The most common places to keep medicine were at the bedside (20%) and in the bathroom (9%). Those who integrated taking it with other daily routines did in the morning (12%) and at bedtime (8%).
Only three of the strategies were significantly associated with good adherence: keeping medication in the bathroom (16% adherent vs. 5% nonadherent); integrating it into a daily routine (morning 25% vs. 5%; evening 13% vs. 6%); and taking it at a specific time of day (29% vs. 17%).
Courtesy Emily Goodman
Dr. Alex Federman
Taking the medication only when needed was associated with significantly worse adherence.
After controlling for other variables, only leaving the medication in the bathroom significantly predicted good adherence (odds ratio 3), compared with those who kept it somewhere else).
Those who integrated medication into other daily routines were also significantly more likely to be adherent (OR 3.7) in a partially adjusted model, but not in a fully adjusted model. Still, the authors noted, this recommendation would be a good suggestion toward improving adherence.
Patients who used these two strategies were more likely to be white, have at least a partial education, and to have been born in the United States. Low income, limited English proficiency, low health literacy, poor physical and psychological health, and erroneous beliefs about asthma predicted poor adherence.
The team postulated that there are two types of nonadherence: simple forgetfulness or lack of understanding about its importance and deliberate nonadherence.
"The bathroom and daily routine strategies may address forgetful nonadherence. ... Taking the medication only as needed, on the other hand, may indicate faulty disease or medication beliefs. ... Taken together, these findings provide further evidence of the value of patient-centered care: Clinicians need to understand why patients do not use their medications appropriately before counseling patients on ways to improve adherence."
The study was supported by a grant from the National Heart, Lung, and Blood Institute. None of the authors had any financial disclosures.