Adherence stages measured by patient-reported outcome instruments in adults with asthma: a scoping review

Abstract

Objective: Individuals who are adherent to their asthma inhaled maintenance medication: (1) initiate their treatment (take the first dose); (2) implement it (take it as per prescribed dosing regimen); and persist with it (take it for the entire prescribing period). To avoid unnecessary hospitalizations and costs, patient adherence should be routinely assessed. To this end, we aimed to identify patient-reported outcome instruments (PROs) used for measurement of patient adherence to inhaled maintenance medication in asthmatic adults and to report on the adherence stage that these instruments measured. Data sources: We conducted a scoping review of six databases. Study selection: We searched for studies in which PROs were used to measure patient adherence to inhaled maintenance medication in asthmatic participants aged ≥18 years. We extracted and synthesized data in order to list the available PROs and to report the adherence stages that these instruments measured. Results: We included 186 studies (87 PROs). Among all 87 instruments, none were found to measure all three adherence stages. We found that 1 measured initiation, 2 evaluated initiation and implementation, 74 assessed implementation, 7 measured implementation and persistence. The most used instrument (n = 41 studies or 22%) was the Self-Reported Medication-Taking Scale, which was found to assess implementation only. Conclusion: Our results suggest that no single PRO exists to measure initiation, implementation and persistence with asthma inhaled maintenance medication. Results from this review could therefore guide the development or refinement of PROs that would aim to measure all three adherence stages.

Keywords:

• Adherence
• adults
• asthma
• maintenance medication
• patient-reported outcome instrument
• scoping review

Acknowledgments

We acknowledge Frédéric Bergeron, M.S.I. for assistance in designing our electronic searches. We thank Justine Veilleux, undergraduate medical student, for comparing data extraction forms. We are grateful to Marie-Ève Boulay, M.Sc., Jean-Pierre Grégoire, Ph.D., Julie Turmel, Ph.D., and Catherine Sweeney, D.M.D. for revising the manuscript. We thank Erica Pridoehl, M.Ed. for editing the English manuscript.

Author contributions

Substantial contributions to the conception or design of the work; or the acquisition of the work; or the analysis, or interpretation of data for the work: MG, LPB, NP, JM

Drafting the work: MG

Revising the work critically for important intellectual content: LPB, NP, JM

Final approval of the version to be published: MG, LPB, NP, JM

Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: MG, LPB, NP, JM

Disclosure statement

Potential conflicts of interest to disclose are: (1) The Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health is supported by unrestricted grants from AstraZeneca; (2) The Chair on Adherence to Treatments was supported by unrestricted grants from AstraZeneca, Merck Canada, Sanofi Canada, Pfizer Canada and the Prends soin de toi program. M.G., N.P., and J.M. have no conflict of interest to declare. L.P.B. considers having no conflict of interest, but wishes to declare what can be perceived as potential conflicts of interest. Advisory Boards: GlaxoSmithKline, Novartis. Conferences (honoraria): AstraZeneca, GlaxoSmithKline, Merck, Novartis. Sponsorship for investigator-generated research: AstraZeneca, GlaxoSmithKline, Merck Frosst, Schering. Sponsorship for research funding for participating in multicenter studies: AllerGen, Altair, Amgen, Asmacure, AstraZeneca, Boehringer-Ingelheim, Genentech, GlaxoSmithKline, Novartis, Ono Pharma, Pharmaxis, Schering, Wyeth. Support for the production of educational materials: AstraZeneca, GlaxoSmithKline, Merck Frosst, Boehringer-Ingelheim, Novartis. Organisational: Chair of the Global Initiative for Asthma (GINA) Guidelines Dissemination and Implementation Committee, Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health, Member of the Executive Committee of Interasma (Global Asthma Organisation). The authors alone are responsible for the content and writing of this article.

Additional information

Funding

This work was supported by the Laval University Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health, and the Laval University Chair on Adherence to Treatments. MG received a Student Research Project Stipend from Knowledge Translation Canada to support this work. MG also received a graduate studentship award from Knowledge Translation Canada.