 |
|
Patient Factors and Medication Guideline Adherence Among Older Women With Asthma
R. Graham Barr, MD, MPH;
Samuel C. Somers, MD;
Frank E. Speizer, MD;
Carlos A. Camargo, Jr, MD, DrPH
Arch Intern Med. 2002;162:1761-1768.
Background Asthma guidelines are well established but often followed poorly. Determinants
of adherence among older persons may differ from younger persons and have
not been well characterized.
Objectives To assess adherence to asthma medication guidelines among older women
with asthma and evaluate predictors of adherence with emphasis on asthma characteristics,
comorbid medical conditions, work-related factors, social supports, caregiving,
and emotional well-being.
Methods We assessed adherence to the National Asthma Education and Prevention
Program medication guidelines among participants in the Nurses' Health Study
who reported a physician diagnosis of asthma and reconfirmed the diagnosis
on a separate questionnaire, excluding those with chronic obstructive pulmonary
disease.
Results Among 121 700 participants in the Nurses' Health Study, 5107 reported
physician-diagnosed asthma meeting inclusion criteria. Mean ± SD age
was 63 ± 7 years in 1998. Adherence with asthma medication guidelines
was 57% for mild persistent, 55% for moderate persistent, and 32% for severe
persistent asthma (P = .001). In multivariate analysis,
nonadherence was associated with severe asthma, increasing age, lower socioeconomic
status, current smoking, earlier onset of asthma, and number of comorbid medical
conditions. Measures of social isolation, caregiving, and emotional well-being
were not associated with nonadherence.
Conclusions Asthma is undertreated among older women, even those who are health
care professionals. Women with advanced age and severe asthma were particularly
at risk. Given that the greatest increase in asthma mortality has occurred
among older women, further research is needed to examine physician prescribing
patterns and patient beliefs in this vulnerable population.
From the Channing Laboratory, Department of Medicine, Brigham and Women's
Hospital (Drs Barr, Somers, Speizer, and Camargo), and General Medicine Division
(Dr Barr) and Department of Emergency Medicine (Dr Camargo), Massachusetts
General Hospital, Harvard Medical School, Boston.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Consumption of cured meats and prospective risk of chronic obstructive pulmonary disease in women
Jiang et al.
Am. J. Clin. Nutr. 2008;87:1002-1008.
ABSTRACT
| FULL TEXT
No Symptoms, No Asthma: The Acute Episodic Disease Belief Is Associated With Poor Self-Management Among Inner-City Adults With Persistent Asthma
Halm et al.
Chest 2006;129:573-580.
ABSTRACT
| FULL TEXT
Quality and Access to Care Among a Cohort of Inner-city Adults With Asthma: Who Gets Guideline Concordant Care?
Halm et al.
Chest 2005;128:1943-1950.
ABSTRACT
| FULL TEXT
Functional Health Literacy and Medication Use: the Pharmacist's Role
Youmans and Schillinger
The Annals of Pharmacotherapy 2003;37:1726-1729.
FULL TEXT
|
