Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts. Issue 11 (7th November 2019)

• Record Type: Journal Article
• Authors: Jácome, Cristina; Pereira, Ana Margarida; Almeida, Rute; Ferreira-Magalhaes, Manuel; Couto, Mariana; Araujo, Luís; Pereira, Mariana; Correia, Magna Alves; Loureiro, Cláudia Chaves; Catarata, Maria Joana; Maia Santos, Lília; Pereira, João; Ramos, Bárbara; Lopes, Cristina; Mendes, Ana; Cidrais Rodrigues, José Carlos; Oliveira, Georgeta; Aguiar, Ana Paula; Afonso, Ivete; Carvalho, Joana; Arrobas, Ana; Coutinho Costa, José; Dias, Joana; Todo Bom, Ana; Azevedo, João; Ribeiro, Carmelita; Alves, Marta; Leiria Pinto, Paula; Neuparth, Nuno; Palhinha, Ana; Gaspar Marques, João; Pinto, Nicole; Martins, Pedro; Todo Bom, Filipa; Alvarenga Santos, Maria; Gomes Costa, Alberto; Silva Neto, Armandina; Santalha, Marta; Lozoya, Carlos; Santos, Natacha; Silva, Diana; Vasconcelos, Maria João; Taborda-Barata, Luís; Carvalhal, Célia; Teixeira, Maria Fernanda; Alves, Rodrigo Rodrigues; Moreira, Ana Sofia; Sofia Pinto, Cláudia; Morais Silva, Pedro; Alves, Carlos; Câmara, Raquel; Coelho, Didina; Bordalo, Diana; Fernandes, Ricardo M; Ferreira, Rosário; Menezes, Fernando; Gomes, Ricardo; Calix, Maria José; Marques, Ana; Cardoso, João; Emiliano, Madalena; Gerardo, Rita; Nunes, Carlos; Câmara, Rita; Ferreira, José Alberto; Carvalho, Aurora; Freitas, Paulo; Correia, Ricardo; Fonseca, Joao A;
• Is Part Of: BMJ open. Volume 9:Issue 11(2019)
• Publication Date: 2019-11-07
• Subjects: asthma -- medication adherence -- discordance -- logistic models; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2019-031732
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objective: 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)) (R 2 =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.