Research digest: Identifying medication adherence challenges to support best practice across Europe

3rd January 2025

A recent study identifying critical indicators related to medication adherence emphasises the complexity of the issue and the difficulty in predicting adherence to medications. The findings suggest a need for tailored, country-specific interventions and health policies to increase adherence, improve health outcomes and reduce economic burdens.

Researchers identified and prioritised indicators related to medication adherence (IRMAs) across 39 European countries and Israel through an online expert survey. Follow-up work involved collecting country-specific data on IRMAs in two countries through a targeted literature review and subsequent data validation with a second online expert survey.

Survey participants were medication adherence experts from various clinical fields, including physicians, pharmacists, psychologists and nurses who were all part of the European Network to Advance Best Practices and Technology on Medication Adherence (ENABLE).

A total of 17 out of 34 invited ENABLE members responded to the initial survey, resulting in 205 indicators of IRMA. The second survey saw 21 participants rank the 205 indicators, and 25 indicators emerged with a relevance score above 3.5.

The researchers were able to group the IRMAs into six main categories:

1. Country characteristics such as healthcare provider, demographics or method of payment
2. Social and economic factors including how medication was paid for and socioeconomic status
3. Therapy-related factors such as the number of medications taken
4. Patient-related factors linked to behaviours and attitudes
5. Condition-related factors around the nature of the illness
6. Healthcare system-related factors such as availability of services.

In addition, the researchers included ‘country population’ as an additional indicator because of its essential role in facilitating comparative analyses across countries in the future.

The findings offered a comprehensive understanding of the factors influencing medication adherence and successfully highlighted the priority areas as perceived by healthcare professionals engaged in this field. They will have significant implications for policymakers, healthcare providers and researchers, according to the researchers.

‘These results suggest that effective adherence-enhancing interventions must extend beyond addressing patient and therapy-related factors to include broader socio-economic and healthcare system-related determinants,’ the researchers said.

The researchers said the findings will enable fair comparisons across countries and provide a basis for the prediction of medication adherence rates in further studies.

Further research is also needed to rank these indicators accordingly and better comprehend their impact, and this could benefit from incorporating patient viewpoints to enhance the comprehensiveness and applicability of the findings, the researchers added.

Reference
Ágh T et al. and European Network to Advance Best Practices and Technology on Medication Adherence (ENABLE) Collaborators (2024). Identifying and presenting key country-specific indicators related to medication adherence: a comprehensive study across European countries. Front. Pharmacol. 15:1390629. doi: 10.3389/fphar.2024.1390629.

Once-daily inhaled steroid use in asthmatic children improves adherence

18th February 2022

Once-daily dosing of inhaled steroids in young children with asthma improved medicine adherence compared with a twice daily regime

The use of a once-daily dosing regime for inhaled steroids in young children is associated with an improvement in medication adherence according to a study by researchers at the Department of Pediatrics, Faculty of Medicine, Université de Montréal, Canada.

Asthma is caused by inflammation and a subsequent narrowing of the small airways in the lungs, leading to the typical symptoms, which include any combination of cough, wheeze, shortness of breath and chest tightness.

According to the World Health Organization, in 2019, asthma affected an estimated 262 million people in 2019 and caused 461000 deaths. Moreover, among children aged 5-14 years, asthma is among the top 10 causes of disability-adjusted life years.

Inhaled steroids are the most effective drugs used in asthma to suppress airway inflammation and suitable for both adults and children. However, adherence to inhaled steroids remains low with one systematic review finding that 24% of asthma exacerbations and 60% of asthma-related hospitalisations could be attributed to poor inhaled steroid adherence.

Simplifying regimes for instance, use of a once-daily inhaled steroid has been shown to significantly increase adherence compared to twice daily usage. However, this study was in adults and there is a lack of robust data for children.

Consequently, in the present study, the Canadian team wanted to examine the real-life impact of prescribing inhaled steroids once-daily compared to twice-daily and how this affected adherence. They performed a retrospective analysis of children visiting an asthma clinic at their hospital who had been prescribed daily inhaled steroid therapy and compared those prescribed either once or twice daily therapy.

They set the primary outcome as the secondary adherence to the inhaled steroid based on the proportion of prescribed days covered (PPDC), which was the total number of days for which the drug was dispensed divided by the total number of days for which the drug was prescribed. The secondary outcome as secondary adherence as either good (> 75%) or poor (< 75%).

Once-daily inhaled steroid use and PPDC

A total of 232 participants with a mean age of 5.8 years (61% male) of whom 110 were prescribed once-daily inhaled steroids were included in the analysis and followed-up for a median of 10.7 months.

The once-daily regime was associated with a higher PPDC compared to twice daily (66.8% vs 58%). After adjustment, children prescribed a once-daily regime had a significantly higher PPDC (7.2%, 95% CI 1.3 – 13.1%) and a higher odds of having a PPDC > 75% (Odds ratio, OR = 1.80, 95% CI 1.01 – 3.26).

However, there were no significant differences between once and twice daily regimes on the time to the first asthma exacerbation (hazard ratio, HR = 0.71, 95% CI 0.38 – 1.31).

Based on these findings, the authors concluded that once-daily dosing improved absolute adherence compared to twice-daily but added that further studies are required to determine whether better adherence leads to clinically meaningful improvements in asthma control.

Citation
Drouin O et al. Adherence to inhaled corticosteroids prescribed once- vs twice-daily in children with asthma Ann Allergy Asthma Immunol 2022