1. Building unique support solutions for individual patient needs Visit us: www.atlantishealthcare.com © 2011 Atlantis Healthcare | Commercial in Confidence Asthma Preventer Non-adherence: A psychological perspective New Zealand Respiratory Conference September 2013 Dr Kate Perry, Lead Health Psychology Specialist

2. © 2011 Atlantis Healthcare | Commercial in Confidence Common – Between 30-70% of occasions (Bender et al., 1997) – Likely an underestimate Not prompted to disclose in consultation Subject to social desirability and recall biases Costly – Loss of health benefit (Stern et al., 2006) – Economic cost (Hoskins et al., 2000) An uncontrolled patient is 3.5 x the cost of a controlled patient (£381 vs £108) Asthma Preventer Non-adherence

3. "Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments” Haynes et al. (2008) 3

4. © 2011 Atlantis Healthcare | Commercial in Confidence Myth 1: Non-adherence is related to socio-demographic factors Age & gender – Average correlation = 0 (DiMatteo, 2004) Education & income – Average correlation < 0.1 (DiMatteo, 2004)

5. © 2011 Atlantis Healthcare | Commercial in Confidence Myth 2: Non-adherence is related to personality Limited evidence for a ‘non-adherent personality type’ (Hevey, 2007) Patients are ‘differentially adherent’ (McHorney & Gadraki, 2012)

6. © 2011 Atlantis Healthcare | Commercial in Confidence Patient Reasons for Medication Non-adherence Unintentional non-adherence Practical barriers Intentional non-adherence Perceptual barriers

7. © 2011 Atlantis Healthcare | Commercial in Confidence Unintentional Reasons for Medication Non-adherence Unintentional non-adherence Practical barriers Practical reasons for not taking medication Resource and ability limitations non-adherence Perceptual barriers

8. © 2011 Atlantis Healthcare | Commercial in Confidence Overcoming resource limitations – Access Reducing cost Delivery Overcoming ability limitations – Dexterity and technique Demonstration and instruction Health literacy – Memory Aids and devises Establishing routine ‘Practical’ Interventions

9. © 2011 Atlantis Healthcare | Commercial in Confidence Patient Reasons for Medication Non-adherence Intentional non-adherence Perceptual barriers Conscious decision not to take medication Motivations and beliefs non-adherence Perceptual barriers

10. © 2011 Atlantis Healthcare | Commercial in Confidence Intentional Reasons for Medication Non-adherence

11. © 2011 Atlantis Healthcare | Commercial in Confidence Elicit patient beliefs about asthma – “How long do you think your asthma will last?” – “How serious do you think your asthma is?” – “How much control do you feel you have over your asthma?” Elicit patient beliefs about preventer medication – “How necessary do you think your preventer medication is?” – “How concerned are you about taking your preventer medication?” Correcting ‘maladaptive’ beliefs – Personalising the information – Use of behaviour change techniques ‘Perceptual’ Interventions

12. © 2011 Atlantis Healthcare | Commercial in Confidence Reasons for non-adherence vary – Unintentional and intentional In consultation – Elicit reasons from patient – Offer solutions that are tailored Practical Perceptual Summary