Shared treatment decision making improves adherence and outcomes in poorly controlled asthma

Sandra R. Wilson, Peg Strub, A. Sonia Buist, Sarah B. Knowles, Philip W. Lavori, Jodi Lapidus, William M. Vollmer, Faith Bocobo, Don German, Alaina Poon, Myngoc Nguyen, John Hoehne, Nancy Brown, Christine Fukui, Joan Holup

Research output: Contribution to journalArticle

365 Scopus citations

Abstract

Rationale: Poor adherence to asthma controller medications results in poor treatment outcomes. Objectives: To compare controller medication adherence and clinical outcomes in 612 adults with poorly controlled asthma randomized to one of two different treatment decision-making models or to usual care. Methods: In shared decision making (SDM), nonphysician clinicians and patients negotiated a treatment regimen that accommodated patient goals and preferences. In clinician decision making, treatment was prescribed without specifically eliciting patient goals/preferences. The otherwise identical intervention protocols both provided asthma education and involved two in-person and three brief phone encounters. Measurements and Main Results: Refill adherence was measured using continuous medication acquisition (CMA) indices - the total days' supply acquired per year divided by 365 days. Cumulative controller medication dose was measured in beclomethasone canister equivalents. In follow-up Year 1, compared with usual care, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.46; P< 0.0001) and long-acting b-agonist adherence (CMA, 0.51 vs. 0.40; P=0.0225); higher cumulative controller medication dose (canister equivalent, 10.9 vs. 5.2; P < 0.0001); significantly better clinical outcomes (asthma-related quality of life, health care use, rescue medication use, asthma control, and lung function). In Year 2, compared with usual care,SDMresulted in significantly lower rescue medication use, the sole clinical outcome available for that year. Compared with clinician decision making, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.59; P=0.03) and long-acting b-agonist adherence (CMA, 0.51 vs. 0.41; P=0.0143); higher cumulative controller dose (CMA, 10.9 vs. 9.1; P=0.005); and quantitatively, but not significantly, better outcomes on all clinical measures. Conclusions: Negotiating patients' treatment decisions significantly improves adherence to asthma pharmacotherapy and clinical outcomes.

Original languageEnglish (US)
Pages (from-to)566-577
Number of pages12
JournalAmerican journal of respiratory and critical care medicine
Volume181
Issue number6
DOIs
StatePublished - Mar 15 2010

Keywords

  • Asthma control
  • Patient - clinician communication
  • Randomized controlled trial

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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  • Cite this

    Wilson, S. R., Strub, P., Buist, A. S., Knowles, S. B., Lavori, P. W., Lapidus, J., Vollmer, W. M., Bocobo, F., German, D., Poon, A., Nguyen, M., Hoehne, J., Brown, N., Fukui, C., & Holup, J. (2010). Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. American journal of respiratory and critical care medicine, 181(6), 566-577. https://doi.org/10.1164/rccm.200906-0907OC