It has been estimated that regular use of inhaled corticosteroids (ICS) could reduce asthma-related hospitalization by 80%. Inhaled corticosteroids can significantly improve lung function, as well as prevent asthma exacerbations and death. Yet, ICS use remains low among patients with asthma, and studies measuring ICS adherence suggest that patients take their prescribed dose on only 20% to 73% of days. Together these findings suggest that increase adherence to ICS could result in significant improvements in asthma-related outcomes. Unfortunately, few behavioral or educational interventions have been shown to be very effective at improving adherence and asthma control, despite in some cases considerable time invested with the patient. Given the importance of adherence information to clinical decision making and disease management, it is surprising that not until recently have there been studies looking at the effects of providing this information to physicians. However, even the limited evidence from these small studies suggests that simply providing adherence information to clinicians can have a profound influence on patient adherence. One challenge is how to provide adherence information in the clinic setting where time and resources are often limited. Weighing canisters and electronic recording devices have been used to measure adherence to ICS, but these methods are too time consuming and expensive to be used by most clinicians. Medication adherence can also be estimated using pharmacy claims data. Since claims data are collected for other reasons, these pharmacy-based adherence measures are relatively inexpensive to generate and they are available on a large number of patients. This application seeks to develop and test a tool, which feeds back adherence information to physicians via the electronic medical record. These adherence measures will be generated by linking prescription data to pharmacy claims. This method has the potential benefit of being both easily use in clinical practice and financially sustainable. After a baseline period, primary care physicians will be randomized to receive ICS adherence information on their patients with persistent asthma. The primary outcomes will be the change in adherence from baseline and the difference in adherence between treatment groups. Also assessed will be changes from baseline and differences between the treatment and control groups in patient-clinician communication, patient attitudes toward adherence, outcomes related to disease control, and medical care costs.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL079055-02
Application #
7116251
Study Section
Epidemiology of Clinical Disorders and Aging Study Section (ECDA)
Program Officer
Smith, Robert A
Project Start
2005-09-01
Project End
2009-06-30
Budget Start
2006-07-01
Budget End
2007-06-30
Support Year
2
Fiscal Year
2006
Total Cost
$349,399
Indirect Cost
Name
Henry Ford Health System
Department
Type
DUNS #
073134603
City
Detroit
State
MI
Country
United States
Zip Code
48202
Levin, Albert M; Gui, Hongsheng; Hernandez-Pacheco, Natalia et al. (2018) Integrative approach identifies corticosteroid response variant in diverse populations with asthma. J Allergy Clin Immunol :
Cajigal, Sonia; Wells, Karen E; Peterson, Edward L et al. (2017) Predictive Properties of the Asthma Control Test and Its Component Questions for Severe Asthma Exacerbations. J Allergy Clin Immunol Pract 5:121-127.e2
Wells, Karen E; Cajigal, Sonia; Peterson, Edward L et al. (2016) Assessing differences in inhaled corticosteroid response by self-reported race-ethnicity and genetic ancestry among asthmatic subjects. J Allergy Clin Immunol 137:1364-1369.e2
Pladevall, Manel; Divine, George; Wells, Karen E et al. (2015) A randomized controlled trial to provide adherence information and motivational interviewing to improve diabetes and lipid control. Diabetes Educ 41:136-46
Yessayan, L; Shafiq, A; Peterson, E et al. (2015) Race, Calcineurin Inhibitor Exposure, and Renal Function After Solid Organ Transplantation. Transplant Proc 47:2968-72
El-Refai, Mostafa; Hrobowski, Tara; Peterson, Edward L et al. (2015) Race and association of angiotensin converting enzyme/angiotensin receptor blocker exposure with outcome in heart failure. J Cardiovasc Med (Hagerstown) 16:591-6
Velez, Mauricio; Peterson, Edward L; Wells, Karen et al. (2015) Association of antidiabetic medications targeting the glucagon-like peptide 1 pathway and heart failure events in patients with diabetes. J Card Fail 21:2-8
Padhukasahasram, Badri; Reddy, Chandan K; Levin, Albert M et al. (2015) Powerful Tests for Multi-Marker Association Analysis Using Ensemble Learning. PLoS One 10:e0143489
Lanfear, David E; Li, Jia; Abbas, Raza et al. (2015) Genetic Factors Influencing B-type Natriuretic Peptide-Mediated Production of Cyclic Guanosine Monophosphate and Blood Pressure Effects in Heart Failure Patients. J Cardiovasc Transl Res 8:545-53
Levin, Albert M; Wang, Yun; Wells, Karen E et al. (2014) Nocturnal asthma and the importance of race/ethnicity and genetic ancestry. Am J Respir Crit Care Med 190:266-73

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