https://orcid.org/0000-0002-6131-9141
Abstract
Moderate-to-severe asthma represents about a quarter of the nearly 10% of Americans diagnosed with asthma. Many patients with moderate-to-severe asthma have uncontrolled symptoms that lead to exacerbations requiring oral corticosteroids. There are many factors contributing to poor asthma control, including poor adherence to prescribed therapies, the under-prescribing of biologics and therapeutic inertia. We convened an eight-member panel from fields of primary care, pulmonology, immunology, health services and clinical research, behavioral science and pharmaceutical medical affairs, with the goal of identifying contributing factors and solutions to therapeutic inertia with asthma biologics. We used the Capability, Opportunity, and Motivation (COM-B) model to classify patient and provider behavior towards therapeutic inertia. The model incorporates existing behavior theories and is driven by the interaction of capability, opportunity, and motivation. We used a Delphi method to identify and develop six primary solutions: 1) integration of patient-centered outcomes into asthma management practice; 2) provider education about asthma treatment; 3) moderate-to-severe asthma care delivery redesign; 4) harmonized, evidence-based protocol for the management of moderate-to-severe asthma; 5) designated coordinator approach for optimal asthma management; and 6) a case coordination digital support tool. Integration of patient-centered outcomes into asthma management practice and provider education were identified as having the highest potential to impact therapeutic and clinical inertia. The COM-B model is effective in identifying improvement within therapeutic inertia targeting the capabilities, opportunities, and motivations of patients, providers, and payer systems.
Ethics Approval
According to the policy activities that constitute research at Duke University, this work met the criteria for quality improvement activities and was considered exempt from review by the Duke University Medical Center Institutional Review Board.
Acknowledgments
We thank Alvin Ong, PharmD, former Sanofi fellow, for his contributions to the workshop content development. The authors also acknowledge support from the Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) [CIN 13-410] within the Durham VA Health Care System.
Disclosure
Sheila M. Thomas, Thomas Barsanti, and Daniel T. Kennedy are employees of Sanofi. Lisa Egbuonu-Davis is a former employee of Sanofi and is a current employee of Danaher Diagnostics. Hayden B. Bosworth reports research grants from Otsuka, Novo Nordisk, Sanofi, Improved Patient Outcomes, and Boehringer Ingelheim; consulting for Preventric Diagnostic, outside the submitted work. The authors report no other conflicts of interest in this work.