Identifying Predictors of Medication Adherence in Adult Patients with Asthma: A Social Problem-Solving Approach

摘要

Asthma is a chronic respiratory illness that has become major public health concern due to its rapid increase in prevalence and increasing economic burden. Asthma management, which includes asthma control, perceived control of asthma and medication adherence, has been documented to be extremely poor. One of the main reasons for poor management includes low rates of medication adherence. The primary goal of this research study was to identify factors related to medication adherence that can eventually be integrated into clinical practice. Identifying these factors would help increase adherence rates and decrease the burden of asthma on individuals as well as the entire population.;The current study examined how individual variables are related to medication adherence in patients with asthma. Research has indicated that patients with high perceived stress are less likely to adhere to a prescribed medication regimen. Social problem-solving, which is the affective, cognitive and behavioral way individuals approach real world problems, is related to the management of various chronic conditions and may moderate the relationship between perceived stress and adherence outcomes. Adult asthma patients for this study were recruited from two different medical sites: an allergy and asthma private practice located in New Jersey and Drexel Pulmonary Medicine located in Philadelphia, PA. Self-report data was collected from participants (N = 104) including demographic information, asthma control, perceived control of asthma, perceived stress, social problem-solving behaviors and medication adherence. Additional patient information was gathered using patient medical and pharmacy records. Bivariate correlational analyses demonstrated positive associations between perceived stress and dysfunctional social problem-solving tendencies and negative associations between perceived stress and self-report adherence. Lower perceived stress was also associated with more adaptive social problem-solving tendencies and higher asthma control. Lower perceived control of asthma was associated with the dysfunctional social problem-solving dimensions and higher pharmacy reports of adherence. Analyses also revealed relationships between higher self-report adherence and more adaptive problem-solving abilities. A hierarchical regression analysis revealed that lower perceived control of asthma was predictive of higher pharmacy refill adherence rates. Social problem-solving did not significantly moderate the relationship between perceived stress and medication adherence. Exploratory analyses indicated that lower self-reports of adherence, lower perceived control of asthma, and more maladaptive problem-solving tendencies were all predictive of higher perceived stress. Additionally, a one-way analysis of variance (ANOVA) was conducted to examine differences among racial and ethnic groups. Individuals who identified as White reported greater self-report adherence, less perceived stress, better social problem-solving abilities, higher perceived control of asthma, and better objective control of asthma, as compared to other racial and ethnic groups. Results suggest integrative medical and psychosocial treatments should be adapted for individuals of various racial and ethnic backgrounds. Interventions that target social problem-solving abilities and perceived stress may be particularly beneficial for improving patient's ability and perceived ability to successfully manage their asthma.