TY - JOUR

T1 - Determining Persistence with an Inhaled Corticosteroid in Asthma

T2 - Assessment Using an Objective Measurement vs the Self-Reported Foster Score

AU - Hedegaard, Britt Overgaard

AU - Hakansson, Kjell Erik Julius

AU - Jensen, Frodi Fridason

AU - Ulrik, Charlotte Suppli

AU - Weinreich, Ulla Moller

PY - 2022

Y1 - 2022

N2 - Introduction: Adherence with controller medication is a major challenge in asthma management. Thus, a reliable method of measurement is mandatory to assess adherence.Aim: To examine the test-retest reliability on adherence with inhaled corticosteroids in adults with asthma using, a self-reported adherence score (Foster score).Methods: Patients with asthma and >1 routine follow-up appointment at a university hospital outpatient clinic reported Foster scores. The objective Medication Possession Ratio (MPR) was calculated based on pharmacy redemption data and physician-prescribed doses of inhaled corticosteroids. The difference between Foster score and MPR at the first and second visit was assessed using a Bland-Altman plot, outcomes reported as limits of agreements and bias. Foster scores from both visits were used to calculate an intraclass correlation coefficient (ICC).Results: Self-reported adherence with asthma controller medication measured by Foster score was significantly higher than the objective MPR (p < 0.0001). The Bland-Altman plot for MPR and Foster score at the first and second visit showed upper and lower limits of agreement of 83.5 - (-1.6) and 80.9 - (-6.9) and bias was 41.0 and 37.0, respectively. Of the included patients, 93.1% reported identical Foster scores between visits, resulting in an excellent ICC of 0.92. Absolute median difference between Foster scores and MPR at first and second visit was 8.7 percentage points (p = 0.049).Conclusion: Foster score shows an excellent ICC; however, its poor agreement with objective measures of adherence suggests that clinicians should not rely on Foster

AB - Introduction: Adherence with controller medication is a major challenge in asthma management. Thus, a reliable method of measurement is mandatory to assess adherence.Aim: To examine the test-retest reliability on adherence with inhaled corticosteroids in adults with asthma using, a self-reported adherence score (Foster score).Methods: Patients with asthma and >1 routine follow-up appointment at a university hospital outpatient clinic reported Foster scores. The objective Medication Possession Ratio (MPR) was calculated based on pharmacy redemption data and physician-prescribed doses of inhaled corticosteroids. The difference between Foster score and MPR at the first and second visit was assessed using a Bland-Altman plot, outcomes reported as limits of agreements and bias. Foster scores from both visits were used to calculate an intraclass correlation coefficient (ICC).Results: Self-reported adherence with asthma controller medication measured by Foster score was significantly higher than the objective MPR (p < 0.0001). The Bland-Altman plot for MPR and Foster score at the first and second visit showed upper and lower limits of agreement of 83.5 - (-1.6) and 80.9 - (-6.9) and bias was 41.0 and 37.0, respectively. Of the included patients, 93.1% reported identical Foster scores between visits, resulting in an excellent ICC of 0.92. Absolute median difference between Foster scores and MPR at first and second visit was 8.7 percentage points (p = 0.049).Conclusion: Foster score shows an excellent ICC; however, its poor agreement with objective measures of adherence suggests that clinicians should not rely on Foster

KW - Foster score

KW - medication possession ratio

KW - controller medication

KW - asthma

KW - self-assessed adherence

KW - self-reported outcome

KW - adherence

KW - persistence

KW - MEDICATION ADHERENCE

KW - VALIDATION

KW - VALIDITY

KW - OUTCOMES

KW - EXACERBATIONS

KW - RELIABILITY

KW - THERAPIES

KW - BELIEFS

KW - ADULTS

U2 - 10.2147/JAA.S332756

DO - 10.2147/JAA.S332756

M3 - Journal article

C2 - 35023932

VL - 15

SP - 25

EP - 33

JO - Journal of Asthma and Allergy

JF - Journal of Asthma and Allergy

SN - 1178-6965

ER -