Review and Feature Article
Enhancing Respiratory Medication Adherence: The Role of Health Care Professionals and Cost-Effectiveness Considerations

https://doi.org/10.1016/j.jaip.2016.03.007Get rights and content
Under a Creative Commons license
open access

Adherence to medication comprises a multiphased temporal process involving (1) initiation of prescribed therapy, (2) implementation as prescribed, and (3) subsequent persistence. Medication adherence remains suboptimal in most patients with long-term respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). Interventions have been shown to effectively improve treatment initiation, implementation, and persistence when delivered at the health care professional level or the system level, but demonstration of the cost-effectiveness of these interventions is necessary to ensure their widespread use. This review summarizes how health care professionals can intervene to improve medication adherence in patients with asthma and COPD, provides some examples of effective primary care interventions, and illustrates some of the challenges to optimal implementation arising from cost-effectiveness modeling. Improving adherence is shown to be an economically viable treatment option for patients with asthma and COPD, but there are differences in the health economics pertaining to each condition and setting that can affect whether an intervention is considered cost-effective. Targeting adherence interventions at patients with the greatest to gain, and tailoring them to individual patient needs, may help to optimize cost-effectiveness ratios and improve the probability of positive reimbursement decisions, systemwide implementation, and resultant health benefits.

Key words

Asthma
COPD
Medication adherence interventions
Initiation
Implementation
Persistence
Health care professionals
cost-effectiveness

Abbreviations used

COPD
chronic obstructive pulmonary disease
FACI
facilitated asthma communication intervention
ICS
inhaled corticosteroids
RCT
randomized controlled trial
SIMPLES
Smoking status, Inhaler technique, Monitoring, Pharmacotherapy, Lifestyle, Education, Support

Cited by (0)

The Expert Adherence Panel Meeting from which the concepts presented in this article were first discussed and the manuscript submission costs were supported by the Respiratory Effectiveness Group. Teva supported the meeting costs at which the concepts in this paper were discussed by the co-authors and the open access publication fee for this article. The authors had full editorial control over the ideas presented.

Conflicts of interest: J. F. M. van Boven has received travel support from the Respiratory Effectiveness Group and European COPD Coalition; has received consultancy fees from AstraZeneca; and has received research support from AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, and Chiesi. M. N. Eakin has received travel support from the Respiratory Effectiveness Group; has received consultancy fees from Boehringer Ingelhiem; has received research support from the National Institutes of Health, Cystic Fibrosis Foundation, and American Lung Association; and has received lecture fees from Praxis Pharmaceuticals. J. M. Foster has received travel support from the Respiratory Effectiveness Group and European Academy of Allergy and Clinical Immunology; is on the Vertex Pharmaceuticals advisory board; and has received research support from GlaxoSmithKline and AstraZeneca. The rest of the authors declare that they they have no relevant conflicts of interest.