What are the barriers to asthma preventer use?

An Australian study has looked at patients’ and carers’ choices and use of asthma preventer medicines

Cost may be a barrier for patient adherence to preventer medicines, according to research led by the Woolcock Institute of Medical Research at the University of Sydney.

Researchers interviewed 24 adults with asthma and 20 carers for children aged 3-17 years with asthma.

One adult was also interviewed as a carer so the total participant number was 43.

Just over one-quarter of participants were concession card holders.

Among participants, more than one quarter of adults with asthma (29%) were not currently using an asthma preventer, while this was stated by 14% of carers of children with asthma.

Of adults that were currently using asthma preventers, 63% were using a combination of regular inhaled corticosteroids (ICS) and long-acting beta2-agonist (LABA), with 14% children with asthma using the ICS/LABA combo.

Sixty percent of children were using ICS alone, compared to just 8% of adults with asthma.

And forty percent of children were using leukotriene receptor antagonist.

Some participants revealed the importance of preventers in maintaining their independence and ability to participate in social and physical activities.

However both adults and carers placed the responsibility for medicine changes firmly with the doctor.

When probed about factors that would affect decision making about preventer choice, if offered, the key factor for most participants was treatment effectiveness.

Reported barriers to preventer adherence included participant behaviours, medicine side effects and cost, and characteristics of healthcare professionals.

The barrier most often cited by participants was perceived side effects of asthma medicines, particularly corticosteroids.

For some adults weight gain from oral corticosteroids was the major concern.

Meanwhile for carers, possible effects of ICS on growth of children were paramount.

Several carers expressed a dislike of giving any medicine to their child and some actively searched for alternative therapies to avoid medicine use – including visiting a naturopath in an attempt to cure their asthma.

Some participants perceived healthcare providers as poor communicators – not “hearing” the patient, or adequately educating them.

However others enjoyed support from healthcare providers, which was helpful to carers especially around time of diagnosis.

Practical issues such as the need (and cost) to visit a doctor to obtain scripts, and the availability of medicines and accessories in pharmacies were perceived to be a problem especially in rural areas.

Some participants mentioned cost issues as a barrier to preventer use during the interviews, however, it was not a focus for most.

Several of those who were eligible for reduced (concessional) co-payments expressed that medicine costs could still be a struggle, and they may need to go without medicine, lower their dose or frequency of use temporarily, or make a sacrifice in some other area.

Affordability of asthma medicines at a societal level was also a concern for many participants—several participants expressed that patients cannot help suffering from diseases such as asthma and shouldn’t have their treatment compromised because of cost.

Study results suggest that to address preventer adherence issues including cost, support is required for both healthcare providers and patients, the researchers conclude.

“General practitioners need to encourage empathic discussion about barriers and enablers,” they say.

“Asthma patients and carers of children with asthma could benefit from education regarding shared decision-making, to empower them in their dealings with healthcare providers and choices of medicine.”

This study was published in the Australian and New Zealand Journal of Public Health (open access).

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