Asthma is a chronic, potentially life-threatening disease that affects 17 million people in the United States. Millions of lost work days from productive activity and thousands of hospitalizations annually are caused by asthma. Despite the high prevalence, asthma is a chronic disease that can be controlled. Corticosteroids are the most effective agents for the long-term treatment of persistent asthma, and administration by inhalation minimizes the potential for systemic side effects. Despite convincing evidence of the benefits of inhaled corticosteroids (ICS), both patients and clinicians seem reluctant to use them regularly. Many patients who are prescribed ICS either never take them, or take them less frequently (e.g., once rather than twice daily), less regularly (e.g., """"""""as needed"""""""" rather than daily), or at lower doses than prescribed. Investigators and reviewers agree that at least 50% of persons for whom medications are prescribed fail to benefit fully because of poor adherence. The reasons for nonadherence are multifaceted and not fully understood. The relationship between clinician and patient, an area where potential impact can be made, is believed to be the strongest predictor of medication adherence. Providing pertinent objective information about asthma related lung function should prompt therapeutic communication between the patient and clinician to improve adherence to ICS. The overall purpose of this project is to improve anti-inflammatory medication adherence and asthma outcomes by cueing therapeutic interaction between patients and their clinicians.
The specific aims are to 1) improve adherence to ICS medication by cueing patient-clinician communication with feedback of objective information about airflow obstruction to reinforce medication-taking behavior; and 2) to document the impact of this cueing intervention on health care outcomes (health care utilization, pulmonary function, need for rescue courses of oral steroids, and functional impact. We hypothesize that cueing patients and their primary care clinicians about the degree of airflow obstruction will prompt interaction between them resulting in greater adherence to ICS medication over one year than will occur in a control group of similar patients who do not receive feed-back. A prospective randomized clinical trial (N=150 subjects) is proposed to test the effectiveness of this intervention. Promoting communication between adults with asthma and their clinicians in a primary care clinical setting has not yet been demonstrated. All clinicians within three general medicine practices and their individual panels of adult patients with moderate to severe asthma will be enrolled and randomized together to either the intervention or usual care. Feedback of interpreted peak flow graphs in relation to current therapy will prompt therapeutic communication. The intent is to cue and support the therapeutic relationship between clinician and patient rather than to directly intervene. The power of cueing communication lies in the ensuing therapeutic dialogue. Improvement of adherence to ICS among people with moderate or severe asthma has been shown to decrease morbidity of asthma and improve health outcomes.
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