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

Astrid Crespo-Lessmann, Vicente Plaza, Francisco Javier González-Barcala, Toni Fernández-Sánchez, Joaquín Sastre, F. Callejas González, J. Jiménez López, M. Martínez Riaza, M. Moscardó Orenes, P. Prieto Montaño, M. Torrecillas Toro, C. Andreu Balaguer, M. Antón Girones, C. Baeza Martinez, I. Flores Martín, P. Gonzalez Delgado, M. Martos Calahorro, G. Mediero Carrasco, R. Rodríguez Pacheco, V. Vilella TomásM. Mota Godoy, J. Zapata Yébenes, O. Villarreal Balza De Vallejo, J. Alvarez Fernandez, T. Bazus Gonzalez, G. Castaño De Las Pozas, C. Diaz Donado, S. Díaz Angulo, G. Gala Ortiz, B. Requejo Mañana, R. Blanco Gonzalez, E. Gómez Nieves, J. Marin Torrado, M. Dordal Culla, J. Juanola Pla, R. Lleonart Bellfll, J. Martos Velasco, E. Pinto Nogues, M. Rivera Ortun, P. Rubinstein Aguñin, N. Subira Farre, J. Valldeperas Combas, I. Ansotegui Zubeldia, G. Bernaola Hortigela, J. Ciruelos Ayuso, G. González Álvarez, M. Herrerias Peña, A. Lahuerta Castro, P. Losada Llorente, P. Marin Martinez, N. Marina Malanda, F. Garcia Gonzalez, T. Peña Miguel, M. Hernandez Hernandez, S. Jimenez Timon, S. Porcel Carreño, M. Alwakil Olbah, A. Arnedillo Muñoz, J. Chamorro Mohedad, D. Gutierrez Fernandez, A. Letran Camacho, C. Merinas Lopez, M. Millan Gonzalez, S. Niño Bernal, L. Fernandez Pellon, E. Morchon Miguel, F. Ortiz Portal, A. Suárez Rodríguez, M. Modesto Alapont, I. Raducan, M. Salvador Segarra, P. Galindo Bonilla, P. Mata Calderon, M. Mena Rodriguez, R. Lama Martinez, M. Martín Pérez, M. Morales Villarejo, M. Blanco Aparicio, M. Do Muíño Joga, L. Fontan Garcia-Boente, V. García Paz, Francisco Javier González-Barcala, R. Nuñez Orjales, C. Rabade Castedo, M. Rico Diaz, A. Moreno Fernandez, S. Aparicio Español, A. Ruiz San Francisco, B. Alcázar Navarrete, L. Cassini Gomez De Cadiz, M. Escribano Rodriguez, J. Florido Lopez, M. Lara Jiménez, J. Lopez Caballero, M. Martínez Ceres, R. Mayorgas Costoya, C. Morales García, M. Rojas Vilchez, A. Romero Ortiz, J. Beitia Mazuecos

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Abstract

© 2017 BMJ Publishing Group Ltd (unless otherwise stated in the text of the article). All rights reserved. Introduction Differences 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. Methods A 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. Results The 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. Conclusion Patient-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.
Original languageEnglish
Article numbere000189
JournalBMJ Open Respiratory Research
Volume4
Issue number1
DOIs
Publication statusPublished - 1 Sep 2017

Keywords

  • Asthma
  • perception of Asthma/breathlessness

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