title: Describing drivers of and barriers to persistence with tiotropium in patients with chronic obstructive pulmonary disease: a mixed-methods approach.
abstract: OBJECTIVE
  To understand the factors influencing persistence with tiotropium in patients with chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  Patients classified as 'persistent' or 'non-persistent' with tiotropium were identified from pharmacy dispensing records. Patients were compared for health status, beliefs and behaviours using data from questionnaires and interviews.
  
  
  RESULTS
  Perceptions of the risks and benefits of medication, fear of worsening illness, and the GP's emphasis on the importance of the medication were key determinants of tiotropium persistence.
  
  
  CONCLUSIONS
  Perceptions, attitudes and beliefs of patients and doctors influence persistence with tiotropium. These complex interactions need to be targeted to improve persistence with medicines in COPD.
authors.affiliation: School of Medicine, University of Tasmania, Hobart, Tas, Australia.
authors.forename: Bonnie J
authors.initials: BJ
authors.lastname: Bereznicki
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Peterson
authors.forename: Shane L
authors.initials: SL
authors.lastname: Jackson
authors.forename: Haydn
authors.initials: H
authors.lastname: Walters
authors.forename: Felicity L
authors.initials: FL
authors.lastname: Hardley
authors.forename: Guy A
authors.initials: GA
authors.lastname: Gavagna
authors.forename: David C
authors.initials: DC
authors.lastname: Marshall
mesh_terms: D001993:Bronchodilator Agents / Q000627:therapeutic use; D057225:Data Mining; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D010361:Patients / Q000523:psychology; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000523:psychology*; D000069447:Tiotropium Bromide / Q000627:therapeutic use*
chemical_list: D001993:Bronchodilator Agents; D000069447:Tiotropium Bromide
keywords: chronic obstructive pulmonary disease; community pharmacy; data-mining; medication persistence