Impact of the physician's participatory style in asthma outcomes and patient satisfaction

Robert John Adams, Brian James Smith, Richard E. Ruffin

Research output: Contribution to journalArticlepeer-review

83 Citations (Scopus)

Abstract

Objectives To identify factors associated with asthma patients' perceptions of the propensity of pulmonologists to involve them in treatment decision-making, and its association with asthma outcomes. Design Cross-sectional observational study performed from June 1995 to December 1997. Setting Pulmonary unit of a university teaching hospital. Patients Adult patients with asthma (n = 128). Measure By patient self-report, mean physician's participatory decision-making (PDM) style score was 72 (maximum 100, 95% CI 65, 79). PDM scores were significantly correlated (P < .0001) with the duration of clinic visits (r = .63), patient satisfaction (r = .53), duration of tenure of doctor-patient relationship (r = .37), and formal education (r = .22, P = .023). Significantly higher PDM style scores were reported when visits lasted longer than 20 minutes and when a patient had a >6-month relationship with a particular doctor. PDM scores were also significantly correlated with possession of a written asthma action plan (r = .54, P < .0001), days affected by asthma (r = .36, P = .0001), asthma symptoms (r = .23, P = .017), and preferences for autonomy in asthma management decisions (r = .28, P = .0035). Those with PDM scores <50 reported significantly lower quality of life for all domains of a disease-specific instrument and the Short-Form 36 health survey version 1.0. In multiple regression analysis, PDM style was associated with the length of the office visit and the duration of tenure of the physician-patient relationship (R 2 = 0.47,P = .0009). The adjusted odds ratio, per standard deviation decrease in PDM scores, for an asthma hospitalization was 2.0 (95% CI 1.2, 3.2) and for rehospitalization was 2.5 (95% CI 1.2, 4.2). Conclusions Patients' report of their physician's PDM style is significantly associated with health-related quality of life, work disability, and recent need for acute health services. Organizational factors, specifically longer visits and more time seeing a particular physician, are independently associated with more participatory visits. This has significant policy implications for asthma management.
Original languageEnglish
Pages (from-to)263-271
Number of pages9
JournalAnnals of Allergy Asthma and Immunology
Volume86
Issue number3
DOIs
Publication statusPublished - 1 Mar 2001
Externally publishedYes

Keywords

  • Asthma
  • treatment
  • decision-making
  • pulmonologists
  • action plan

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