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

  • Cristina Isabel Oliveira Jácome

    Autor

  • Ana Margarida Barbosa Ribeiro Pereira

    Autor

  • Rute Alexandra Borges De Almeida

    Autor

  • Diana Margarida Gonçalves Solha Pereira Da Silva

    Autor

  • Diana Sofia Antunes Bordalo

    Autor

  • Ricardo João Cruz Correia

    Autor

  • João De Almeida Lopes Da Fonseca

    Autor

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

BMJ Open  BMJ Publishing Group

Tipo:
Article
Páginas:
-
Link para outro recurso:
www.scopus.com

Citações Recebidas na Web of Science: 15

Citações Recebidas na Scopus: 19

Documentos

  • Não há documentos

Métricas

Filiações mostrar / ocultar

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

Partilhar a publicação