Assessing Patient and Provider Perceptions of Factors Associated with Patient Engagement in Asthma Care.

RATIONALE

National quality improvement initiatives emphasize building partnerships between patients and providers by promoting patient engagement through communication, shared decision-making, and self-care skills. Efforts to promote patient engagement are especially important for people with asthma. To cultivate effective partnerships in asthma care, patients and providers may benefit from understanding each other's values and perceptions regarding treatment goals, shared decision-making, as well as barriers to optimal care and outcomes.

OBJECTIVES

We conducted a survey study to assess and compare asthma patient and provider perceptions of factors that are associated with effective partnerships and patient engagement.

METHODS

Surveys were administered to adult patients with poorly controlled asthma (n = 328) and their physicians (n = 40) before they participated in collaborative learning sessions held in 40 allergy and immunology practices across the United States. The surveys included items for both groups to report their asthma-related treatment goals and perceptions about information needs and knowledge, shared decision-making, and barriers to medication adherence.

RESULTS

Providers rated their knowledge about different aspects of their patients' health status (on a scale from 1 = poor knowledge to 5 = excellent knowledge). The lowest percentages of ratings 4 and 5 were for knowledge about patients' financial status (29%), adherence (42%), lifestyle (46%), and workplace situation (46%). The highest percentages of ratings 4 and 5 were for knowledge about patients' exacerbation history (75%), smoking status (76%), hospitalization history (79%), and comorbidities (79%). The percentages of patients and providers, respectively, who indicated the following treatment goals as important differed significantly: preventing exacerbations (62% and 83%; P = 0.01), preventing emergency department visits (44% and 76%; P < 0.01), and improving ability to perform daily activities (69% and 48%; P < 0.01). However, there were no significant differences in percentages of provider-reported goals and goals that providers estimated their patients would indicate as important. Disconnects were also observed for perceived barriers to asthma medication adherence.

CONCLUSIONS

The observed disconnects in patient and provider perceptions may inform strategies for cultivating effective partnerships and patient engagement to improve care quality and outcomes for people with asthma.