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Published on: November 4, 2010
Shared treatment decision making improves adherence and outcomes in poorly controlled asthma
Sandra R Wilson1, Peg Strub, A Sonia Buist
1Palo Alto Medical Foundation Research Institute, CA 94301, USA. wilsons@pamfri.org
American Journal of Respiratory and Critical Care Medicine
|December 19, 2009
Summary
Shared decision making (SDM) significantly improves asthma medication adherence and clinical outcomes compared to usual care. This patient-centered approach enhances controller and long-acting beta-agonist adherence, leading to better asthma management.
Area of Science:
- Pulmonary Medicine
- Clinical Pharmacy
- Health Services Research
Background:
- Poor adherence to asthma controller medications is a significant barrier to effective treatment.
- Suboptimal medication adherence leads to increased morbidity and healthcare utilization in asthma patients.
Purpose of the Study:
- To compare the impact of shared decision-making (SDM) versus clinician-centered decision-making and usual care on medication adherence and clinical outcomes in adults with poorly controlled asthma.
- To evaluate the effectiveness of a patient-centered approach in improving asthma management.
Main Methods:
- A randomized controlled trial involving 612 adults with poorly controlled asthma.
- Intervention groups received asthma education and structured patient-clinician encounters, with SDM involving negotiation of treatment based on patient goals.
- Usual care served as the control group.
Main Results:
- Shared decision-making (SDM) significantly improved controller medication adherence (CMA 0.67 vs. 0.46) and long-acting beta-agonist adherence (CMA 0.51 vs. 0.40) compared to usual care in Year 1.
- SDM also led to higher cumulative controller medication doses and significantly better clinical outcomes, including quality of life, healthcare use, rescue medication use, asthma control, and lung function.
- Compared to clinician decision-making, SDM showed significantly better adherence and quantitatively improved clinical outcomes.
Conclusions:
- Negotiating treatment decisions with patients significantly enhances adherence to asthma pharmacotherapy.
- Shared decision-making is an effective strategy for improving both medication adherence and clinical outcomes in patients with poorly controlled asthma.
- This patient-centered approach offers a promising model for optimizing asthma management.
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