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 - initiation, implementation, 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.
My research interests are prediction modelling, data linkage, and machine learning
Funded by Health Data Research UK. This PhD is affiliated with the Asthma UK Centre for Applied Research.