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Which of the following statements, provided when interviewing the patient on admission, is indicative of an adherence barrier?

A. “I occasionally forget to take my cetirizine”

B. “I’m not sure what an asthma action plan is”

C. “I don’t always pick up my inhaler due to cost”

D. “My albuterol inhaler is what makes me feel better”

E. All of the above

Correct answer: E

Rationale: As asthma patients transition through the healthcare system, each transition is an opportunity to optimize medication therapy and reduce risk of adverse health outcomes. This will include reconciling medications, providing patient education, and identifying and addressing adherence barriers. Nonadherence to medications or expression that the patient may forget to take medications is a signal to discuss barriers to taking medications as prescribed. Even if the medication is unrelated to the disease state being assessed, it still provides insight into the lifestyle, habits, and difficulties in consistently adhering to medications. Answer B, regarding an asthma action plan, can be indicative of an adherence barrier because of a lack of understanding and knowledge regarding the consequences of poor asthma management. Patients who understand the potential consequences of poor control have a higher likelihood of adhering to medications and preventing adverse outcomes. Cost presents a very obvious barrier to adherence, as patients who cannot afford medications are limited in their ability to consistently take medications. Steroid inhalers may have a higher cost or copayment than albuterol and may be underutilized due to the higher cost and lack of perceived benefit compared to albuterol, which provides immediate relief of symptoms. While albuterol works quickly and effectively as a rescue inhaler, it does not address the underlying inflammation or provide long-term control.1 A patient who states they do not always pick up their inhaler due to cost requires assessment of a potential adherence barrier. This may require education on treatment goals and consequences of uncontrolled asthma, a discussion on the difference between rescue and maintenance medications, clearly defined expectations with each therapy including onset of action, and an assessment of cost issues. Patients may not feel the higher cost or copay associated with their maintenance therapy is justified if they do not see the value of that medication. Therefore, it is important to collect additional information from our patient to learn more about her adherence barrier, and address accordingly. Lastly, stating that albuterol makes the patient feel better indicates that the patient may not understand the differences between the two medications (controller and reliever) and therefore may not find value in a controller which does not provide an immediate feeling of relief. This being ...

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