PITCH: What factors that influence patients’ purchase and use of asthma preventer medicines

Conference:

SAPC ASM 2018 - London

Talk Code:

2D.3b

Presenter:

Nicholas Zwar

Co-authors:

Helen Reddel, Sharon Davis, Tracey Laba, Elizabeth Roughead, Anthony Flynn, Aine Heaney

Author institutions:

University of Wollongong, UNSW Australia, Woolcock Institute of Medical Research, George Institute, University of South Australia, Asthma Foundation Queensland & NSW, NPS MedicineWise

Problem

Out-of-pocket costs strongly affect patient adherence with medicines. For asthma, guidelines recommend that most patients should be prescribed regular low-dose inhaled corticosteroids (ICS-alone), but in Australia, most are prescribed combination ICS/long-acting beta 2-agonists (LABA), which cost more to patients and government. In some European studies, GPs varied prescribing practices to reduce out-of-pocket costs to patients, however little is known about how costs influence patient decisions to purchase and use asthma preventer medicines. We aimed to explore factors that influence patients’ purchase and use of preventers and the feasibility and acceptability to patients of financial incentives to encourage use of low-dose ICS-alone rather than ICS/LABA combination medicines.

Approach

Semi-structured telephone and face-to-face interviews were conducted with a purposive sample of patients with asthma/carers of children with asthma (n=44). Patients were recruited through Asthma Foundation contact lists and through a practice-based research network. The participants consisted of: adults with asthma = 21; carers of children 5-17 years with asthma = 20; both carer and adult with asthma = 3.

Findings

Interview data are still being analysed but key themes that have emerged to date are: patients view effectiveness as the key consideration in choice of preventer; most patients considered they had no influence on the medicine prescribed; cost of medicines was an issue for some participants (e.g. users of multiple medicines and low-income earners) but medicine effectiveness was seen as more important; participants would prefer a lower cost preventer if equally effective. The idea of financial incentives was met with some scepticism.

Consequences

Patients did not regard themselves as primary decision-makers about preventer choice, as GPs played a crucial ‘gatekeeper’ role for prescriptions. Effectiveness of preventer class medicines was the stated priority for patients. A financial incentive would have limited appeal as a stand-alone intervention and needs to be accompanied by education about medicine effectiveness for GPs and patients.

Submitted by:

Nicholas Zwar

Funding acknowledgement:

Australian National Health and Medical Research Council