Supporting adherence to asthma medication: what happens in primary care?

Abstract

Background: Clinical guidelines recommend primary care practitioners to support medication adherence. In asthma management, little is known about how practitioners deliver this routinely. Reliably assessing adherence support in routine care and uncovering relevant determinants can help identify avenues for intervention and guideline implementation. Methods: Within a European study (ASTROLAB), 117 French general practitioners answered an online survey on 25 adherence support activities, sociocognitive determinants, professional background, and demographics. We examined items using item-response and classical test theory, and explored associations between adherence support and determinants. Findings: Substantial variability in practitioner responses was found; some activities were reported by most practitioners (education about medication, 98%), while others were rarely performed (encourage reminders use, 23%). Twelve activities formed a unidimensional scale (α=.75; H=.37; mean=7.2 ± 2.8; range 0-12). Support scores were unrelated to background variables, but showed significant associations with sociocognitive determinants (Ï=.19-.31). Discussion: Routine adherence support can be assessed reliably in primary care via practitioner self-reports. Targeting sociocognitive variables such as self-efficacy and perceived norms could lead to better guideline implementation.