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      Patient-centered care and its effect on outcomes in the treatment of asthma

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          Abstract

          Patient-centered care may be pivotal in improving health outcomes for patients with asthma. In addition to increased attention in both research and clinical forums, recent legislation also highlights the importance of patient-centered outcomes research in the Patient Protection and Affordable Care Act. However, whether patient-centered care has been shown to improve outcomes for this population is unclear. To answer this question, we performed a systematic review of the literature that aimed to define current patient-focused management issues, characterize important patient-defined outcomes in asthma control, and identify current and emerging treatments related to patient outcomes and perspectives. We used a parallel search strategy via Medline ®, Cochrane Central Register of Controlled Trials, CINAHL ® (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO ®, complemented with a reference review of key articles that resulted in a total of 133 articles; 58 were interventions that evaluated the effect on patient-centered outcomes, and 75 were descriptive studies. The majority of intervention studies demonstrated improved patient outcomes (44; “positive” results); none showed true harm (0; “negative”); and the remainder were equivocal (14; “neutral”). Key themes emerged relating to patients’ desires for asthma knowledge, preferences for tailored management plans, and simplification of treatment regimens. We also found discordance between physicians and patients regarding patients’ needs, beliefs, and expectations about asthma. Although some studies show promise regarding the benefits of patient-focused care, these methods require additional study on feasibility and strategies for implementation in real world settings. Further, it is imperative that future studies must be, themselves, patient-centered (eg, pragmatic comparative effectiveness studies) and applicable to a variety of patient populations and settings. Despite the need for further research, enough evidence exists that supports incorporating a patient-centered approach to asthma management, in order to achieve improved outcomes and patient health.

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          Most cited references182

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          Shared Treatment Decision Making Improves Adherence and Outcomes in Poorly Controlled Asthma

          American Journal of Respiratory and Critical Care Medicine, 181(6), 566-577
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            Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations.

            To measure patients' perceptions of patient centredness and the relation of these perceptions to outcomes. Observational study using questionnaires. Three general practices. 865 consecutive patients attending the practices. Patients' enablement, satisfaction, and burden of symptoms. Factor analysis identified five components. These were communication and partnership (a sympathetic doctor interested in patients' worries and expectations and who discusses and agrees the problem and treatment, Cronbach's alpha=0.96); personal relationship (a doctor who knows the patient and their emotional needs, alpha=0.89); health promotion (alpha=0.87); positive approach (being definite about the problem and when it would settle, alpha=0.84); and interest in effect on patient's life (alpha=0.89). Satisfaction was related to communication and partnership (adjusted beta=19.1; 95% confidence interval 17.7 to 20.7) and a positive approach (4.28; 2.96 to 5.60). Enablement was greater with interest in the effect on life (0.55; 0.25 to 0.86), health promotion (0.57; 0.30 to 0.85), and a positive approach (0.82; 0.52 to 1.11). A positive approach was also associated with reduced symptom burden at one month (beta=-0.25; -0.41 to -0.10). Referrals were fewer if patients felt they had a personal relationship with their doctor (odds ratio 0.70; 0.54 to 0.90). Components of patients' perceptions can be measured reliably and predict different outcomes. If doctors don't provide a positive, patient centred approach patients will be less satisfied, less enabled, and may have greater symptom burden and higher rates of referral.
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              Self-management education and regular practitioner review for adults with asthma.

              A key component of many asthma management guidelines is the recommendation for patient education and regular medical review. A number of controlled trials have been conducted to measure the effectiveness of asthma education programmes. These programmes improve patient knowledge, but their impact on health outcomes is less well established. This review was conducted to examine the strength of evidence supporting Step 6 of the Australian Asthma Management Plan: "Educate and Review Regularly"; to test whether health outcomes are influenced by education and self-management programmes. The objective of this review was to assess the effects of asthma self-management programmes, when coupled with regular health practitioner review, on health outcomes in adults with asthma. We searched the Cochrane Airways Group trials register and reference lists of articles. Randomised trials of self-management education in adults over 16 years of age with asthma. Trial quality was assessed and data were extracted independently by two reviewers. Study authors were contacted for confirmation. Thirty six trials, which compared self-management education with usual care, were included. Self-management education reduced hospitalisations (relative risk 0.64, 95% confidence interval 0.50 to 0.82); emergency room visits (relative risk 0.82, 95% confidence interval (0.73 to 0.94); unscheduled visits to the doctor (relative risk 0.68, 95% confidence interval 0.56 to 0.81); days off work or school (relative risk 0.79, 95% confidence interval 0.67 to 0.93); nocturnal asthma (relative risk 0.67, 95% confidence interval 0.0.56 to 0.79); and quality of life (standard mean difference 0.29, confidence interval 0.11 to 0.47). Measures of lung function were little changed. Education in asthma self-management which involves self-monitoring by either peak expiratory flow or symptoms, coupled with regular medical review and a written action plan improves health outcomes for adults with asthma. Training programmes that enable people to adjust their medication using a written action plan appear to be more effective than other forms of asthma self-management.
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                Author and article information

                Journal
                Patient Relat Outcome Meas
                Patient Relat Outcome Meas
                Patient Related Outcome Measures
                Patient Related Outcome Measures
                Dove Medical Press
                1179-271X
                July 2011
                06 March 2011
                : 2
                : 81-109
                Affiliations
                [1 ]Pediatric Residency Program, University of Chicago Medical Center, Chicago, IL, USA;
                [2 ]Internal Medicine-Pediatric Residency Program, University of Chicago Medical Center, Chicago, IL, USA;
                [3 ]Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA;
                [4 ]Section of Hospital Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
                Author notes
                [*]

                Drs Qamar and Pappalardo contributed equally to this paper

                Correspondence: Valerie G Press, Section of Hospital Medicine, Department of Medicine, University of Chicago Medical Center, 5841 S Maryland Ave, MC 5000 W305, Chicago, IL 60637, USA, Tel +1 773 702 5170 Fax +1 773 795 7398 Email vpress@ 123456medicine.bsd.uchicago.edu
                Article
                prom-2-081
                10.2147/PROM.S12634
                3417925
                22915970
                24150dae-89e6-47c6-bd6c-1cba90e2e1d4
                © 2011 Qamar et al, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                History
                : 10 June 2011
                Categories
                Review

                Medicine
                patient-focused,patient outcomes,quality of life
                Medicine
                patient-focused, patient outcomes, quality of life

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