Improving long-term adherence to sublingual immunotherapy. Results of a proactive patient-centered management...

Background. Long-term adherence to sublingual immunotherapy (SLIT) results very poor in real-life studies. Effective actions are needed. Key point of any policy aimed to overcoming non-cost related barriers to medication long-term adherence is to actively support patients' needs and preferences starting from shared decisions making. Objective. To explore SLIT related viewpoints, needs and preferences of a homogeneous group of patients. To assess their priority order and to what extent each of them could affect SLIT adherence. To find a rational basis for a proactive action-plan to support patients' needs and preferences and assess results on SLIT long-term adherence. Patients and methods. Preferences and viewpoint of patients in treatment-related decisions and their health-related needs have been explored by structured, direct interview of 65 adult patient. The activities of the hospital outpatient clinic were rearranged to support needs and requests shared by all patients, and to allow tailored interventions integrating them into routine practice. Adherence to SLIT was studied on a different group of 129 patients aged 14 to 42 years and defined as number of patients who completed three years of therapy. Results. SLIT was completed by 98 patients (76%). Main cause of discontinuation for 31 remaining patients have been pregnancy (16%), change of work residence (19%), side-effects (10%), perceived inefficacy (26%), and non-compliance (29%). Conclusions. To improve adherence, it is necessary to investigate patient-related factors to find a common ground to take actions aimed to remove barriers to long-term SLIT-adherence that virtually can work for all patients, but flexible enough to allow patient-tailored interventions. The substantial differences on disease's perception between patients with only allergic rhinitis and those with asthma entail the necessity of differentiated approaches. Management strategy based on shared decision making followed by proactive and ongoing interventions to support patients' needs and preferences proves effective to ensure a good long-term adherence to SLIT in real-life.