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Improving adherence in chronic airways disease: are we doing it wrongly?

Gráinne d'Ancona, John Weinman
Breathe 2021 17: 210022; DOI: 10.1183/20734735.0022-2021
Gráinne d'Ancona
1Pharmacy Dept/Thoracic Medicine, Guy's and St Thomas’ NHS Foundation Trust, London, UK
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  • For correspondence: grainne.dancona@gstt.nhs.uk
John Weinman
2Institute of Pharmaceutical Sciences, King's College London, London, UK
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Tables

  • Table 1

    Capability, opportunity and motivation to perform a behaviour (COM-B) [37] model applied to patients with respiratory disease and suggested solutions

    BarrierPotential solution
    Capability (patient factors)
     Psychological ability
      Does not understand treatmentsEnsure your patient understands the purpose of their medicines
      Forgets to take medicinesUse reminder apps or an alarm on their phone
    Does not have a plan to take their treatmentFacilitate implementation intention: work with the patient to help them identify ways that medicines taking could be associated with their established daily activities (e.g. tooth brushing)
     Physical ability
      Poor dexterityIssue an inhaler device they can readily use or equipment to facilitate its use
    Opportunity (external to patient)
     Physical factors
      Restricted access to healthcare systemEncourage regular review (even when well), provide emergency access to care and advice
      Financial constraintsProvide information on pre-payment or exemption certificates, prescribe several inhalers at once in systems that charge per prescription (rather than per item)
      Complex regimenSimplify regimens where possible
      Dislike of the taste of the medicineChange to an alternative brand, formulation or delivery device (e.g. some patients distinctly prefer a DPI or pMDI)
     Social factors
      Lack of support from healthcare providersBe supportive and non-judgemental
      Lack of social circle supportEngage family members, friends or other patients for support and encouragement
      Religious/cultural beliefsThis may lead to rejection of an inhaler containing alcohol, so offer a DPI or an inhaler brand without alcohol
    Motivation
     Reflective factors
    Patient's beliefs about medicines/​about their conditionSupport understanding of the disease as present even in the absence of symptoms, and how the use of the chosen medicine treats the disease
    Describe the benefits of the therapy in terms of short-, medium- and longer-term benefits
    Acknowledge the potential for side-effects, and contextualise their risk of experiencing them, how to manage them or how long they may persist; this may need to be in comparison to previously tried therapies
    Reassure the patient that, if necessary, alternatives exist
     Automatic factors
      Patient moodAddressing low self-esteem, depression and anxiety will support better adherence
      HabitChange incongruent regimens to suit the patient's lifestyle/preference (e.g. if evening doses are regularly forgotten, suggest the dose be taken in the morning)
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Improving adherence in chronic airways disease: are we doing it wrongly?
Gráinne d'Ancona, John Weinman
Breathe Jun 2021, 17 (2) 210022; DOI: 10.1183/20734735.0022-2021

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Improving adherence in chronic airways disease: are we doing it wrongly?
Gráinne d'Ancona, John Weinman
Breathe Jun 2021, 17 (2) 210022; DOI: 10.1183/20734735.0022-2021
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  • Article
    • Abstract
    • Abstract
    • Barriers to adherence: healthcare professional factors
    • Barriers to adherence: patient factors
    • Interventions tested for impact on adherence
    • Limitations of improvements in adherence
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