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      Impact of Adding a Decision Aid to Patient Education in Adults with Asthma: A Randomized Clinical Trial

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          Abstract

          Background

          Not providing adequate patient education interventions to asthma patients remains a major care gap. To help asthma patients and caregivers discuss inhaled controller medication use, our team has previously developed a decision aid (DA). We sought to assess whether adding this DA to education interventions improved knowledge, decisional conflict, and asthma control among adults with asthma.

          Methods

          A parallel clinical trial (NCT02516449). We recruited adults with asthma, aged 18 to 65 years, prescribed inhaled controller medication to optimize asthma control. Educators randomly allocated participants either to the education + DA or to the education group. At baseline and two-month follow-up, we measured asthma knowledge (primary outcome) with a validated self-administered questionnaire (score –37 to +37). Secondary outcomes included decisional conflict and asthma control. Blinded assessors collected data. Between the two time points, the within- and between-group changes were estimated by generalized linear mixed models.

          Results

          Fifty-one participants (response rate: 53%; age: 44 ± 13 years; women: n = 32) were randomized either to the education + DA group (n = 26) or to the education group (n = 25), and included in statistical analyses. Between baseline and follow-up, mean [95% CI] knowledge scores increased from 21.5 [19.9–23.2] to 25.1 [23.1–27.0] in the education + DA group ( P = 0.0002) and from 24.0 [22.3–25.7] to 26.0 [24.0–28.0] in the education group ( P = 0.0298). In both of the groups, decisional conflict and asthma control improved. There were no differences between groups.

          Conclusions

          Education improved knowledge, decisional conflict, and asthma control whether the DA was added or not.

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          Most cited references37

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          Concurrent and predictive validity of a self-reported measure of medication adherence.

          Adherence to the medical regimen continues to rank as a major clinical problem in the management of patients with essential hypertension, as in other conditions treated with drugs and life-style modification. This article reviews the psychometric properties and tests the concurrent and predictive validity of a structured four-item self-reported adherence measure (alpha reliability = 0.61), which can be easily integrated into the medical visit. Items in the scale address barriers to medication-taking and permit the health care provider to reinforce positive adherence behaviors. Data on patient adherence to the medical regimen were collected at the end of a formalized 18-month educational program. Blood pressure measurements were recorded throughout a 3-year follow-up period. Results showed the scale to demonstrate both concurrent and predictive validity with regard to blood pressure control at 2 years and 5 years, respectively. Seventy-five percent of the patients who scored high on the four-item scale at year 2 had their blood pressure under adequate control at year 5, compared with 47% under control at year 5 for those patients scoring low (P less than 0.01).
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            Validation of a decisional conflict scale.

            The study objective was to evaluate the psychometric properties of a decisional conflict scale (DCS) that elicits: 1) health-care consumers' uncertainty in making a health-related decision; 2) the factors contributing to the uncertainty; and 3) health-care consumers' perceived effective decision making. The DCS was developed in response to the lack of instruments available to evaluate health-care-consumer decision aids and to tailor decision-supporting interventions to particular consumer needs. The scale was evaluated with 909 individuals deciding about influenza immunization or breast cancer screening. A subsample of respondents was retested two weeks later. The test-retest reliability coefficient was 0.81. Internal consistency coefficients ranged from 0.78 to 0.92. The DCS discriminated significantly (p < 0.0002) between those who had strong intentions either to accept or to decline invitations to receive influenza vaccine or breast cancer screening and those whose intentions were uncertain. The scale also discriminated significantly (p < 0.0002) between those who accepted or rejected immunization and those who delayed their decisions to be immunized. There was a weak inverse correlation (r = -0.16, p < 0.05) between the DCS and knowledge test scores. The psychometric properties of the scale are acceptable. It is feasible and easy to administer. Evaluations of responsiveness to change and validation with more difficult decisions are warranted.
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              Development and validation of a questionnaire to measure asthma control.

              International guidelines on asthma management indicate that the primary goal of treatment should be optimum asthma control. The aim of this study was to develop and validate the Asthma Control Questionnaire (ACQ). The authors generated a list of all symptoms used to assess control and sent it to 100 asthma clinicians who were members of guidelines committees (18 countries). They scored each symptom for its importance in evaluating asthma control. From the 91 responses, the five highest scoring symptoms were selected for the ACQ. In addition, there is one question on beta2-agonist use and another on airway calibre (total questions=7). The ACQ was tested in a 9-week observational study of 50 adults with symptomatic asthma. The ACQ and other measures of asthma health status were assessed at baseline, 1, 5 and 9 weeks. In patients whose asthma was stable between clinic visits, reliability of the ACQ was high (intraclass correlation coefficient (ICC)=0.90). The questionnaire was very responsive to change in asthma control (p<0.0001). Cross-sectional and longitudinal validity were supported by correlations between the ACQ and other measures of asthma health status being close to a priori predictions. In conclusion, the Asthma Control Questionnaire has strong evaluative and discriminative properties and can be used with confidence to measure asthma control.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                20 January 2017
                2017
                : 12
                : 1
                : e0170055
                Affiliations
                [1 ]Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health, Laval University, Quebec City, QC, Canada
                [2 ]Quebec Heart and Lung Institute-Laval University, Quebec City, QC, Canada
                [3 ]Canada Research Chair in Implementation of Shared Decision Making in Primary Care, Laval University, Quebec City, QC, Canada
                [4 ]CHU de Quebec Research Center, Population Health and Optimal Health Practices Research Unit, Quebec City, QC, Canada
                [5 ]Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada
                Universite de Bretagne Occidentale, FRANCE
                Author notes

                Competing Interests: Potential conflicts of interest to disclose are: 1) the Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health is supported by unrestricted grants from AstraZeneca, and 2) the Chair on Adherence to Treatments was supported by unrestricted grants from AstraZeneca, Merck Canada, Sanofi Canada, Pfizer Canada and the Prends soin de toi program. M.G., F.L., and J.M. have no conflict of interest to declare. L.P.B. considers having no conflict of interest but wishes to declare what can be perceived as potential conflicts of interest. Advisory Boards: GlaxoSmithKline, Novartis. Conferences (honoraria): AstraZeneca, GlaxoSmithKline, Merck, Novartis. Sponsorship for investigator-generated research: AstraZeneca, GlaxoSmithKline, Merck Frosst, Schering. Sponsorship for research funding for participating in multicenter studies: AllerGen, Altair, Amgen, Asmacure, AstraZeneca, Boehringer-Ingelheim, Genentech, GlaxoSmithKline, Novartis, Ono Pharma, Pharmaxis, Schering, Wyeth. Support for the production of educational materials: AstraZeneca, GlaxoSmithKline, Merck Frosst, Boehringer-Ingelheim, Novartis. Organizational: Chair of the Global Initiative for Asthma (GINA) Guidelines Dissemination and Implementation Committee, Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health, Member of the Executive Committee of Interasma (Global Asthma Organization). This does not alter our adherence to all PLOS ONE policies on sharing data and materials. The authors alone are responsible for the content and writing of this paper.

                • Conceptualization: MEG FL JM LPB.

                • Data curation: MEG.

                • Formal analysis: MEG.

                • Funding acquisition: LPB FL JM.

                • Investigation: MEG.

                • Methodology: MEG FL JM LPB.

                • Project administration: MEG.

                • Resources: LPB.

                • Supervision: LPB.

                • Visualization: MEG.

                • Writing – original draft: MEG.

                • Writing – review & editing: FL JM LPB.

                Author information
                http://orcid.org/0000-0002-0559-5731
                Article
                PONE-D-16-36299
                10.1371/journal.pone.0170055
                5249233
                28107540
                f421954f-265b-4c1a-9e9c-0d7288c1d70f
                © 2017 Gagné et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 10 September 2016
                : 25 December 2016
                Page count
                Figures: 1, Tables: 3, Pages: 16
                Funding
                Funded by: AllerGen NCE Inc.
                Award ID: 11CKT2
                Award Recipient :
                LPB (principal investigator) and FL (coinvestigator) received a grant from the Allergy, Genes and Environment Network for funding the research: http://allergen-nce.ca/. Reference number for the project: 11CKT2. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Pulmonology
                Asthma
                Medicine and Health Sciences
                Health Care
                Patients
                Medicine and Health Sciences
                Pharmaceutics
                Drug Therapy
                People and Places
                Population Groupings
                Age Groups
                Adults
                Medicine and Health Sciences
                Health Care
                Health Education and Awareness
                Medicine and Health Sciences
                Health Care
                Patient Advocacy
                Medicine and Health Sciences
                Public and Occupational Health
                Behavioral and Social Aspects of Health
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Body Mass Index
                Medicine and Health Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Body Mass Index
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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                Uncategorized

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