Logo do repositório
 
Publicação

Patient-physician discordance in assessment of adherence to inhaled controller medication

2019-11-01Artigo científico Acesso aberto
Ver registo simples
dc.contributor.authorJácome, Cristina
dc.contributor.authorPereira, Ana Margarida
dc.contributor.authorAlmeida, Rute
dc.contributor.authorFerreira-Magalhaes, Manuel
dc.contributor.authorCouto, Mariana
dc.contributor.authorAraujo, Luís
dc.contributor.authorPereira, Mariana
dc.contributor.authorCorreia, Magna Alves
dc.contributor.authorLoureiro, Cláudia Chaves
dc.contributor.authorCatarata, Maria Joana
dc.contributor.authorMaia Santos, Lília
dc.contributor.authorPereira, João
dc.contributor.authorRamos, Bárbara
dc.contributor.authorLopes, Cristina
dc.contributor.authorMendes, Ana
dc.contributor.authorCidrais Rodrigues, José Carlos
dc.contributor.authorOliveira, Georgeta
dc.contributor.authorAguiar, Ana Paula
dc.contributor.authorAfonso, Ivete
dc.contributor.authorCarvalho, Joana
dc.contributor.authorArrobas, Ana
dc.contributor.authorCoutinho Costa, José
dc.contributor.authorDias, Joana
dc.contributor.authorTodo Bom, Ana
dc.contributor.authorAzevedo, João
dc.contributor.authorRibeiro, Carmelita
dc.contributor.authorAlves, Marta
dc.contributor.authorLeiria Pinto, Paula
dc.contributor.authorNeuparth, Nuno
dc.contributor.authorPalhinha, Ana
dc.contributor.authorGaspar Marques, João
dc.contributor.authorPinto, Nicole
dc.contributor.authorMartins, Pedro
dc.contributor.authorTodo Bom, Filipa
dc.contributor.authorAlvarenga Santos, Maria
dc.contributor.authorGomes Costa, Alberto
dc.contributor.authorSilva Neto, Armandina
dc.contributor.authorSantalha, Marta
dc.contributor.authorLozoya, Carlos
dc.contributor.authorSantos, Natacha
dc.contributor.authorSilva, Diana
dc.contributor.authorVasconcelos, Maria João
dc.contributor.authorTaborda-Barata, Luís
dc.contributor.authorCarvalhal, Célia
dc.contributor.authorTeixeira, Maria Fernanda
dc.contributor.authorAlves, Rodrigo Rodrigues
dc.contributor.authorMoreira, Ana Sofia
dc.contributor.authorSofia Pinto, Cláudia
dc.contributor.authorMorais Silva, Pedro
dc.contributor.authorAlves, Carlos
dc.contributor.authorCâmara, Raquel
dc.contributor.authorCoelho, Didina
dc.contributor.authorBordalo, Diana
dc.contributor.authorFernandes, Ricardo M.
dc.contributor.authorFerreira, Rosário
dc.contributor.authorMenezes, Fernando
dc.contributor.authorGomes, Ricardo
dc.contributor.authorCalix, Maria José
dc.contributor.authorMarques, Ana
dc.contributor.authorCardoso, João
dc.contributor.authorEmiliano, Madalena
dc.contributor.authorGerardo, Rita
dc.contributor.authorNunes, Carlos
dc.contributor.authorCâmara, Rita
dc.contributor.authorFerreira, José Alberto
dc.contributor.authorCarvalho, Aurora
dc.contributor.authorFreitas, Paulo
dc.contributor.authorCorreia, Ricardo
dc.contributor.authorFonseca, Joao A.
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.institutionCentro de Estudos de Doenças Crónicas (CEDOC)
dc.contributor.pblBMJ Publishing Group
dc.date.accessioned2019-11-21T23:18:09Z
dc.date.available2019-11-21T23:18:09Z
dc.date.issued2019-11-01
dc.descriptionCJ 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).
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 (FEV 1) 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 (r s =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)), FEV 1 ≥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.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent499081
dc.identifier.doi10.1136/bmjopen-2019-031732
dc.identifier.issn2158-2440
dc.identifier.otherPURE: 15522040
dc.identifier.otherPURE UUID: a7b8340b-b590-49a2-a245-87881ca8bc85
dc.identifier.otherScopus: 85074692327
dc.identifier.otherPubMed: 31699737
dc.identifier.otherWOS: 000512774800249
dc.identifier.otherORCID: /0000-0001-5149-7473/work/196571895
dc.identifier.urihttp://www.scopus.com/inward/record.url?scp=85074692327&partnerID=8YFLogxK
dc.identifier.urlhttps://www.scopus.com/pages/publications/85074692327
dc.language.isoeng
dc.peerreviewedyes
dc.subjectasthma
dc.subjectdiscordance
dc.subjectlogistic models
dc.subjectmedication adherence
dc.subjectGeneral Medicine
dc.titlePatient-physician discordance in assessment of adherence to inhaled controller medicationen
dc.title.subtitleA cross-sectional analysis of two cohortsen
dc.typejournal article
degois.publication.issue11
degois.publication.titleBMJ open
degois.publication.volume9
dspace.entity.typePublication
rcaap.rightsopenAccess

Ficheiros

Principais
A mostrar 1 - 1 de 1
Miniatura
Nome:
e031732.full.pdf
Tamanho:
487.38 KB
Formato:
Adobe Portable Document Format
Ver/Abrir

Coleções

NMS: CEDOC - Artigos em revista internacional com arbitragem científica