Portal de investigação
Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts
Data de publicação:
Data Ahead of Print:
Autores da FMUP
Participantes de fora da FMUP
- Ferreira--Magalhaes, M
- Couto, M
- Araujo, L
- Pereira, M
- Correia, MA
- Loureiro, CC
- Catarata, MJ
- Santos, LM
- Pereira, J
- Ramos, B
- Lopes, C
- Mendes, A
- Rodrigues, JCC
- Oliveira, G
- Aguiar, AP
- Afonso, I
- Carvalho, J
- Arrobas, A
- Costa, JC
- Dias, J
- Bom, AT
- Azevedo, J
- Ribeiro, C
- Alves, M
- Pinto, PL
- Neuparth, N
- Palhinha, A
- Marques, JG
- Pinto, N
- Martins, P
- Bom, FT
- Santos, MA
- Costa, AG
- Neto, AS
- Santalha, M
- Lozoya, C
- Santos, N
- Vasconcelos, MJ
- Taborda-Barata, L
- Carvalhal, C
- Teixeira, MF
- Alves, RR
- Moreira, AS
- Pinto, CS
- Silva, PM
- Alves, C
- Câmara, R
- Coelho, D
- Fernandes, RM
- Ferreira, R
- Menezes, F
- Gomes, R
- Calix, MJ
- Marques, A
- Cardoso, J
- Emiliano, M
- Gerardo, R
- Nunes, C
- Câmara, R
- Ferreira, JA
- Carvalho, A
- Freitas, P
- Inspirers Grp
Unidades de investigação
Abstract
Objective We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance. Design Baseline data from two prospective multicentre observational studies. Setting 29 allergy, pulmonology and paediatric secondary care outpatient dinics in Portugal. Participants 395 patients (>= 13 years old) with persistent asthma. Measures Data on demographics, patient-physician relationship, upper airway control, asthma control, asthma treatment, forced expiratory volume in one second (FEV1) and healthcare use were collected. Patients and physicians independently assessed adherence to inhaled controller medication during the previous week using a 100mm Visual Analogue Scale (VAS). Discordance was defined as classification in distinct VAS categories (low 0-50; medium 51-80; high 81-100) or as an absolute difference in VAS scores >= 10mm. Correlation between patients' and physicians' VAS scores/categories was explored. A multinomial logistic regression identified the predictors of physician overestimation and underestimation. Results High inhaler adherence wm reported both by patients (median (percentile 25 b percentile 75) 85 (65-95) mm; 53% VAS>80) and by physicians (84 (68-95) mm; 53% VAS>80). Correlation between patient and physician VAS scores was moderate (r(s)4.580; p<0.001). Discordance occurred in 56% of cases: in 28% physicians overestimated adherence and in 27% underestimated. Low adherence as assessed by the physician (OR=27.35 (9.85 to 75.95)), FEV1 >= 80% (OR=2.59 (1.08 to 6.20)) and a first appointment (OR=5.63 (1.24 to 25.56)) were predictors of underestimation.M uncontrolled asthma (OR=2.33 (1.25 to 4.34)), uncontrolled upper airway disease (OR=2.86 (1.35 to 6.04)) and prescription of short-acting betamonists alone (OR=3.05 (1.15 to 8.08)) were associated with overestimation. Medium adherence as assessed by the physician was significantly associated with higher risk of discordance, both for overestimation and underestimation of adherence (OR=14.50 (6.04 to 34.81); OR=2.21 (1.07 to 4.58)), while having a written action plan decreased the likelihood of discordance (OR=0.25 (0.12 to 0.52); OR=0.41 (0.22 to 0.78)) (R-2=44%). Conclusion Although both patients and physicians report high inhaler adherence, discordance occurred in half of cases. Implementation of objective adherence measures and effective communication are needed to improve patient-physician agreement.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Dados da publicação
- ISSN/ISSNe:
- 2044-6055, 2044-6055
- Tipo:
- Article
- Páginas:
- -
- Link para outro recurso:
- www.scopus.com
BMJ Open BMJ Publishing Group
Citações Recebidas na Web of Science: 15
Citações Recebidas na Scopus: 19
Documentos
- Não há documentos
Filiações
Keywords
- MILD PERSISTENT ASTHMA; VISUAL ANALOG SCALE; NONADHERENCE; RISK; QUESTIONNAIRE; INTERVENTION; ASSOCIATION; BUDESONIDE; AGREEMENT; THERAPY
Financiamento
Proyectos asociados
Predição do resultado neonatal baseado na idade gestacional e peso ao nascimento: uma graduação de risco para cenários de nascimento com poucos recursos.
Investigador Principal: Ricardo João Cruz Correia
Estudo Observacional Académico (NEONATAL) . 2019
Citar a publicação
Jácome C,Pereira AM,Almeida R,Ferreira M,Couto M,Araujo L,Pereira M,Correia MA,Loureiro CC,Catarata MJ,Santos LM,Pereira J,Ramos B,Lopes C,Mendes A,Rodrigues JCC,Oliveira G,Aguiar AP,Afonso I,Carvalho J,Arrobas A,Costa JC,Dias J,Bom AT,Azevedo J,Ribeiro C,Alves M,Pinto PL,Neuparth N,Palhinha A,Marques JG,Pinto N,Martins P,Bom FT,Santos MA,Costa AG,Neto AS,Santalha M,Lozoya C,Santos N,Silva D,Vasconcelos MJ,Taborda L,Carvalhal C,Teixeira MF,Alves RR,Moreira AS,Pinto CS,Silva PM,Alves C,Câmara R,Coelho D,Bordalo D,Fernandes RM,Ferreira R,Menezes F,Gomes R,Calix MJ,Marques A,Cardoso J,Emiliano M,Gerardo R,Nunes C,Câmara R,Ferreira JA,Carvalho A,Freitas P,Correia R,Fonseca JA,Inspirers GRP. Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts. BMJ Open. 2019. 9. (11):e031732. IF:2,496. (2).
