We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance.(SFRH/BPD/115169/2016) funded by Fundação
para a Ciência e Tecnologia (FCT); ERDF (European Regional
Development Fund) through the operations: POCI-01-0145-FEDER-029130
('mINSPIRERS—mHealth to measure and improve adherence to medication
in chronic obstructive respiratory diseases—generalisation and evaluation
of gamification, peer support and advanced image processing technologies')
cofunded by the COMPETE2020 (Programa Operacional Competitividade e
Internacionalização), Portugal 2020 and by Portuguese Funds through FCT
(Fundação para a Ciência e a Tecnologia).info:eu-repo/semantics/publishedVersio

Afonso, Ivete

Aguiar, Ana Paula

Almeida, Rute

Alvarenga Santos, Maria

Alves, Carlos

Alves, Marta

Alves, Rodrigo Rodrigues

Araujo, Luís

Arrobas, Ana

Azevedo, João

Bordalo, Diana

Calix, Maria José

Cardoso, João

Carvalhal, Célia

Carvalho, Aurora

Carvalho, Joana

Catarata, Maria Joana

Cidrais Rodrigues, José Carlos

Coelho, Didina

Correia, Magna Alves

Correia, Ricardo

Coutinho Costa, José

Couto, Mariana

Câmara, Raquel

Câmara, Rita

Dias, Joana

Emiliano, Madalena

Fernandes, Ricardo M

Ferreira, José Alberto

Ferreira, Rosário

Ferreira-Magalhaes, Manuel

Fonseca, Joao A

Freitas, Paulo

Gaspar Marques, João

Gerardo, Rita

Gomes Costa, Alberto

Gomes, Ricardo

Jácome, Cristina

Leiria Pinto, Paula

Lopes, Cristina

Loureiro, Cláudia Chaves

Lozoya, Carlos

Maia Santos, Lília

Marques, Ana

Martins, Pedro

Mendes, Ana

Menezes, Fernando

Morais Silva, Pedro

Moreira, Ana Sofia

Neuparth, Nuno

Nunes, Carlos

Oliveira, Georgeta

Palhinha, Ana

Pereira, Ana Margarida

Pereira, João

Pereira, Mariana

Pinto, Nicole

Ramos, Bárbara

Ribeiro, Carmelita

Santalha, Marta

Santos, Natacha

Silva Neto, Armandina

Silva, Diana

Sofia Pinto, Cláudia

Taborda-Barata, Luís

Teixeira, Maria Fernanda

Todo Bom, Ana

Todo Bom, Filipa

Vasconcelos, Maria João

BMJ Open

English

Universidade do Algarve

Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts

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)) (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.info:eu-repo/semantics/publishedVersio

Jácome, C

Pereira, AM

Almeida, R

Ferreira-Magalhaes, M

Couto, M

Araujo, L

Pereira, M

Alves Correia, M

Chaves Loureiro, C

Catarata, MJ

Maia Santos, L

Pereira, J

Ramos, B

Lopes, C

Mendes, A

Cidrais Rodrigues, JC

Oliveira, G

Aguiar, AP

Afonso, I

Carvalho, J

Arrobas, A

Coutinho Costa, J

Dias, J

Todo Bom, A

Azevedo, J

Ribeiro, C

Alves, M

Leiria Pinto, P

Neuparth, N

Palhinha, A

Gaspar Marques, J

Pinto, N

Martins, P

Todo Bom, F

Alvarenga Santos, M

Gomes Costa, A

Silva Neto, A

Santalha, M

Lozoya, C

Santos, N

Silva, D

Vasconcelos, MJ

Taborda-Barata, L

Carvalhal, C

Teixeira, MF

Rodrigues Alves, R

Moreira, AS

Sofia Pinto, C

Morais Silva, P

Alves, C

Câmara, R

Coelho, D

Bordalo, D

Fernandes, R

Ferreira, R

Menezes, F

Gomes, R

Calix, MJ

Marques, A

Cardoso, J

Emiliano, M

Gerardo, R

Nunes, C

Ferreira, JA

Carvalho, A

Freitas, P

Correia, R

Fonseca, J

Repository of the Hospital Center of Central Lisbon

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

Repositório do Centro Hospitalar de Lisboa Central, EPE

Sapientia

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)) (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.CJ is a post-doc fellow (SFRH/BPD/115169/2016) funded by Fundação para a Ciência e Tecnologia (FCT), reimbursed by Fundo Social Europeu and by national funds of MCTES. This work was funded by ERDF (European Regional Development Fund) through the operations: POCI-01-0145-FEDER-029130 ('mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases—generalisation and evaluation of gamification, peer support and advanced image processing technologies') cofunded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).info:eu-repo/semantics/publishedVersio

Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts

Abstract

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Universidade do Algarve

Repository of the Hospital Center of Central Lisbon

Repositório do Centro Hospitalar de Lisboa Central, EPE

Sapientia

Repositório Científico do Centro Hospitalar do Porto

Repositório da Universidade Nova de Lisboa