Inhaled corticosteroids offer considerable protection against asthma exacerbations. However, few patients take their inhaled steroids as prescribed. Underuse of inhaled steroids is common among inner-city children. Commonly cited barriers to adherence include lack of access to medication, cost of medication, and ease of access to refills. Therefore, we are collaborating with inner-city school districts to examine the effect of school based supervised asthma therapy on asthma morbidity.
Two hundred and ninety six children (ages 6-13) with persistent asthma who have enrolled in the study were examined. Children are currently in the baseline data collection phase of the study. In this phase, rescue and controller medication are provided at no charge to participants but medication use is not yet supervised. To obtain refills of medications, parents are instructed to call the study coordinator and request that medication be mailed to them. We examined the number of children who had rescue medication at school at the time of enrollment and the number of children who have refilled their controller medication on schedule since the time of enrollment.
Ninety-two percent of children in the sample are black, 7% are white and 44% are female. Of the 296 children, 36 (8%) had rescue medication at school at the time of enrollment. On average, children had approximately 1.4 fewer refills than were expected (p<0.0001). To date, two hundred thirteen children have been due to refill their controller medication. Of these 213, 148 (69%) have never refilled their controller medication and 36 (17%) have refilled their medication at the expected rate. The remaining 29 (14%) have refilled their medication at less than the expected rate. Refill rates did not differ by race, gender or age of the child.
These data indicate that even when commonly cited barriers to adherence are removed, refill rates are much lower than expected.
There is a need to consider other social and behavioral factors which may influence patients’ decisions to adhere to medication regimens.
Lynn Gerald, None.