Patient-Physician Discordance in Assessment of Adherence to Inhaled Controller Medication: a Cross-Sectional Analysis of Two Cohorts

Detalhes bibliográficos
Autor(a) principal: Jácome, C
Data de Publicação: 2019
Outros Autores: Pereira, AM, Almeida, R, Ferreira-Magalhaes, M, Couto, M, Araujo, L, Pereira, M, Alves Correia, M, Chaves Loureiro, C, Catarata, MJ, Maia Santos, L, Pereira, J, Ramos, B, Lopes, C, Mendes, A, Cidrais Rodrigues, JC, Oliveira, G, Aguiar, AP, Afonso, I, Carvalho, J, Arrobas, A, Coutinho Costa, J, Dias, J, Todo Bom, A, Azevedo, J, Ribeiro, C, Alves, M, Leiria Pinto, P, Neuparth, N, Palhinha, A, Gaspar Marques, J, Pinto, N, Martins, P, Todo Bom, F, Alvarenga Santos, M, Gomes Costa, A, Silva Neto, A, Santalha, M, Lozoya, C, Santos, N, Silva, D, Vasconcelos, MJ, Taborda-Barata, L, Carvalhal, C, Teixeira, MF, Rodrigues Alves, R, Moreira, AS, Sofia Pinto, C, Morais Silva, P, Alves, C, Câmara, R, Coelho, D, Bordalo, D, Fernandes, R, Ferreira, R, Menezes, F, Gomes, R, Calix, MJ, Marques, A, Cardoso, J, Emiliano, M, Gerardo, R, Nunes, C, Ferreira, JA, Carvalho, A, Freitas, P, Correia, R, Fonseca, J
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10400.17/3353
Resumo: 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 clinics 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 100 mm 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 ≥10 mm. 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 was reported both by patients (median (percentile 25 to 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 (rs=0.580; 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. An 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 beta-agonists 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)) (R2=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.
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spelling Patient-Physician Discordance in Assessment of Adherence to Inhaled Controller Medication: a Cross-Sectional Analysis of Two CohortsHDE ALERHSM PNEUAdolescentAdultAdministration, InhalationAsthma / drug therapyCohort StudiesFemaleMaleHumansMiddle AgedMedication Adherence / statistics & numerical dataYoung AdultPhysician-Patient RelationsProspective StudiesOBJECTIVE: 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 clinics 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 100 mm 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 ≥10 mm. 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 was reported both by patients (median (percentile 25 to 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 (rs=0.580; 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. An 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 beta-agonists 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)) (R2=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.BMJ Publishing GroupRepositório do Centro Hospitalar Universitário de Lisboa Central, EPEJácome, CPereira, AMAlmeida, RFerreira-Magalhaes, MCouto, MAraujo, LPereira, MAlves Correia, MChaves Loureiro, CCatarata, MJMaia Santos, LPereira, JRamos, BLopes, CMendes, ACidrais Rodrigues, JCOliveira, GAguiar, APAfonso, ICarvalho, JArrobas, ACoutinho Costa, JDias, JTodo Bom, AAzevedo, JRibeiro, CAlves, MLeiria Pinto, PNeuparth, NPalhinha, AGaspar Marques, JPinto, NMartins, PTodo Bom, FAlvarenga Santos, MGomes Costa, ASilva Neto, ASantalha, MLozoya, CSantos, NSilva, DVasconcelos, MJTaborda-Barata, LCarvalhal, CTeixeira, MFRodrigues Alves, RMoreira, ASSofia Pinto, CMorais Silva, PAlves, CCâmara, RCoelho, DBordalo, DFernandes, RFerreira, RMenezes, FGomes, RCalix, MJMarques, ACardoso, JEmiliano, MGerardo, RNunes, CCâmara, RFerreira, JACarvalho, AFreitas, PCorreia, RFonseca, J2019-11-12T15:26:15Z2019-11-072019-11-07T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/3353engBMJ Open. 2019 Nov 7;9(11):e031732.10.1136/bmjopen-2019-031732info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-03-10T09:42:32Zoai:repositorio.chlc.min-saude.pt:10400.17/3353Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T17:20:40.236507Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Patient-Physician Discordance in Assessment of Adherence to Inhaled Controller Medication: a Cross-Sectional Analysis of Two Cohorts
title Patient-Physician Discordance in Assessment of Adherence to Inhaled Controller Medication: a Cross-Sectional Analysis of Two Cohorts
spellingShingle Patient-Physician Discordance in Assessment of Adherence to Inhaled Controller Medication: a Cross-Sectional Analysis of Two Cohorts
Jácome, C
HDE ALER
HSM PNEU
Adolescent
Adult
Administration, Inhalation
Asthma / drug therapy
Cohort Studies
Female
Male
Humans
Middle Aged
Medication Adherence / statistics & numerical data
Young Adult
Physician-Patient Relations
Prospective Studies
title_short Patient-Physician Discordance in Assessment of Adherence to Inhaled Controller Medication: a Cross-Sectional Analysis of Two Cohorts
title_full Patient-Physician Discordance in Assessment of Adherence to Inhaled Controller Medication: a Cross-Sectional Analysis of Two Cohorts
title_fullStr Patient-Physician Discordance in Assessment of Adherence to Inhaled Controller Medication: a Cross-Sectional Analysis of Two Cohorts
title_full_unstemmed Patient-Physician Discordance in Assessment of Adherence to Inhaled Controller Medication: a Cross-Sectional Analysis of Two Cohorts
title_sort Patient-Physician Discordance in Assessment of Adherence to Inhaled Controller Medication: a Cross-Sectional Analysis of Two Cohorts
author Jácome, C
author_facet Jácome, C
Pereira, AM
Almeida, R
Ferreira-Magalhaes, M
Couto, M
Araujo, L
Pereira, M
Alves Correia, M
Chaves Loureiro, C
Catarata, MJ
Maia Santos, L
Pereira, J
Ramos, B
Lopes, C
Mendes, A
Cidrais Rodrigues, JC
Oliveira, G
Aguiar, AP
Afonso, I
Carvalho, J
Arrobas, A
Coutinho Costa, J
Dias, J
Todo Bom, A
Azevedo, J
Ribeiro, C
Alves, M
Leiria Pinto, P
Neuparth, N
Palhinha, A
Gaspar Marques, J
Pinto, N
Martins, P
Todo Bom, F
Alvarenga Santos, M
Gomes Costa, A
Silva Neto, A
Santalha, M
Lozoya, C
Santos, N
Silva, D
Vasconcelos, MJ
Taborda-Barata, L
Carvalhal, C
Teixeira, MF
Rodrigues Alves, R
Moreira, AS
Sofia Pinto, C
Morais Silva, P
Alves, C
Câmara, R
Coelho, D
Bordalo, D
Fernandes, R
Ferreira, R
Menezes, F
Gomes, R
Calix, MJ
Marques, A
Cardoso, J
Emiliano, M
Gerardo, R
Nunes, C
Ferreira, JA
Carvalho, A
Freitas, P
Correia, R
Fonseca, J
author_role author
author2 Pereira, AM
Almeida, R
Ferreira-Magalhaes, M
Couto, M
Araujo, L
Pereira, M
Alves Correia, M
Chaves Loureiro, C
Catarata, MJ
Maia Santos, L
Pereira, J
Ramos, B
Lopes, C
Mendes, A
Cidrais Rodrigues, JC
Oliveira, G
Aguiar, AP
Afonso, I
Carvalho, J
Arrobas, A
Coutinho Costa, J
Dias, J
Todo Bom, A
Azevedo, J
Ribeiro, C
Alves, M
Leiria Pinto, P
Neuparth, N
Palhinha, A
Gaspar Marques, J
Pinto, N
Martins, P
Todo Bom, F
Alvarenga Santos, M
Gomes Costa, A
Silva Neto, A
Santalha, M
Lozoya, C
Santos, N
Silva, D
Vasconcelos, MJ
Taborda-Barata, L
Carvalhal, C
Teixeira, MF
Rodrigues Alves, R
Moreira, AS
Sofia Pinto, C
Morais Silva, P
Alves, C
Câmara, R
Coelho, D
Bordalo, D
Fernandes, R
Ferreira, R
Menezes, F
Gomes, R
Calix, MJ
Marques, A
Cardoso, J
Emiliano, M
Gerardo, R
Nunes, C
Ferreira, JA
Carvalho, A
Freitas, P
Correia, R
Fonseca, J
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dc.contributor.none.fl_str_mv Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE
dc.contributor.author.fl_str_mv Jácome, C
Pereira, AM
Almeida, R
Ferreira-Magalhaes, M
Couto, M
Araujo, L
Pereira, M
Alves Correia, M
Chaves Loureiro, C
Catarata, MJ
Maia Santos, L
Pereira, J
Ramos, B
Lopes, C
Mendes, A
Cidrais Rodrigues, JC
Oliveira, G
Aguiar, AP
Afonso, I
Carvalho, J
Arrobas, A
Coutinho Costa, J
Dias, J
Todo Bom, A
Azevedo, J
Ribeiro, C
Alves, M
Leiria Pinto, P
Neuparth, N
Palhinha, A
Gaspar Marques, J
Pinto, N
Martins, P
Todo Bom, F
Alvarenga Santos, M
Gomes Costa, A
Silva Neto, A
Santalha, M
Lozoya, C
Santos, N
Silva, D
Vasconcelos, MJ
Taborda-Barata, L
Carvalhal, C
Teixeira, MF
Rodrigues Alves, R
Moreira, AS
Sofia Pinto, C
Morais Silva, P
Alves, C
Câmara, R
Coelho, D
Bordalo, D
Fernandes, R
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, J
dc.subject.por.fl_str_mv HDE ALER
HSM PNEU
Adolescent
Adult
Administration, Inhalation
Asthma / drug therapy
Cohort Studies
Female
Male
Humans
Middle Aged
Medication Adherence / statistics & numerical data
Young Adult
Physician-Patient Relations
Prospective Studies
topic HDE ALER
HSM PNEU
Adolescent
Adult
Administration, Inhalation
Asthma / drug therapy
Cohort Studies
Female
Male
Humans
Middle Aged
Medication Adherence / statistics & numerical data
Young Adult
Physician-Patient Relations
Prospective Studies
description 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 clinics 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 100 mm 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 ≥10 mm. 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 was reported both by patients (median (percentile 25 to 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 (rs=0.580; 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. An 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 beta-agonists 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)) (R2=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.
publishDate 2019
dc.date.none.fl_str_mv 2019-11-12T15:26:15Z
2019-11-07
2019-11-07T00:00:00Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10400.17/3353
url http://hdl.handle.net/10400.17/3353
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv BMJ Open. 2019 Nov 7;9(11):e031732.
10.1136/bmjopen-2019-031732
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv BMJ Publishing Group
publisher.none.fl_str_mv BMJ Publishing Group
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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