Physician-Patient Concordance in Pharmacological Management of Patients with COPD. (3rd September 2015)

• Record Type: Journal Article
• Authors: Small, Mark; Higgins, Victoria; Lees, Adam; Johns, Nicola; Mastrangelo, Anthony; Nazareth, Tara; Turner, Stuart J.
• Is Part Of: COPD. Volume 12:Number 5(2015:Oct.)
• Page Start: 473
• Page End: 483
• Publication Date: 2015-09-03
• Subjects: communication -- disease impact -- physician-patient relationship -- symptoms; Lungs -- Diseases, Obstructive -- Periodicals; 616.24
• DOI: 10.3109/15412555.2014.995287
• Languages: English
• ISSNs: 1541-2555

Abstract

Abstract: A retrospective analysis of a cross-sectional, multicenter survey was conducted in United States (US) medical practices to evaluate the concordance between patients with COPD and their physicians on disease-specific characteristics. Associations between patient and disease-related characteristics with monotherapy, dual therapy, or triple therapy prescribed as COPD maintenance regimens were also examined. Eligible physicians completed patient record forms (PRFs) for up to 6 consecutive patients with COPD. Patients for whom a PRF was completed were invited to complete a patient self-completion (PSC) survey consisting of questions similar to those on the PRF, as well as several validated measures to assess the impact of COPD on patients' lives. A total of 469 patients completed a PSC that was matched with the PRF completed by their physician, forming the sample for the concordance analysis. Moderate agreement (kappa (κ) = 0.41–0.60) was observed for 79% of measures, with the lowest concordance rating corresponding to hemoptysis (κ = 0.22). There were few differences in demographic or clinical characteristics between patients prescribed monotherapy and dual therapy. Triple therapy rather than monotherapy or dual therapy was more often prescribed for patients with greater frequency of symptoms, negative impact of COPD on daily life and interpersonal relationships, and respiratory impairment based on the most recent FEV1. Diverse factors influence US physicians' perceptions of disease and treatment choices, including patient symptoms, quality of life, and disease impact. Our results highlight that concordance between physicians and patients regarding symptoms and physical function may contribute to optimal management of COPD.