Health beliefs and compliance with inhaled corticosteroids by asthmatic patients in primary care practices

The aim of this study was to determine factors associated with regular use of inhaled corticosteroids (ICS) by asthmatic patients in primary care prac tices. A cross-sectional survey was carried out over 13 family practices in the Philadelphia greater Metropolitan area. A total of 394 patients aged 1 8-49 years, who received medical care for asthma from their primary care ph ysician and had been prescribed ICS between 1 January 1995 and 31 December 1996. were included. The study measured self-reported demographics, experience with asthma, use of and attitudes about ICS, and health beliefs in six domains. Only 38% of patients reported using ICS at least twice a day almost every d ay. The most frequently cited reasons for inconsistent or non-use of ICS we re related to a belief that ICS were unnecessary during asymptomatic period s and to a general concern about side-effects. By logistic regression, fact ors associated with regular use of ICS were two patient health beliefs, nam ely the health belief of 'Active' participation in clinical decision-making with their physician (OR=4.6, 95% CI 2.8, 7.5), and the health belief that asthma was a 'Serious' health problem (OR=2.3, 95% CI 1.4. 3.7), and hospi talization for asthma within the previous 12 months (OR=2.3, 95% CI 1.6, 4. 6). Patients were more likely to report regular use of ICS if they saw themselv es as active participants in their treatment planning and conceptualized as thma as a potentially serious illness. These results support the themes of patient education and shared decision-making between patients and physician s that are promoted by the Asthma Guidelines from the National Heart. Lung and Blood institute (NHLBI).