Patient Preference and Adherence (Apr 2021)
Therapeutic Inertia in Prescribing Biologics for Patients with Moderate-to-Severe Asthma: Workshop Summary
Abstract
Isabelle P Sico,1 Amber Oberle,2 Sheila M Thomas,3 Thomas Barsanti,3 Lisa Egbuonu-Davis,3 Daniel T Kennedy,3 Leah L Zullig,1,4,5 Hayden B Bosworth1,4– 7 1Department of Population Health Science, Duke University School of Medicine, Durham, NC, USA; 2Division of Pulmonary, Allergy and Critical Care, Duke University, Durham, NC, USA; 3Medical Affairs, Sanofi, Bridgewater, NJ, USA; 4Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA; 5Division of General Internal Medicine, Duke University, Durham, NC, USA; 6School of Nursing, Duke University, Durham, NC, USA; 7Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USACorrespondence: Hayden B BosworthDuke University School of Medicine, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USATel +1 919-286-6936Email [email protected]: Moderate-to-severe asthma represents about a quarter of the nearly 10% of Americans diagnosed with asthma. Many patients with moderate-to-severe asthma have uncontrolled symptoms that lead to exacerbations requiring oral corticosteroids. There are many factors contributing to poor asthma control, including poor adherence to prescribed therapies, the under-prescribing of biologics and therapeutic inertia. We convened an eight-member panel from fields of primary care, pulmonology, immunology, health services and clinical research, behavioral science and pharmaceutical medical affairs, with the goal of identifying contributing factors and solutions to therapeutic inertia with asthma biologics. We used the Capability, Opportunity, and Motivation (COM-B) model to classify patient and provider behavior towards therapeutic inertia. The model incorporates existing behavior theories and is driven by the interaction of capability, opportunity, and motivation. We used a Delphi method to identify and develop six primary solutions: 1) integration of patient-centered outcomes into asthma management practice; 2) provider education about asthma treatment; 3) moderate-to-severe asthma care delivery redesign; 4) harmonized, evidence-based protocol for the management of moderate-to-severe asthma; 5) designated coordinator approach for optimal asthma management; and 6) a case coordination digital support tool. Integration of patient-centered outcomes into asthma management practice and provider education were identified as having the highest potential to impact therapeutic and clinical inertia. The COM-B model is effective in identifying improvement within therapeutic inertia targeting the capabilities, opportunities, and motivations of patients, providers, and payer systems.Keywords: asthma, COM-B, clinical inertia, therapeutic inertia
