The importance of clinical management problems in older people with COPD and asthma: Do patients and physicians agree?

Department of Respiratory and Sleep Medicine, John Hunter Hospital, New South Wales, Australia.
Primary care respiratory journal: journal of the General Practice Airways Group (Impact Factor: 2.5). 03/2011; 20(4):389-95. DOI: 10.4104/pcrj.2011.00025
Source: PubMed


COPD and asthma in older people are complex conditions associated with multiple clinical problems. The relative importance of these problems to both patients and physicians and the level of agreement between them is largely unknown.
Older people with asthma and COPD underwent a multidimensional assessment to characterise the prevalence of clinical problems. Each individual's problems were then summarised and presented separately to the patient and physician to rate problem importance. Problems were scored using a 5-point Likert scale from unimportant to very important.
The highest-rated problems were dyspnoea, activity limitation and airway inflammation, and these areas had good patient-physician concordance. Poor concordance was found for inhaler technique adequacy, airflow obstruction and obesity. Good concordance was found for written action plans, but this was less important to both patients and physicians.
In asthma and COPD, patients and their physicians agree about the importance of managing activity limitation, dyspnoea, and airway inflammation. Other areas of management had little concordance or were viewed as less important. Self-management skills were not rated as important by patients and this may hinder successful management. Eliciting problems and addressing their importance to treatment goals may improve care in COPD and asthma.

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Available from: Vanessa M Mcdonald
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    • "Previous research indicated that neither clinicians nor patients rated the presence of a written action plan as being as important as other factors (such as dyspnoea and activity limitation) in their COPD management [23]. A Canadian survey of 389 patients with COPD between 2006 and 2007 showed only 34% had an action plan or prescription for exacerbation self-management [24]. "
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    ABSTRACT: Objective To explore clinicians’ views on antibiotic and/or steroid ‘rescue packs’ used as self-treatment for patients with exacerbations of COPD. Methods 21 focus groups conducted in 7 countries - Netherlands, Russia, Norway, China (Hong Kong), Wales, Germany and Poland involving 142 primary care clinicians and pulmonologists. Results We found wide variation in reported use of and attitudes to self-treatment among GPs and pulmonologists in the participating countries. Clinicians highlighted the importance of identifying patients who were most likely to benefit (those with more severe disease) and most likely to use the treatment appropriately (demonstrated by previous behaviour), and the importance of adequate patient education and ongoing communication in regard to use of self-treatment packs. Clinicians recognised patient empowerment and facilitating prompt treatment as potential benefits of self-treatment. However, many felt they did not have the time or resources for appropriate patient selection and education. Conclusion Clinicians do not feel it is appropriate to offer self-treatment rescue packs to all patients routinely without careful consideration of patient understanding of their illness and their capacity for self-management. Practice Implications Adequate resources and continuity of patient care are required for clinicians to feel confident in the safe and effective implementation of this strategy.
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    • "This is contrary to recommendations for the management of COPD by many studies and guidelines [18-20]. However, another study has similarly shown that self-management skills were not rated as important by patients [21]. Furthermore, the psychosocial impact of their disease such as fear limited their ability to manage their own symptoms [22]. "
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    • "None of the studies described the use of shared decision making in their interventions. A person-centred approach to care where the agendas’ of the patient and health care provider are addressed and agreed upon may effectively improve adherence in COPD [54]. A recent study examined the effect of shared decision making compared to clinician decision making among patients with asthma, using adherence to controller therapy as the outcome [55]. "
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