P57 Addressing complex non-adherence among patients with severe asthma using a dedicated adherence clinic

• Published in: Thorax Vol. 78; no. Suppl 4; pp. A139 - A140
• Main Authors: Almutairi, M, Hussein, H, White, L, Gilbey, S, Marriott, J, Mansur, A
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Thoracic Society 06.11.2023; BMJ Publishing Group LTD
• Subjects: Asthma; Mental health; Patients; ‘The heat is on’ – Can we get greener in asthma?
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax-2023-BTSabstracts.209

BackgroundDrivers of non-adherence to treatment in some patients with severe asthma can be complex and may benefit from psychological interventions which address patient beliefs, attitudes, and cognitions about their illness and medications[2].AimsTo evaluate the impact of a dedicated clinic on adherence to inhaled corticosteroid (ICS) in patients presenting with complex non-adherence.MethodsA clinic led by a clinical psychologist and a specialist asthma nurse delivered three sessions each a month apart to patients who had complex factors that underpinned their non-adherence (e.g. mental health concerns) or where previous adherence interventions had not worked. An adherence optimisation algorithm (figure 1) was applied. Patients were classed as non-adherent if their ICS prescription possession ratio (PPR) was ≤75%. Adherence barriers and the patient‘s understanding of their management plan were explored, and shared decision about the management plan was made that took in consideration underlying factors such as mental health and social or personal beliefs. Barriers to adherence were further addressed through treatment regime simplification and cognitive-behavioural and motivational strategies using the SIMPLE strategy [2]ResultsA total of 11 patients with complex non-adherence were put through the clinic protocol [mean age 34 years (19–52), 9 (82%) females]. Four patients declined to participate, while three completed the three sessions, two completed two sessions, and two completed one session reflecting the challenges of working with this group of patients. All patients were provided with an individualised written treatment plan that included for example minimal medications for those with depression on a ‘bad day’. The mean±SD baseline ICS PPR of 9 cases (2 cases missing follow-up data) was 64±31.98% vs 91±17.71% post-complex adherence clinic intervention, p> 0.09.Abstract P57 Figure 1Adherence optimisation algorithmConclusionsThis study explored the psychological and other barriers to adherence among patients with severe asthma. Our data provides initial evidence that addressing complex factors in this patients’ group may improve adherence for some patients. Further research is required confirm these findings.