Relationships between patient activation and asthma medication adherence in an underserved rural patient population

Background: Up to 80% of patients with asthma have problems adhering to prescribed medication regimens. Recent studies have stressed the importance of patients taking an active role in their health care, which may impact the use of medications. The purpose of this study was to explore the relationships between adherence to asthma maintenance medication and patient activation in an underserved rural population.

Methods: As part of a randomized controlled trial, we conducted a baseline survey. Patients with asthma who received their medications from the Family Health Center of Marshfield, Inc. (a federally qualified health center) 340B mail-order pharmacy were invited to participate. Enrollment criteria included age ≥ 19 years, English-speaking, and receipt of ≥ 1 asthma medication(s) dispensed and medication possession ratio of ≤ 80% or ≥ 120% for controller medication(s) in the 6 month period ending January 31, 2009. Self-reported adherence was assessed with the Morisky Medication Adherence Scale© (MMAS). MMAS scores were dichotomized to represent low adherence (MMAS < 6) and medium/high adherence (MMAS ≥ 6). The Patient Activation Measure (PAM) was used to measure patient activation or individuals' knowledge, skill, and confidence for managing their own health and health care. The PAM is comprised of four components: believes active role important, confidence and knowledge to take action, taking action, and staying the course under stress. Aggregate scores were created for the overall PAM as well as the four components. Logistic regression models were estimated to examine the relationships between adherence (low or medium/high) and patient activation (overall and component scores), adjusting for the level of impairment due to asthma. Bootstrapping with 1000 replications and post estimation procedures were used to estimate odds ratios and bias-corrected confidence intervals.

Results: Ninety-eight adults were recruited of the 130 patients approached; 76 were currently prescribed a controller medication with a mean age of 43.5 (SD=15.9), 78% female and 95% white. The majority of participants were classified as low adherers to controller medications (63%). Results revealed that those who were low adherers were less likely to have greater overall patient activation (OR=0.90, 95%CI: 0.82-0.99), confidence and knowledge to take action (OR=0.25, 95%CI: 0.07-0.88), and ability to stay the course under stress (OR=0.30, 95%CI: 0.09-0.73).

Conclusions: Findings suggest that greater confidence and resiliency may be instrumental in patients' use of asthma medication. Results may inform interventions to help underserved, rural patients adhere to asthma medication regimens.