Personalized care can help patients adhere to biologic treatment for asthma

Key takeaways:

• Many patients are afraid these medications have serious side effects.
• Phone and text reminders may help patients maintain treatment.
• Practices should try to mitigate transportation and other obstacles.

SAN ANTONIO — Personalized treatment strategies can help providers overcome barriers to biologic care for patients with asthma, Lukena Karkhanis, MD, said at the 16th Annual Allergy, Asthma & Immunology CME Conference.

The first barrier is a fear of side effects, Karkhanis, medical director at Allergy SA, based in Texas, said during her presentation.

“There are some patients that have read about horrible side effects of biologics that are used in rheumatology, and they think this is the same,” she said. “It takes a little bit of explanation to tell them these are completely different medications.”

Patients also struggle with the complexity of administration, beyond the need for injections, she continued, as ongoing communication can be demanding.

“When I sign somebody up for a biological, I tell them about 40 times before I leave the room, ‘Please answer your phone. You’re going to get all these weird-sounding people calling you,’” she said.

In addition to her office, Karkhanis said, drug manufacturers, insurance providers and specialty pharmacies often call patients, who may not know how to navigate all these different partners in care.

Karkhanis said that providers should encourage their patients to talk to these people in addition to paying attention to any mail they may receive.

“They will call you every month, and you have to say, ‘Yes, I’m still on the drug. Please deliver my drug,” she said.

Patients also may fail to adhere to treatment if they do not perceive any benefit, Karkhanis continued.

“If they don’t feel better, you have to make sure you’re addressing their symptoms,” she said.

For example, she said, patients who snore should not expect their biologic to improve their condition. Instead, they should be treated for sleep apnea.

“Nothing I can do with the biologic is going to treat your sleep apnea,” she said. “Patients need to understand that there can be various comorbidities that also need to be taken care of.”

Forgetfulness and priorities are additional challenges, she said.

“It’s our lifestyle. We need reminders for everything,” she said, adding that physicians should use apps, texts and other techniques to provide patients with the reminders they need to better adhere to treatment.

Karkhanis said she would like to tell patients that their asthma care and her recommendations for it should be their number one priority.

“But the patient’s like, ‘No, my child’s kindergarten graduation is my priority, and I will just get my dose some other time,’” she said. “People make their own decisions, so reminders, education, all of these things then can be incorporated into their lifestyle.”

Financial constraints also are barriers, considering the expense of these medications and of health insurance, Karkhanis said.

“Patients have to be able to access therapy. We have extremely efficacious, very safe medications, but you have to be able to afford it,” she said.

“You have to explain to them what help they can get, and who is going to provide that help, and how they can be in charge of making sure that they can afford the medication that they really need,” she continued.

Finally, Karkhanis said that many patients have psychological and emotional barriers.

“Many people are scared and saying they don’t want to get injections. They don’t even want to get started,” she said. “They don’t want to accept that their asthma is that bad.”

Karkhanis emphasized the importance of education and shared decision-making in these situations.

“It does require a lot of counseling. Sometimes it takes up a lot of our time and is not reimbursable,” she said. “You want to put the patient on a biologic, but they have to take it. Otherwise, it’s all work down the drain.”

Education and empowerment are key to overcoming these barriers, Karkhanis said, along with simplification and follow-up.

“Write it down for them. Text them. Simplify it for them,” she said. “We definitely need regular follow-up and support.”

Karkhanis said that she makes her patients with severe asthma return at least every 3 months, in addition to their biologic visits. When patients skip these visits, her staff reaches out to them.

“My staff is on the phone with them, calling and saying, ‘You need to come back in. We’re not going to keep refilling that medication. You need to come back in. You need to be checked out. You need to get on top of your asthma,’” she said.

Practices also need to take personalized approaches to patients with unique and individual barriers to care such as transportation, Karkhanis said.

“Here in San Antonio, one of our offices is on the south side of town, and a large portion of our patients who come there don’t have a car. They take the bus,” she said. “Then, if one day, I tell them, ‘Oh, you can’t come to that office. You have to come to my other office,’ they can’t come.”

Practices may need to ensure that patients with arthritis who have difficulties with self-injections can come into the office for treatment as well, Karkhanis continued.

Or patients might not want to store medication in their refrigerators at home, where their children can find it, play with it and potentially inject themselves, she added.

“It cost $5,000, so I will store it in my fridge, and you bring your child into the office, and we will administer it for you,” she suggested.

Further, patients who cannot come in every 2 weeks for a specific biologic may then need a different biologic with a different dosing schedule that is a better fit, she added.

Karkhanis stressed the importance of automating messaging systems too and of working with the vendors that provide them to ensure that correct reminders go out to the right patients in a timely manner.

“You don’t have time to call each and every biologic patient to remind them,” she said. “Say that every patient that is on this list needs to get a reminder every 2 weeks, and this one gets one every 4 weeks.”

But there may be a downside to all this communication, she noted.

“Then you have patients who miss their appointment and come in and say, ‘You didn’t send me a text,’” she said. “But you’re an adult. Why are you waiting for my text? You know you should remember. It’s your asthma. It’s your injection.”

But that is what the patient population can be like, she said.

Overall, Karkhanis said, physicians need to tailor care to their patients’ individual needs to ensure adherence and successful outcomes.

“You can’t fit a square peg into a round hole,” she said. “You’ve got to personalize their treatment.”