Motivational interviewing feedback and technology improves asthma control and adherence
Published online: January 14, 2019
Asthma patients have difficulties following physician medication instructions. For more severe patients, this can lead to poor asthma control and reduced quality of life. If non-adherence is recognized, Motivational Interviewing Adherence Interventions (MIAI) can be given to improve asthma outcomes.
In a recent article in The Journal of Allergy Clinical Immunology: In Practice, Weinstein and colleagues reported a study of forty moderate-to-severe adult asthma patients to determine if electronic adherence monitoring with MIAI improved asthma control (using the Asthma Control Questionnaire or ACQ) and promoted adherence to mometasone furoate/formoterol, (MF/F) an inhaled asthma medication. Twenty patients in the intervention group completed a questionnaire from a web app, Asthma Adherence Pathway (AAP), identifying attitudes and beliefs about asthma treatment. They were also given an electronic monitor to measure MF/F adherence. Twenty patients received standard of asthma care from allergists and pulmonologists. Allergists/pulmonologists in the intervention group reviewed MF/F adherence monthly for 3 months. If mean values of MF/F adherence fell below 60% during the a one-month period, physicians used MIAI based on attitudes and beliefs identified initially by the AAP.
The mean MF/F adherence in the intervention group was 81% during the 3 months. Adherence was not measured in the control group. The ACQ values for the two groups were similar at baseline. Thirteen intervention patients achieved significant clinical improvement compared with 6 control patients (P < .016). At the end of three months the intervention group showed significantly greater improvement in the ACQ (0.75) than the control group ACQ (0.19).
The findings are consistent with the Asthma Adherence Management Model (The Journal of Allergy and Clinical Immunology: In Practice 2013), which states that adherence can be achieved by: 1) identification of a patient’s beliefs and barriers about asthma management; 2) objectively monitoring patient’s medication use; 3) providing feedback about medication use; and 4) employing advanced communication skills such as Motivational Interviewing or Shared Decision Making to improve asthma control and promote adherence.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.