TY - JOUR
T1 - Shared treatment decision making improves adherence and outcomes in poorly controlled asthma
AU - Wilson, Sandra R.
AU - Strub, Peg
AU - Buist, A. Sonia
AU - Knowles, Sarah B.
AU - Lavori, Philip W.
AU - Lapidus, Jodi
AU - Vollmer, William M.
AU - Bocobo, Faith
AU - German, Don
AU - Poon, Alaina
AU - Nguyen, Myngoc
AU - Hoehne, John
AU - Brown, Nancy
AU - Fukui, Christine
AU - Holup, Joan
PY - 2010/3/15
Y1 - 2010/3/15
N2 - 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.
AB - 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.
KW - Asthma control
KW - Patient - clinician communication
KW - Randomized controlled trial
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U2 - 10.1164/rccm.200906-0907OC
DO - 10.1164/rccm.200906-0907OC
M3 - Article
C2 - 20019345
AN - SCOPUS:77749322623
SN - 1073-449X
VL - 181
SP - 566
EP - 577
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 6
ER -