Barriers to Patient-Clinician Collaboration in Asthma Management: The Patient Experience
59
Citation
24
Reference
10
Related Paper
Citation Trend
Abstract:
Objective. To describe what adult patients with asthma report about their experiences with their own self-management behavior and working with their clinicians to control asthma. Methods. The study sample consisted of 104 patients with persistent asthma participating in a clinical trial on asthma monitoring. All subjects were seen by primary care clinicians of a large, academic medical center. This qualitative post hoc analysis examined the views of adults with asthma about their asthma-related health care. Patients attended monthly visits as part of their study participation, during which data were derived from semistructured interviews. All patients included in this analysis participated in the study for 1 year. At the end of study participation, patients were asked to complete an evaluation of their clinician's communication behavior. All study clinicians were also asked to complete a self-evaluation of their own communication behavior. Results. Five major themes of barriers to successful self-management were identified, including personal constraints, social constraints, communication failures, medication issues, and health care system barriers to collaboration with their clinicians. Patients most frequently reported lack of communication surrounding issues relating to day-to-day management of asthma (31%) and home management of asthma (24%). Clinicians generally rated themselves well for consistency in showing nonverbal attentiveness (89%) and maintaining interactive conversations (93%). However, only 30% of clinicians reported consistency in helping patients make decisions about asthma management and only 33% of clinicians reported consistency in tailoring medication schedules to the patient's routines. Conclusion. These findings emphasize the difficulties of establishing and maintaining a therapeutic partnership between patients and clinicians. The results underscore the need for system-wide interventions that promote the success of a therapeutic patient-clinician relationship in order to achieve long-term success in chronic disease management.Keywords:
Asthma management
Self-Management
AbstractUnderstanding of asthma and comanagement between patient and physician improves outcome. Feasibility of programs to achieve these goals in underserved settings is not documented. We used the Precede-Proceed model to document (a) community acceptance of a program to engage peer support of asthma management and care; (b) program revision to emphasize greater attention to availability of care and promotional events as channels for education; (c) engagement of intended audiences in planning and implementation; (d) participation of parents in program activities; and (e) peer-based education/support to reach parents, including socially isolated parents whose children experience heightened morbidity.Key Words: PediatricAfrican-AmericanHealth promotionCommunity organizationParent/familyEducationManagementNeeds assessmentSocialPublic health
Asthma management
Cite
Citations (31)
Reduction in asthma morbidity following a community-based asthma self-management programme in Tonga.
BACKGROUND: The Tonga Asthma Self-management Project assessed whether the introduction of an asthma self-management plan would reduce asthma morbidity. METHODS: The project involved a 'before and after' trial, with each participant serving as his/her own control. Asthma patients used the self-management plan to manage their asthma medication or obtain medical help based on their peak expiratory flow (PEF) rate and/or asthma symptoms. RESULTS: The 110 participants initially had relatively high asthma morbidity: 68% had had an emergency medical visit for asthma in the previous 12 months. Ninety-two (84%) completed the 12-month programme. Emergency doctor visits fell from 66% in the previous 12 months to 18% (P = 2 nights a week (from 40% to 13%, P < 0.001), severe asthma attacks (from 54% to 18%, P < 0.001) and mean PEF rates (from 341 l/min to 417 l/min, a 22% increase, P < 0.001). CONCLUSIONS: The potential benefits of asthma self-management plans and community-based asthma education are supported by the findings of the Tonga study. Their implementation is essential in the resource-scarce Pacific health setting.
Asthma management
Asthma attack
Cite
Citations (7)
Definition and prevalence. What is abnormal in asthma? Pathophysiology of asthma. How to diagnose asthma. Subtypes of asthma. Aims and essentials of treatment. Basics of asthma pharmacology, including drug delivery systems. Management of acute asthma. Management of chronic asthma. Childhood asthma. Educating the patient: Getting the most out of asthma management. Questions frequently asked by asthma patients.
Asthma management
Pathophysiology of asthma
Cite
Citations (4)
The revision in 2016 asthma management and prevention guideline includes both the diagnosis of asthma and the control-based asthma management. It points out that asthma is a heterogeneous disease, and the diagnosis of asthma should be based on the characteristic pattern of symptoms and evidence of variable airflow limitation, emphasizing the diagnosis of atypical asthma. Besides, the epidemiology of asthma, assessment of asthma, management severe asthma, special type of asthma and asthma in special populations have been added in this version. The revised guideline provides an important reference for the standardized management of asthma.
Guideline
Asthma management
Disease Control
Disease management
Cite
Citations (5)
Asthma rates are increasing in children. School nurses have opportunities to care for children with asthma but need to overcome barriers impacting their ability to manage asthma in the school setting. This study (a) assessed barriers present in the school setting, (b) determined the impact of barriers on performance of asthma management behaviors, and (c) determined the impact of barriers on importance ratings of asthma management behaviors, asthma self-efficacy, and asthma attitudes (N = 537). Results revealed 72% of the nurses reported at least one barrier. As numbers of barriers increased, performance of asthma management behaviors decreased. Significant relationships were found between specific asthma management behaviors and specific barriers. No significant relationships were found between barriers and asthma self-efficacy, asthma attitude, or importance ratings of asthma management behaviors. Removing barriers may allow the nurse to perform at greatest effectiveness, enhancing the positive outcomes that result from appropriate asthma management.
Asthma management
Self-Management
Self-Efficacy
Cite
Citations (17)
Background: Asthma is a prevalent disorder in the Gulf region. However, available data concerning asthma control and patients' perception with regard to their disease are still insufficient. Objective: To investigate patients' perception and behavior with regard to the asthma-related burden, the level of asthma control, and asthma management in three Gulf countries. Methods: This study presented a subset analysis of the Asthma Insights and Management survey about the asthma burden and management in the Gulf region and Russia. In this subset analysis, we retrieved the data of the patients from Saudi Arabia, United Arab Emirates, and Kuwait. Results: The current survey's population was composed of 452 patients. One hundred fifty-four patients (34.1%) rated themselves as having poorly controlled asthma, whereas 60.3% of the patients perceived their asthma as completely or well controlled. However, only two patients (0.4%) had controlled asthma according to the global asthma guidelines criteria for asthma control. Most of the patients (67.7%) reported that their asthma got worse when outdoors. Almost 70% of the patients on daily control plus a quick relief regimen reported that their asthma got worse when they were outdoors. Over the past 12 months, 95 patients (21%) reported asthma exacerbation. More than half of the included patients experienced an asthma attack that stopped their activities, whereas 54.2% of the patients were forced to leave work or school due to an asthma attack, and 53.1% had to cancel an appointment or had to go to bed due to the severity of the attack. With concern to asthma management, only 30.5% of the patients were given a lung function test for the assessment of their asthma. A written action plan for asthma treatment was developed by the physician or the practice nurse for only 21.7% of the patients. Conclusion: In the Gulf region, asthma exerts a substantial burden on patients who are affected. Such a burden significantly impacted patients' quality of life.
Asthma management
Asthma Exacerbations
Asthma attack
Cite
Citations (8)
Asthma management
Personalized Medicine
Cite
Citations (14)
Ten million children in the United States have asthma. Since children are in school about 6 hr a day, school nurses are positioned to intervene and influence asthma outcomes. A descriptive correlational study was designed to investigate performance of school nurses' asthma management behaviors in relationship to asthma knowledge, asthma attitude, asthma self-efficacy, and rating of importance of asthma management behaviors. Results indicated that asthma attitude, asthma self-efficacy, and rating of importance of asthma management behaviors were associated with performance of asthma management behaviors. The higher the rating of importance of asthma management behaviors, the more likely school nurses were to perform the behaviors (p < .05). Higher levels of asthma self-efficacy were associated with performance of asthma management behaviors, indicating the importance of strengthening school nurses' asthma self-efficacy in asthma management. By understanding factors influencing performance of asthma management behaviors by school nurses, interventions can be implemented to increase asthma management behaviors, leading to improved outcomes for students with asthma.
Asthma management
Self-Efficacy
Self-Management
School nursing
Cite
Citations (17)
ISSUES AND PURPOSE. To assess home asthma management among rural families with a school‐age child who has asthma. DESIGN AND METHODS. Exploratory analysis of baseline data of a tri‐ethnic sample of rural families with school‐age children who have asthma. RESULTS. Parents and children enact a moderate amount of asthma management behaviors. Preventive behaviors were correlated with the Asthma Behavior Inventory and treatment behaviors were correlated with the child's asthma severity. Factors that could affect asthma management include no insurance, no visits to providers in 12 months, or no asthma medications. PRACTICE IMPLICATIONS. Nurses must use every contact with families to assess their asthma management and availability of resources, and to determine the fit between asthma severity and the asthma management plan.
Asthma management
Affect
Cite
Citations (18)
Asthma is a chronic lung condition that requires active provider and patient management to prevent chronic symptoms and exacerbations. Data from the 2002 Wisconsin Behavioral Risk Factor Survey were used to determine asthma prevalence and characterize asthma symptom severity, control, and management among Wisconsin adults. About 8.5% or an estimated 345,000 adults in Wisconsin reported currently having asthma. Most adults with asthma (66%) have symptoms consistent with intermittent asthma. Over 80% of Wisconsin adults with asthma reported experiencing asthma symptoms in the past 30 days and 14% reported going to the emergency department for asthma in the past 12 months. The National Asthma Education and Prevention Program Management and Diagnosis Guidelines are considered the standard of quality for asthma care. Asthma management in Wisconsin falls short of meeting these guidelines. Classifying the severity of asthma, scheduling routine follow-up care, recommending measures to control asthma triggers, and treating or preventing comorbid conditions are key asthma management clinical activities. Increased clinical management coupled with improved patient self-management is needed to reduce the burden of asthma in Wisconsin. The Wisconsin Asthma Plan, released by the Wisconsin Asthma Coalition, provides concrete steps for improving provider and patient asthma management.
Asthma management
Cite
Citations (1)