Are there differences in the patient-reported medication-related problems among asthma and allergy patients? A community pharmacy survey in Finland

(2023) 23:1570 Heikkilä et al. BMC Public Health https://doi.org/10.1186/s12889-023-16423-y BMC Public Health Open Access RESEARCH Are there differences in the patient‑reported medication‑related problems among asthma and allergy patients? A community pharmacy survey in Finland Juha Markus Heikkilä1*, Paula Bergman2, Juha Jantunen3, Johanna Salimäki4, Marika Pohjanoksa‑Mäntylä1 and Paula Kauppi5 Abstract Background A medication-related problem is an event involving medication that interferes with desired health outcomes. Those are largely studied among asthma patients, but little is known about medication-related problems among allergy patients. The objective of this study was to determine the most common patient-reported medicationrelated problems among asthma patients compared to allergy patients during the self-management of diseases. The other objective was to identify how demographic variables and the received treatment information influence reported problems. Methods A nationwide survey was conducted in Finnish community pharmacies (n = 785) in September 2016. The survey targeted patients buying prescription medicines for asthma or allergy. Results Responses were received from 46% of targeted pharmacies from 956 respondents. At least one medica‑ tion problem was reported by 24% of asthma patients and 12% of allergy patients. The most common problems among asthma patients were having problems taking medicines on time (16%), problems in the administration technique (7%) and in the use of the inhaler (4%). Among allergy patients, 10% reported problems remembering to take medicines on time. Severe asthma and allergy increased the risk for medication-related problems (OR 1.20, 95% CI 1.04–1.40 and OR 1.17, 95% CI 1.0–1.37). A higher age and less education were associated with fewer reported medication-related problems among both patient groups. Conclusions Asthma patients reported more medication-related problems than allergy patients. Among both inves‑ tigated patient groups, remembering to take medicines on time was the most common. Health care professionals should educate younger patients but also older and less educated asthma and allergy patients to recognize and, to solve medication-related problems. In addition, severe asthma patients still need medication counseling. Keywords Asthma, Allergy, Medication-related problem, Drug-related problem, Self-management *Correspondence: Juha Markus Heikkilä Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecom‑ mons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Heikkilä et al. BMC Public Health (2023) 23:1570 Background A medication-related problem is defined as an event or circumstance involving medication that interferes or has potential to interfere with desired health outcomes [1]. Medication-related problems leading to unfavorable patient outcomes during self-management of the disease are known phenomena among asthma patients [2– 11]. However, among allergy patients, this is not widely researched [11–13]. Guided self-management of asthma is well established and recommended under clinical practice guidelines [14–16]. For allergic diseases, there is also increasing evidence showing benefits of guided self-management approaches [17–19]. Counseling, including treatment information, should be actively provided by all health care professionals (HCPs) involved in the patients’ care to enable successful self-management of chronic diseases such as asthma or allergy [14–16]. Patients’ self-management should be supported with individualized written action plans, including guidance on maintenance treatment and on how to act when experiencing an increase in symptoms and medication-related problems [14–16, 19]. Respiratory diseases and allergies are important public health issues in Finland. Therefore respiratory and allergy patients have been particularly focused on by Finnish health care professionals since 1994 when a public health program called the National Asthma Program started [20, 21]. The program was later developed and continued by the National Allergy Program until 2018 [22, 23]. The emphasis of the programs was on the education of physicians, nurses and pharmacists on asthma and allergies to counsel patients on self-management of these diseases to lower the burden of these diseases in Finland [20–24]. Poor medication adherence is a well-known problem among asthma patients [3–5]. The phenomenon is known among both aged [4] and adolescent [5] patients. Based on observations by pharmacists among asthma patients, inappropriate use of medicine by the patients, inappropriate choice of medicine and adverse drug reactions were the most common medication-related problems [3]. Among allergy patients using physician-prescribed antihistamine tablets, it has been found that only a minority of patients were adherent to the guidance given by HCPs [12]. The same phenomena have been recognized among rhinitis patients [13] Additionally, asthma inhalers are often technically suboptimally used, leading to reduced drug deposition in the lungs and poor asthma control [6– 11]. Based on pharmacists’ observations, it was identified that one allergy patient out of five had difficulties in using eye drops and understanding the information on package leaflets of the medicinal product [11]. Studies identifying medication-related problems among asthma and allergy patients are commonly based Page 2 of 11 on register data [2, 12] or on observations by HCPs. [3, 6–11] Only a few studies focusing on medication-related problems are based on patient reports on patients’ perspectives [5]. Additionally, little is known about the association between patients’ sociodemographic characteristics and medication-related problems. Medication related problems are well known among asthma patients, [2–11] but less is known concerning those among allergy patients [11–13]. Most of the research is based on HCP’s evaluation or (...truncated)