Disease Management & Health Outcomes

, Volume 15, Issue 6, pp 355–376 | Cite as

Patient and Physician Factors Contributing to Poor Outcomes in Patients with Asthma and COPD

  • Adrian Gillissen
  • Hubertus Wirtz
  • Uwe Juergens
Review Article

Abstract

Poor adherence with medical regimens by patients with asthma and chronic obstructive pulmonary disease (COPD) is a major problem facing medical practitioners, with patients typically taking approximately half the prescribed doses of self-administered medications. Poor adherence with medication regimens results in inadequate disease control and is assumed to be associated with poor long-term outcomes and high medical and social costs. Efforts to assist patients with treatment adherence are thought to improve the benefits of prescribed medications; however, even the most effective interventions do not necessarily lead to significant improvements in adherence and treatment outcomes.

Simple interventions (such as re-calling patients who miss appointments, making every effort to keep patients in care, and simplifying treatment regimens) and complex strategies (including combinations of more thorough patient instructions and counseling, reminders, close follow-up, supervised self-monitoring, family therapy, crisis intervention, and telephone follow-up) may improve adherence and treatment outcomes for both short- and long-term treatments. All these measures are highly dependent on a good physician-patient relationship, and the willingness and ability of caregivers to closely follow guidelines and recommendations.

The diversity and complexity of interventions, and uncertainty about their effects, make it difficult to assess which interventions are effective and which are not. The literature regarding interventions remains surprisingly limited. There is little evidence to show that medication adherence can be improved consistently, or that interventions will inevitably lead to improvements in treatment outcomes, especially considering the resources usually available in outpatient settings. Most studies assessing successful complex interventions have not assessed the effect on clinical endpoints. Studies in COPD are sparse compared with those in asthma, leaving room for further research efforts. As all self-administered treatments are affected by low adherence, and as the number of efficacious, self-administered treatments continues to grow, detailed knowledge about this complex issue may help to ensure better management in patients with obstructive pulmonary diseases.

Notes

Acknowledgments

No sources of funding were used to assist in the preparation of this review. Dr Gillissen has previously acted as a consultant for GlaxoSmithKline, AstraZeneca, and Merck Frost; has received honoraria from AstraZeneca, Asche Chiesi, Merck Frost, and GlaxoSmithKline; and has received grants from AstraZeneca and Merck Frost. Dr Wirtz has acted as a consultant for Altana Pharma and has received honoraria from Altana Pharma, AstraZeneca, GlaxoSmithKline, Merck Sharp & Dohme, and Norvartis; and Dr Juergens has received honoraria from Merck Sharp & Dohme and GlaxoSmithKline.

Author’s website: http://www.rkk-leipzig.de

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Copyright information

© Adis Data Information BV 2007

Authors and Affiliations

  • Adrian Gillissen
    • 1
  • Hubertus Wirtz
    • 2
  • Uwe Juergens
    • 3
  1. 1.St. George Medical CenterRobert-Koch-HospitalLeipzigGermany
  2. 2.Department of Pulmonary MedicineUniversity HospitalLeipzigGermany
  3. 3.University Hospital BonnBonnGermany

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