BARRIERS AND FACILITATORS TO ASTHMA MEDICATION ADHERENCE 1 Patients

51 Background. Although asthma morbidity can be prevented through long-term controller 52 medication, most patients with persistent asthma do not take their daily inhaled corticosteroid. 53 The objective of this study was to gather patients’ insights into barriers and facilitators to taking 54 long-term daily inhaled corticosteroids as basis for future knowledge translation interventions. 55 Methods. We conducted a collective qualitative case study. We interviewed 24 adults, 56 adolescents, or parents of children, with asthma who had received a prescription of long-term 57 inhaled corticosteroids in the previous year. The one-hour face-to-face interviews revolved 58 around patients’ perceptions of asthma, use of asthma medications, current self-management, 59 prior changes in self-management, as well as patient-physician relationship. We sought barriers 60 and facilitators to optimal asthma management. Interviews were transcribed verbatim and 61 transcripts were analyzed using a thematic approach. 62 Results. Patients were aged 2-76 years old and 58% were female. Nine patients were followed 63 by an asthma specialist (pulmonologist or allergist), 13 patients by family doctors or 64 pediatricians, and two patients had no regular follow-up. Barriers and facilitators to long-term 65 daily inhaled corticosteroids were classified into the following loci of responsibility and its 66 corresponding domains: (1) patient (cognition; motivation, attitudes and preferences; practical 67 implementation; and parental support); (2) patient-physician interaction (communication and 68 patient-physician relationship); and (3) health care system (resources and services). Patients 69 recognized that several barriers and facilitators fell within their own responsibility. They also 70 underlined the crucial impact (positive or negative) on their adherence of the quality of patient71 physician interaction and health care system accessibility. 72 Conclusions. We identified a close relationship between reported barriers and facilitators to 73 adherence to long-term daily controller medication for asthma within three loci of responsibility. 74 As such, patients’ adherence must be approached as a multi-level phenomenon; moreover, 75 interventions targeting the patient, the patient-physician interaction, and the health care system 76 BARRIERS AND FACILITATORS TO ASTHMA MEDICATION ADHERENCE 3 are recommended. The present study offers a potential taxonomy of barriers and facilitators to 77 adherence to long-term daily inhaled corticosteroids therapy that, once validated, may be used 78 for planning a knowledge translation intervention and may be applicable to other chronic 79 conditions. 80 81