But for the minority with severe persistent asthma, medication and lifestyle changes are not enough.
The recommendations add potential adverse events, increase costs, and are based on the assumption that patients are fully (or partially) compliant with therapy and persistent on medication.
The absolute difference in proportion adherent or persistent with medications ranged from -41% to +8% for rural versus urban patients.
Loss of follow-up due to deaths and emigration is estimated to be less than 2% of those who were not persistent with medications, assuming that the death and emigration rates were similar to those of the overall New Zealand population within similar age groups during the study period.
These items were used to classify respondents as currently persistent to their medication.
The average weekly dose during the 12 months after the index date and the total dispensed quantity within those 12 months was calculated for patients who were persistent on index medication for at least 12 months.
In our study, the persistence curve revealed an obvious drop (38.3%) in the first year, but a less prominent (19.5%) drop in the second year among those subjects persistent with their medication at the end of the first year.
In a systematic review and meta-analysis of longitudinal studies it was found that non-adherence with medication, persistent substance use, carers' criticism and poorer premorbid adjustment significantly increased the risk for relapse in first-episode psychosis [ 5].
Clearly, sound clinical judgment is needed to set safe and reasonable goals for diabetes management, especially in elderly patients and those with known cardiovascular disease or other high-risk factors; however, in our younger patients, aggressive treatment of all metabolic abnormalities with persistent titration of medication until all goals are met is needed.
It is possible that the additional medical costs among these patients may have been due, at least in part, to how well their diabetes was managed (as evidenced by worse A1C outcomes), and may have been lower had they been more adherent or persistent to their medication.
