up: Addressing Adherence Barriers in COPD

AUGUST 07, 2017
Jeannette Y. Wick, RPh, MBA, FASCP
Non-adherence is always possible and often probable when treating patients with this pulmonary problem.

Patients with chronic obstructive pulmonary disease (COPD) often have difficulty adhering to medications, leading to exacerbations, and often hospitalization.

In a recently-published study in the journal Respiratory Medicine, the researchers emphasize 6 key points for providers to consider when prescribing and dispensing:
  1. Adherence is multidimensional.
Adherence includes 5 types of factors: patient-related, economic/social, health system, condition-related, and therapy-related. Positive interactions between providers and patients improve adherence, but acknowledging society's role and its impact on this connection is equally important.

      2. Health care providers can use many approaches to assess adherence.

Among others, monitoring drug levels, using electronic monitors, weighing the patient's inhaler canister, and employing patient questionnaires have benefits and pitfalls. These are not uniformly-available and none of these approaches works by itself. The study found the best way gauge self-reported adherence was to assess attitude toward treatment with the Morisky-Green test (find an online version here: http://www.pmidcalc.org/?sid=3945130&newtest=Y). They also measured the patient’s disease knowledge with the 3-question Batalla test. (This test asks the following: Is COPD a lifelong disease? Can you control this disease by quitting smoking and/or with medication? Mention one or more organs that can get damaged by COPD Western Mark)
    
     3. Patient factors are independent predictors of poor adherence.

Factors associated with poor adherence include comorbidities, mental health disorders, current smoking, and lack of confidence in the provider. Depression is a common diagnosis in patients with COPD. Researchers found these comorbid illnesses correlated with lower adherence to COPD maintenance medications. These diagnoses often lessen health-related quality of life (HRQoL). However, improved HRQoL may trigger non-adherence in some patients with COPD.
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     4. Physicians can improve adherence.

The authors recommended selecting dosing frequencies that match patients’ lifestyles, appropriate medication doses, and patient-tolerated routes of administration. These factors can improve HRQoL and increase adherence. However, adherence to 1 class of medications doesn't necessarily mean patients adhere to all medications. The researchers advise clinicians to inquire about each drug separately and address medication adherence often.

    5. Outside factors contribute to medication adherence.

Spousal and caregiver support can improve a patient’s adherence. Community pharmacists can help patients lower medication cost and improve their access to medications by monitoring formularies and adjusting them accordingly.

    6. No standard intervention will improve adherence.

However, spending extra time with patients on multiple medications and communicating effectively can help when emphasizing the importance of adherence. 

Reference

 Adherence to Long-Term Therapies - Evidence for Action. World Health Organization website. http://apps.who.int/medicinedocs/en/d/Js4883e/7.2.html. Accessed August 2, 2017.

Rogliani P, Ora J, Puxeddu E, et al. Adherence to COPD treatment: Myth and reality. Respir Med. 2017;129:117-123.

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