PURPOSE: Daily adherence to inhaled corticosteroid (ICS) regimens is one of the most important factors linked to achieving optimal asthma control. Motivational intervieiwing (MI) is a client-centred communication technique that focuses on enhancing intrinsic motivation to change and supporting self-efficacy. It has been shown to improve a variety of health behaviors including medication adherence in other disorders, but its efficacy for the improvement of ICS adherence in asthmatics has yet to be examined. This study assessed the efficacy of MI (3 x 30 min sessions within a 6 week period) to improve daily ICS adherence in poorly controlled, non-adherent asthmatics.
METHODS: Fifty adults with objectively confirmed asthma were recruited from the outpatient asthma clinic of a university-affiliated hospital. Poorly controlled (ACQ score ≥ 1.50) non-adherent (filled < 50% of ICS medication in the last year) asthmatics underwent baseline assessments and were randomly assigned to MI (n=23) or usual care (UC: n=27). ICS adherence (% pharmacy refills) was objectively measured at 6 and 12-months post-intervention. GLM analyses were intent-to-treat, and results were adjusted for a-priori-defined covariates including baseline adherence.
RESULTS: Average baseline 12-month adherence in the MI and UC groups was 31% and 29% respectively. Six month analyses revealed a mean change in %ICS refills of +23.4% in the MI group vs. only 12.8% in the UC group (between group net improvement associated with MI = 10.6%). Final 12-month analyses revealed a mean change in %ICS refills of +21% (MI group) vs. 10% in the UC group (between group net improvement associated with MI = 11%).
CONCLUSIONS: Results suggest that a brief (90 min) MI intervention that targets ICS adherence can produce clincially significant improvements in ICS adherence in poorly controlled, non-adherent asthmatics that are maintained at 1-year.
CLINICAL IMPLICATIONS: Findings provide support for conducting a full RCT, and suggest that greater efforts should be made to train asthma healthcare providers in MI, so that it may be incorporated into clinical practice and asthma education programs.
DISCLOSURE: Kim Lavoie: Grant monies (from industry related sources): I was awarded an investigator-initiated grant from GSK through a competitive open competition which funded the study to be presented., Consultant fee, speaker bureau, advisory committee, etc.: I received speaker fees from GSK and Merck to train health professionals on how to do motivational interviewing to improve health behaviours
The following authors have nothing to disclose: Gregory Moullec, Lucie Blais, Marie-France Beauchesne, Catherine Lemiere, Manon Labrecque, Tavis Campbell, Simon Bacon
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