Repository logo
 
Publication

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

2019-11-07Journal article Open access
Simple item page
dc.contributor.authorJácome, C
dc.contributor.authorPereira, AM
dc.contributor.authorAlmeida, R
dc.contributor.authorFerreira-Magalhaes, M
dc.contributor.authorCouto, M
dc.contributor.authorAraujo, L
dc.contributor.authorPereira, M
dc.contributor.authorAlves Correia, M
dc.contributor.authorChaves Loureiro, C
dc.contributor.authorCatarata, MJ
dc.contributor.authorMaia Santos, L
dc.contributor.authorPereira, J
dc.contributor.authorRamos, B
dc.contributor.authorLopes, C
dc.contributor.authorMendes, A
dc.contributor.authorCidrais Rodrigues, JC
dc.contributor.authorOliveira, G
dc.contributor.authorAguiar, AP
dc.contributor.authorAfonso, I
dc.contributor.authorCarvalho, J
dc.contributor.authorArrobas, A
dc.contributor.authorCoutinho Costa, J
dc.contributor.authorDias, J
dc.contributor.authorTodo Bom, A
dc.contributor.authorAzevedo, J
dc.contributor.authorRibeiro, C
dc.contributor.authorAlves, M
dc.contributor.authorLeiria Pinto, P
dc.contributor.authorNeuparth, N
dc.contributor.authorPalhinha, A
dc.contributor.authorGaspar Marques, J
dc.contributor.authorPinto, N
dc.contributor.authorMartins, P
dc.contributor.authorTodo Bom, F
dc.contributor.authorAlvarenga Santos, M
dc.contributor.authorGomes Costa, A
dc.contributor.authorSilva Neto, A
dc.contributor.authorSantalha, M
dc.contributor.authorLozoya, C
dc.contributor.authorSantos, N
dc.contributor.authorSilva, D
dc.contributor.authorVasconcelos, MJ
dc.contributor.authorTaborda-Barata, L
dc.contributor.authorCarvalhal, C
dc.contributor.authorTeixeira, MF
dc.contributor.authorRodrigues Alves, R
dc.contributor.authorMoreira, AS
dc.contributor.authorSofia Pinto, C
dc.contributor.authorMorais Silva, P
dc.contributor.authorAlves, C
dc.contributor.authorCâmara, R
dc.contributor.authorCoelho, D
dc.contributor.authorBordalo, D
dc.contributor.authorFernandes, R
dc.contributor.authorFerreira, R
dc.contributor.authorMenezes, F
dc.contributor.authorGomes, R
dc.contributor.authorCalix, MJ
dc.contributor.authorMarques, A
dc.contributor.authorCardoso, J
dc.contributor.authorEmiliano, M
dc.contributor.authorGerardo, R
dc.contributor.authorNunes, C
dc.contributor.authorCâmara, R
dc.contributor.authorFerreira, JA
dc.contributor.authorCarvalho, A
dc.contributor.authorFreitas, P
dc.contributor.authorCorreia, R
dc.contributor.authorFonseca, J
dc.date.accessioned2019-11-12T15:26:15Z
dc.date.available2019-11-12T15:26:15Z
dc.date.issued2019-11-07
dc.description.abstractOBJECTIVE: 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.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationBMJ Open. 2019 Nov 7;9(11):e031732.pt_PT
dc.identifier.doi10.1136/bmjopen-2019-031732pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3353
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherBMJ Publishing Grouppt_PT
dc.subjectHDE ALERpt_PT
dc.subjectHSM PNEUpt_PT
dc.subjectAdolescentpt_PT
dc.subjectAdultpt_PT
dc.subjectAdministration, Inhalationpt_PT
dc.subjectAsthma / drug therapypt_PT
dc.subjectCohort Studies
dc.subjectFemale
dc.subjectMale
dc.subjectHumans
dc.subjectMiddle Aged
dc.subjectMedication Adherence / statistics & numerical data
dc.subjectYoung Adult
dc.subjectPhysician-Patient Relations
dc.subjectProspective Studies
dc.titlePatient-Physician Discordance in Assessment of Adherence to Inhaled Controller Medication: a Cross-Sectional Analysis of Two Cohortspt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.issue11pt_PT
oaire.citation.startPagee031732pt_PT
oaire.citation.titleBMJ Openpt_PT
oaire.citation.volume9pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

Files

Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
BMJ Open.pdf
Size:
487.36 KB
Format:
Adobe Portable Document Format
Download
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
1.71 KB
Format:
Item-specific license agreed upon to submission
Description:
Download

Collections

ALER - Artigos
PNEU - Artigos