Concordance of opinions between patients and physicians and their relationship with symptomatic control and future risk in patients with moderate–severe asthma

IntroductionDifferences between the opinions of patients and physicians on the impact of asthma are common. We hypothesised that patient–physician discordance may negatively affect asthma outcome.MethodsA total of 2902 patients (61% women, mean age 47 years) with moderate–severe asthma and 231 physi...

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Bibliographic Details
Published in:	BMJ open respiratory research Vol. 4; no. 1; p. e000189
Main Authors:	Crespo-Lessmann, Astrid, Plaza, Vicente, González-Barcala, Francisco-Javier, Fernández-Sánchez, Toni, Sastre, Joaquín
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group LTD 01-09-2017 BMJ Publishing Group
Subjects:	Antidepressants Anxiety Asthma Chronic obstructive pulmonary disease Clinical medicine Communication Health care Hospitals Mental depression Patient satisfaction Perceptions Tuberculosis perception of Asthma/breathlessness Asthma
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Summary:	IntroductionDifferences between the opinions of patients and physicians on the impact of asthma are common. We hypothesised that patient–physician discordance may negatively affect asthma outcome.MethodsA total of 2902 patients (61% women, mean age 47 years) with moderate–severe asthma and 231 physicians participated in a prospective study. At the baseline visit, data on demographics, clinical variables, degree of asthma control according to the Asthma Control Test (ACT), basic spirometry and the Hospital Anxiety and Depression Scale (HADS) were collected and an ad hoc questionnaire was completed that allowed the degree of concordance between doctors and patients to be assessed. A scheduled telephone call after 3 months was used to elicit the ACT score and the future risk of asthma. At the final visit at 6 months, the following data were recorded: ACT score, spirometry, HADS score and an ad hoc questionnaire to assess the agreement between the doctor and the patient. Changes in study variables according to patient–physician concordance or discordance were analysed.ResultsThe rate of patient–physician discordance was 27.2%, with overestimation of disease impact by the physician in 12.3% and underestimation in 14.9%. Patient–physician opinion discordance, particularly in the case of physicians underestimating the impact of asthma, showed worse results with statistically significant differences in ACT score, a higher percentage of patients with poor asthma control and lower HADS scores. The need for hospital and emergency department admissions was also higher.ConclusionPatient–physician opinion discordance may be contributing to lower symptomatic control and increased future risk, with a higher impact when physicians underestimate the impact of asthma on their patients.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2052-4439 2052-4439
DOI:	10.1136/bmjresp-2017-000189