Enhancing Collaboration Between Doctors and Patients to Improve Asthma
Condition: Asthma; Lung Diseases
MeSH terms: Asthma; Lung Diseases
Study type: Interventional

Summary: 
      The purpose of this study is to improve anti-inflammatory medication adherence and asthma
      outcomes by using reports of peak flow monitoring to prompt communication between patients
      and their doctors.
    

Detailed description: 
      BACKGROUND:

      Asthma is a chronic, potentially life-threatening disease that affects 17 million people in
      the United States. Asthma leads to millions of lost work days and thousands of
      hospitalizations annually. For the millions of people with this disease, it is chronic but
      controllable. Corticosteroids are the most effective medication for the long-term treatment
      of persistent asthma, and inhaling the medication minimizes the potential for systemic side
      effects. Despite convincing evidence of the benefits of inhaled corticosteroids (ICS), both
      patients and doctors seem reluctant to use them regularly. Many people 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.
      Doctors agree that at least 50% of people who are prescribed ICS fail to benefit fully
      because of poor adherence. The many reasons for non-adherence are not fully understood. The
      relationship between the doctor and patient, an area in which potential impact can be made,
      is believed to be the strongest predictor of medication adherence. Providing pertinent
      information about asthma related lung function should prompt communication between the
      patient and doctor to improve adherence to ICS.

      DESIGN NARRATIVE:

      The overall purpose of this study is to improve anti-inflammatory medication adherence and
      asthma outcomes by encouraging communication between patients and their doctor. The specific
      aims of the study include the following: 1) improve adherence to ICS medication by
      encouraging patient-doctor communication with feedback of objective information about airflow
      obstruction to reinforce medication-taking behavior; and 2) document the impact that the
      encouragement of communication has on health care outcomes, including health care
      utilization, pulmonary function, need for rescue courses of oral steroids, and functional
      impact. The hypothesis of the study is that informing patients and their primary care doctors
      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 feedback. Promoting communication between adults with
      asthma and their doctors in a primary care clinical setting has not yet been studied. All
      doctors within three general medicine practices and their adult patients with moderate to
      severe asthma will be enrolled and assigned to either the intervention or usual care.
      Feedback of interpreted peak flow graphs in relation to current medication therapy will
      prompt the communication. The intent is to encourage and support the relationship between the
      doctor and patient rather than to directly intervene. The power of encouraging communication
      lies in the ensuing dialogue between the doctor and patient. Improvement of adherence to ICS
      among people with moderate or severe asthma has been shown to decrease morbidity of asthma
      and improve health outcomes.
    

Intervention name(s): Status Reports
Intervention type(s): Behavioral
Intervention description(s): Interpreted Analysis of Peak-Flow Monitoring Trends
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment