Studies Assess Costs and Accessibility for Asthma Medications

Two recent studies evaluated the effects of asthma through addressing the costs and adherence to medications as well as the accessibility to certain resources for patients.

One study assessed the patient adherence in Australia, specifically looking at the cost-related under-use of asthma medicines among adults and children. The study involved a cross-sectional population-based online survey of adults with asthma and parents of children between the ages of 5 and 17 with asthma.

The results consisted of completed surveys from 792 adults with asthma and 609 parents of children with asthma. Of the adults, 419 (52.9%) reported delaying or skipping refills/doses or taking fewer puffs in the last 12 months because of the cost, while 243 (30.7) reported foregoing basic needs in the last 12 months to pay for asthma medicines.

For the parents of children with asthma, 209 (34.3%) reported delaying or skipping doses or taking fewer puffs in the last 12 months due to the cost, and 269 (44.2%) reported foregoing basic needs in the last 12 months for asthma treatment.

Additionally, the results revealed that cost-related medicine under-use was reported lower among:

• Women, older patients, and older parents of children
• Those not using any inhaled corticosteroids (adults only) or using fewer medicines (children only)
• Those with no reported concerns about medicines
• Those who were more comfortable talking with their doctor about hanging medicines (adults) or about medicine costs (children)
• Parents who were more involved with the doctor in making medication-related decisions for their child
• Participants/children with better asthma symptom control, no specialist visits, and no urgent asthma care in the previous 12 months

“Health professionals should be encouraged to ask patients if they have concerns about their asthma medicines including about cost; to optimize cost-effectiveness by checking inhaler technique and avoiding over-treatment; and to consider offering options with a lower overall out-of-pocket cost,” the authors concluded.

Another study investigated if an English-only patient portal of the electronic health record would benefit patients who have limited educational opportunities, resources, and access to information technology.

The study included adults with uncontrolled asthma who lived in low-income urban neighborhoods. Each patient received portal training (PT) and half were randomized to home visits (HV) by community health workers. The training included 7 tasks, such as reviewing an upcoming appointment and requesting a refill. The patients were followed for 1 year.

The results revealed fewer than 60% of patients used the portal independently—the frequeny of portal use was associated with younger age, higher reported household income, and education beyond high school. Portal use was also less likely in patients with diabetes, hypertension, or hospitalizations for asthma, but it was not linked with gender, race, ethnicity, or Spanish as a primary language.

The most frequent usage of the portal was for reading messages and getting lab results, while the least frequent usage was sending messages and making appointments.

“Patients with the most uncontrolled asthma and other medical comorbidities were least likely to use the portal,” the authors concluded. “The patient portal needs revision to accommodate patients with the highest asthma morbidity and healthcare needs.”

References

1. Reddel HK, Laba T, Jan S, et al. Effects of out-of-pocket costs on patient adherence with asthma medicines. Presented at the American Thoracic Society 2018 International Conference. May 20, 2018; San Diego, California. Abstract A1083.

2. Apter AJ, Bryant-Stephens T, Perez L, et al. Electronic health record patient portal access for low income and minority adults with uncontrolled ashtma. Presented at the American Thoracic Society 2018 International Conference. May 20, 2018; San Diego, California. Abstract A1074.