Impact of the physician's participatory style in asthma outcomes and patient satisfaction

doi:10.1016/S1081-1206(10)63296-6

Annals of Allergy, Asthma & Immunology

Volume 86, Issue 3, March 2001, Pages 263-271

https://doi.org/10.1016/S1081-1206(10)63296-6 Get rights and content

Objectives

To identify factors associated with asthma patients' perceptions of the propensity of pulmonologists to involve them in treatment decision-making, and its association with asthma outcomes.

Design

Cross-sectional observational study performed from June 1995 to December 1997.

Setting

Pulmonary unit of a university teaching hospital.

Patients

Adult patients with asthma (n = 128).

Measurements and Results

By patient self-report, mean physician's participatory decision-making (PDM) style score was 72 (maximum 100, 95% CI 65, 79). PDM scores were significantly correlated (P < .0001) with the duration of clinic visits (r = .63), patient satisfaction (r = .53), duration of tenure of doctor-patient relationship (r = .37), and formal education (r = .22, P = .023). Significantly higher PDM style scores were reported when visits lasted longer than 20 minutes and when a patient had a >6-month relationship with a particular doctor. PDM scores were also significantly correlated with possession of a written asthma action plan (r = .54, P < .0001), days affected by asthma (r = .36, P = .0001), asthma symptoms (r = .23, P = .017), and preferences for autonomy in asthma management decisions (r = .28, P = .0035). Those with PDM scores <50 reported significantly lower quality of life for all domains of a disease-specific instrument and the Short-Form 36 health survey version 1.0. In multiple regression analysis, PDM style was associated with the length of the office visit and the duration of tenure of the physician-patient relationship (R ² = 0.47,P = .0009). The adjusted odds ratio, per standard deviation decrease in PDM scores, for an asthma hospitalization was 2.0 (95% CI 1.2, 3.2) and for rehospitalization was 2.5 (95% CI 1.2, 4.2).

Conclusions

Patients' report of their physician's PDM style is significantly associated with health-related quality of life, work disability, and recent need for acute health services. Organizational factors, specifically longer visits and more time seeing a particular physician, are independently associated with more participatory visits. This has significant policy implications for asthma management.

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ORIGINAL ARTICLESImpact of the physician's participatory style in asthma outcomes and patient satisfaction

Objectives

Design

Setting

Patients

Measurements and Results

Conclusions

Am J Med

Respir Med

J Clin Epidemiol

Chest

Expert panel report 2: guidelines for the diagnosis and management of asthma

Global Strategy for Asthma Management and Prevention. NHLBI/WHO workshop report, 1993

Asthma self-management programs: premises, not promises

J Asthma

Controlled trial evaluation of an asthma education programme for adults

Thorax

The cost and effectiveness of an education program for adults who have asthma

J Gen Intern Med

Results of a program to reduce admissions for adult asthma

Ann Intern Med

British Thoracic Society Research Committee. Peak flow based asthma self-management: a randomised controlled study in general practice

Thorax

Patterns of anti-inflammatory therapy in the post-guidelines era: a retrospective claims analysis of managed care members

Am J Manag Care

Assessing the effects of physician-patient interactions on the outcome of chronic disease

Med Care

Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes

J Gen Intern Med

Expanding patient involvement in care. Effects on patient outcomes

Ann Intern Med

Patient exposition and provider explanation in routine interviews and hypertensive patients' blood pressure control

Health Psychol

Effect of a joint physician-patient training program on health outcomes and interpersonal care

Clin Res

Meta-analysis of correlates of provider behavior in medical encounters

Med Care

Patient and visit characteristics related to physicians' participatory decision making style

Medical Care

Validity of a modified version of the Mark's Asthma Quality of Life Questionnaire

J Asthma

Standardization of spirometry-1987 update

Am Rev Respir Dis

Airway responsiveness. Standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society

Eur Respir J Suppl

Characteristics of physicians with participatory decision-making styles

Ann Intern Med

Assessment of Visit-Specific Patient Satisfaction

SF-36 Health Survey Manual and In-tepretation Guide

Specialty differences in the management of asthma. A cross-sectional assessment of allergists' patients and generalists' patients in a large HMO

Arch Intern Med

Antecedents of adherence to medical recommendations: results from the Medical Outcomes Study

J Behav Med

ORIGINAL ARTICLES
Impact of the physician's participatory style in asthma outcomes and patient satisfaction