title: The Madison Avenue effect: how drug presentation style influences adherence and outcome in patients with asthma.
abstract: BACKGROUND
  Little is known about how drug presentation influences medication adherence.
  
  
  OBJECTIVE
  To examine the effect of an educational program aimed at increasing expectations of treatment benefit on medication adherence.
  
  
  METHODS
  Data are analyzed from 99 participants who underwent electronic drug monitoring during the Trial of Asthma Patient Education, a randomized, placebo-controlled, multicenter trial. Participants with suboptimally controlled asthma were randomized to placebo or montelukast in conjunction with a presentation mode that was either neutral or designed to increase outcome expectancy. Adherence was monitored electronically over 4 weeks and was defined as ≥ 80% use of prescribed doses. Outcome expectancy, peak expiratory flow, prebronchodilator FEV₁, asthma control (Juniper asthma control questionnaire), and asthma-related quality of life were assessed at baseline and at the 4-week follow-up.
  
  
  RESULTS
  Average electronic medication adherence was 69.9%. There was a significant interaction between presentation mode and drug assignment, with participants in the enhanced/montelukast group having a higher change in outcome expectancy (Δ 2.1 points; P < .001) and better medication adherence (odds ratio, 4.0; 95% CI, 1.1-14.3) compared with those in the neutral/placebo group. There was no difference in asthma symptoms, quality of life, or clinical outcomes on the basis of presentation mode. Rather, increased outcome expectancy was associated with modest improvements in asthma symptoms after adjusting for presentation mode, drug assignment, and medication adherence.
  
  
  CONCLUSIONS
  The use of an enhanced presentation aimed at increasing outcome expectancy may lead to improved medication adherence.
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA. crand@jhmi.edu
authors.forename: Emmanuelle M
authors.initials: EM
authors.lastname: Clerisme-Beaty
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Bartlett
authors.forename: W Gerald
authors.initials: WG
authors.lastname: Teague
authors.forename: John
authors.initials: J
authors.lastname: Lima
authors.forename: Charles G
authors.initials: CG
authors.lastname: Irvin
authors.forename: Rubin
authors.initials: R
authors.lastname: Cohen
authors.forename: Mario
authors.initials: M
authors.lastname: Castro
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wise
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Rand
mesh_terms: D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010353:Patient Education as Topic; D016896:Treatment Outcome