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

2019-11-07Journal article Open access
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dc.contributor.authorJácome, C.
dc.contributor.authorPereira, A.
dc.contributor.authorAlmeida, R.
dc.contributor.authorFerreira-Magalhães, Manuel
dc.contributor.authorCouto, M.
dc.contributor.authorAraujo, L.
dc.contributor.authorPereira, M.
dc.contributor.authorCorreia, M.
dc.contributor.authorLoureiro, C.
dc.contributor.authorCatarata, M.
dc.contributor.authorMaia Santos, L.
dc.contributor.authorPereira, J.
dc.contributor.authorRamos, B.
dc.contributor.authorLopes, C.
dc.contributor.authorMendes, A.
dc.contributor.authorCidrais Rodrigues, J.
dc.contributor.authorOliveira, G.
dc.contributor.authorAguiar, A.
dc.contributor.authorAfonso, I.
dc.contributor.authorCarvalho, J.
dc.contributor.authorArrobas, A.
dc.contributor.authorCoutinho Costa, J.
dc.contributor.authorDias, J.
dc.contributor.authorTodo Bom, A.
dc.contributor.authorAzevedo, J.
dc.contributor.authorRibeiro, C.
dc.contributor.authorAlves, M.
dc.contributor.authorLeiria Pinto, P.
dc.contributor.authorNeuparth, N.
dc.contributor.authorPalhinha, A.
dc.contributor.authorGaspar Marques, J.
dc.contributor.authorPinto, N.
dc.contributor.authorMartins, P.
dc.contributor.authorTodo Bom, F.
dc.contributor.authorAlvarenga Santos, M.
dc.contributor.authorGomes Costa, A.
dc.contributor.authorSilva Neto, A.
dc.contributor.authorSantalha, M.
dc.contributor.authorLozoya, C.
dc.contributor.authorSantos, N.
dc.contributor.authorSilva, D.
dc.contributor.authorVasconcelos, M.
dc.contributor.authorTaborda-Barata, L.
dc.contributor.authorCarvalhal, C.
dc.contributor.authorTeixeira, M.
dc.contributor.authorAlves, R.
dc.contributor.authorMoreira, A.
dc.contributor.authorSofia Pinto, C.
dc.contributor.authorMorais Silva, P.
dc.contributor.authorAlves, C.
dc.contributor.authorCâmara, R.
dc.contributor.authorCoelho, D.
dc.contributor.authorBordalo, D.
dc.contributor.authorFernandes, R.
dc.contributor.authorFerreira, R.
dc.contributor.authorMenezes, F.
dc.contributor.authorGomes, R.
dc.contributor.authorCalix, M.
dc.contributor.authorMarques, A.
dc.contributor.authorCardoso, J.
dc.contributor.authorEmiliano, M.
dc.contributor.authorGerardo, R.
dc.contributor.authorNunes, C.
dc.contributor.authorCâmara, R.
dc.contributor.authorFerreira, J.
dc.contributor.authorCarvalho, A.
dc.contributor.authorFreitas, P.
dc.contributor.authorCorreia, R.
dc.contributor.authorFonseca, J.
dc.date.accessioned2020-05-04T23:07:20Z
dc.date.available2020-05-04T23:07:20Z
dc.date.issued2019-11-07
dc.description.abstractObjective: 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.pt_PT
dc.description.sponsorshipCJ 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).pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJácome C, Pereira AM, Almeida R, et al. Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts. BMJ Open. 2019;9(11):e031732. Published 2019 Nov 7. doi:10.1136/bmjopen-2019-031732pt_PT
dc.identifier.doi10.1136/bmjopen-2019-031732pt_PT
dc.identifier.issn2044-6055
dc.identifier.urihttp://hdl.handle.net/10400.16/2359
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherBMJ Publishing Grouppt_PT
dc.relationPOCI-01-0145-FEDER-029130pt_PT
dc.relation.publisherversionhttps://bmjopen.bmj.com/content/9/11/e031732.longpt_PT
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/pt_PT
dc.subjectasthmapt_PT
dc.subjectdiscordancept_PT
dc.subjectlogistic modelspt_PT
dc.subjectmedication adherencept_PT
dc.titlePatient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohortspt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.conferencePlaceEnglandpt_PT
oaire.citation.issue11pt_PT
oaire.citation.startPagee031732pt_PT
oaire.citation.titleBMJ openpt_PT
oaire.citation.volume9pt_PT
person.familyNameFerreira-Magalhães
person.givenNameManuel
person.identifier.ciencia-id4018-CE80-5801
person.identifier.orcid0000-0001-9477-8822
person.identifier.ridH-3421-2015
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublication73a4d758-5b1e-492c-bb1b-d4a2fad534d2
relation.isAuthorOfPublication.latestForDiscovery73a4d758-5b1e-492c-bb1b-d4a2fad534d2

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