Profile photo of Holly Tibble
PhD Title
Medication non-adherence in asthma: data-driven approaches to understanding patient behaviour
Funded by
Health Data Research UK
Prof Aziz Sheikh, Dr Athanasios Tsanas & Prof Robert Horne
Based at
University of Edinburgh

Medication non-adherence in asthma: data-driven approaches to understanding patient behaviour

One factor contributing to excessive asthma morbidity and mortality is medication non-adherence: individuals not undergoing their treatment as prescribed. Not identifying adherence as a causal factor for poor asthma control can have many additional negative effects, including inappropriate dose escalation, and underestimated incidence of adverse effects. No less importantly, reducing asthma non-adherence will lessen the financial burden of asthma expenditure through both inefficient prescribing and the consequences of poorly controlled asthma.   

In 2012, Vrijens et al. defined a new taxonomy for medication adherence, which described the three key stages at which a patient might become non-adherent - initiationimplementation, and persistence. Despite this well-established multi-domain approach to adherence measurement, many intervention studies assess adherence using only a single measure, including simple percentages of doses taken. This is often because a single metric is simpler to interpret than using multiple measures, and it is thus easier to categorise improvements in adherence. While there are health care record studies which look simultaneously at all three domains, the interactions between the three domains are less well known. Knowing whether late-initiators are often early to discontinue or whether those who stay on the treatment for many years have consistent adherence, could help us to easily define the mechanism by which an intervention is effective, and better characterise the non-adherent population.  

About me

My research interests are prediction modelling, data linkage, and machine learning


  • Horne E, Tibble H, Sheikh A, Tsanas A, Challenges of Clustering Multimodal Clinical Data: Review of Applications in Asthma Subtyping, JMIR Med Inform 2020;8(5):e16452 DOI: 10.2196/16452
  • Tibble, H., Tsanas, A., Horne, E., Horne, R., Mizani, M., Simpson, C.R., Sheikh, A. (2019) Predicting asthma attacks in primary care: protocol for developing a machine learning-based prediction model. BMJ Open. 9:e028375. doi: 10.1136/bmjopen-2018-028375
  • Vine, R., Tibble, H., Pirkis, J., Judd, F., Spittal, M. J. (2018) Does legislative change affect the use and duration of compulsory treatment orders? Australia New Zealand Journal of Psychiatry. (In Press)
  • Bismark, M. M., Tibble, H., Moore, J., Morris, J. M., Paterson, R., Fletcher, M., Studdert, D. M. (2018). Eyes and ears on patient safety: Sources of complaints about the health, performance and conduct of health practitioners.  Journal of Patient Safety.  (Available online)
  • Tibble, H., Law, H. D., Spittal, M. J., Karmel, R., Borschman, R., Hail-Jares, K., Thomas, L. A., Kinner, S. A. (2018). The importance of including aliases in data linkage with vulnerable populations.  BMC Medical Research Methodology. 18(76).
  • Thomas, L. A., Tibble, H., Too, L. S., Hopcraft, M. S., Bismark, M. M. (2018).  Complaints about dental practitioners: an analysis of 6 years of complaints about dentists, dental prosthetists, oral health therapists, dental therapists and dental hygienists in Australia. Australian Dental Journal. 63(3), 285-293
  • Thomas, L. A., Milligan, E., Tibble, H., To, L. S., Studdert, D. M., Spittal, M. J., Bismark, M. M. (2018). Health, perfrmance and conduct concerns among older doctors: a retrospective cohort study of notifications received by medical regulators in Australia. Journal of Patient Safety and Risk Management. 23(2), 54-62
  • Hettiarachci, V. L., Kinner, S. A.,Tibble, H., Borschmann, R. (2018). Self-harm among young people detained in the youth justice system in Sri Lanka. International Journal of Environmental Research and Public Health. 15(2), 209
  • Tibble, H. M., Broughton, N. S., Studdert, D. M., Spittal, M. J., Hill, N., Morris, J. M. Bismark, M. M. (2017). Why do surgeons receive more complaints than their physician peers? ANZ Journal of Surgery.  88(4), 269-273
  • Fletcher, J., Spittal, M., Brophy, L.,Tibble, H., Kinner, S., Elsom, S., Hamilton, B. E. (2017) Outcomes of the Victorian Safewards Trial in 13 wards: Impact on seclusion rates and fidelity measurement. International Journal of Mental Health Nursing. 26(5), 461-471
  • Pirkis, J., Currier, D., Butterworth, P., Milner, A., Kavanagh, A., Tibble, H., Robinson, J., Spittal, M.J. (2017). Socio-Economic Position and Suicidal Ideation in Men.  International Journal of Environmental Research and Public Health. 14(4), 365
  • Knight, V., Campbell, O., Harper, M., Langner, K., Campbell, J., Campbell, T., Carney, A., Chorley, M., Davidson-Pilon, C., Glass, K., Glynatsi, N., Ehrlich, T., Jones, M., Koutsovoulos, G., Tibble, H.Müller, J., Palmer, G., Petunoc, P., Slavin, P., Standen, T., Visintini, L., Molden, K., (2016). An Open Framework for the Reproducible Study of the Iterated Prisoner's Dilemma. Journal of Open Research Software. 4(1), p.e35


Funded by Health Data Research UK. This PhD is affiliated with the Asthma UK Centre for Applied Research.

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