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Published on: April 6, 2017
Assessing adherence to inhaled corticosteroids in asthma patients using an integrated measure based on primary and
Lucie Blais1,2,3, Fatima-Zohra Kettani4,5, Amélie Forget4,5
1Faculté de Pharmacie, Université de Montréal, Montréal, QC, Canada. lucie.blais@umontreal.ca.
Insights
Primary adherence to inhaled corticosteroids (ICS) is low in adults, while secondary adherence is poor in both children and adults. An integrated measure (IPSA) provides more accurate adherence estimates than proportion of days covered alone.
Area of Science:
- Pulmonology
- Pharmacology
- Public Health
Background:
- Studies on primary adherence to inhaled corticosteroids (ICS) in asthma patients are scarce, particularly in pediatric populations.
- Assessing adherence solely by secondary measures (e.g., medication use over time) can overestimate patient compliance.
- Primary adherence (initial prescription fill) is a critical, yet understudied, component of medication adherence.
Purpose of the Study:
- To evaluate real-world primary and secondary adherence to ICS in pediatric and adult asthma patients.
- To develop and assess an integrated primary and secondary adherence (IPSA) measure for a more accurate assessment.
- To highlight the limitations of using only secondary adherence metrics.
Main Methods:
- Retrospective analysis of clinical databases for 198 children and 206 adults with ICS prescriptions (2010-2012) and ≥12 months follow-up.
- Primary adherence defined as filling the ICS prescription within 12 months.
- Secondary adherence calculated as proportion of days covered (PDC) for patients with at least one fill; IPSA incorporated primary adherence correction.
Main Results:
- 12-month primary adherence was 89.4% in children and 69.4% in adults.
- 12-month secondary adherence was 33.9% in children and 52.8% in adults.
- 12-month IPSA was 30.3% in children and 36.6% in adults.
Conclusions:
- Primary adherence to ICS is notably lower in adults compared to children.
- Secondary adherence is suboptimal in both pediatric and adult asthma patients.
- The IPSA measure offers a more comprehensive and valid assessment of ICS adherence than PDC alone, particularly in adults.
Purpose:
There are very few studies on primary adherence (i.e., first filling of a prescription) to inhaled corticosteroids (ICS) in asthma patients; two have involved children. Moreover, adherence can be overestimated when considering only secondary adherence (i.e., following the medication recommendations for a defined period) and ignoring primary adherence. We aimed thus to evaluate the real-world primary and secondary adherence to ICS and to develop an integrated primary and secondary adherence (IPSA) measure.
Methods:
From two clinical databases of pediatric and adult asthma patients, we included 198 children and 206 adults with one ICS prescription recorded in their medical chart between 2010 and 2012 and follow-up data for ≥12 months. Adherence was estimated from written prescriptions and prescription claims data. Primary adherence was defined as filling the ICS prescription at a pharmacy within 12 months. Secondary adherence was defined as the proportion of days covered (PDC) in subjects who filled their prescription at least once. The IPSA was based on the PDC with a correction factor for primary adherence.
Results:
Primary adherence to ICS at 12 months was 89.4 % in children and 69.4 % in adults. Secondary adherence at 12 months in children was 33.9 %, and the IPSA was 30.3 %. These values were 52.8 and 36.6 %, respectively, in adults.
Conclusions:
Primary adherence to ICS is low in adults and secondary adherence is poor in children and adults. Using the PDC as a unique measure of adherence led to significant overestimation in adults; IPSA leads to more valid estimates of adherence to ICS.
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