title: Enhancing Respiratory Medication Adherence: The Role of Health Care Professionals and Cost-Effectiveness Considerations.
abstract: 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.
authors: Department of Primary Care, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Unit of Pharmacoepidemiology & Pharmacoeconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands. Electronic address: j.f.m.van.boven@rug.nl.
authors: Job F M
authors: JF
authors: van Boven
authors: Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom.
authors: Dermot
authors: D
authors: Ryan
authors: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md.
authors: Michelle N
authors: MN
authors: Eakin
authors: Allergy and Respiratory Diseases Clinica, DIMI Department of Internal Medicine, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
authors: Giorgio W
authors: GW
authors: Canonica
authors: Patient Connect Service, Surrey, United Kingdom.
authors: Aji
authors: A
authors: Barot
authors: Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.
authors: Juliet M
authors: JM
authors: Foster
mesh_terms: D001249:Asthma / Q000188:drug therapy* / Q000191:economics; D003362:Cost-Benefit Analysis; D006282:Health Personnel; D006801:Humans; D055118:Medication Adherence; D011320:Primary Health Care; D024382:Professional Role; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics; D019141:Respiratory System Agents / Q000627:therapeutic use
chemical_list: D019141:Respiratory System Agents
keywords: Asthma; COPD; Health care professionals; Implementation; Initiation; Medication adherence interventions; Persistence; cost-effectiveness