ObjectiveWe aimed to compare patient’s and physician’s ratings of inhaled medication adherence and to identify predictors of patient-physician discordance.DesignBaseline data from two prospective multicentre observational studies.Setting29 allergy, pulmonology and paediatric secondary care outpatient clinics in Portugal.Participants395 patients (≥13 years old) with persistent asthma.MeasuresData on demographics, patient-physician relationship, upper airway control, asthma control, asthma treatment, forced expiratory volume in one second (FEV1) and healthcare use were collected. Patients and physicians independently assessed adherence to inhaled controller medication during the previous week using a 100 mm Visual Analogue Scale (VAS). Discordance was defined as classification in distinct VAS categories (low 0–50; medium 51–80; high 81–100) or as an absolute difference in VAS scores ≥10 mm. Correlation between patients’ and physicians’ VAS scores/categories was explored. A multinomial logistic regression identified the predictors of physician overestimation and underestimation.ResultsHigh inhaler adherence was reported both by patients (median (percentile 25 to percentile 75) 85 (65–95) mm; 53% VAS>80) and by physicians (84 (68–95) mm; 53% VAS>80). Correlation between patient and physician VAS scores was moderate (rs=0.580; p<0.001). Discordance occurred in 56% of cases: in 28% physicians overestimated adherence and in 27% underestimated. Low adherence as assessed by the physician (OR=27.35 (9.85 to 75.95)), FEV1 ≥80% (OR=2.59 (1.08 to 6.20)) and a first appointment (OR=5.63 (1.24 to 25.56)) were predictors of underestimation. An uncontrolled asthma (OR=2.33 (1.25 to 4.34)), uncontrolled upper airway disease (OR=2.86 (1.35 to 6.04)) and prescription of short-acting beta-agonists alone (OR=3.05 (1.15 to 8.08)) were associated with overestimation. Medium adherence as assessed by the physician was significantly associated with higher risk of discordance, both for overestimation and underestimation of adherence (OR=14.50 (6.04 to 34.81); OR=2.21 (1.07 to 4.58)), while having a written action plan decreased the likelihood of discordance (OR=0.25 (0.12 to 0.52); OR=0.41 (0.22 to 0.78)) (R2=44%).ConclusionAlthough both patients and physicians report high inhaler adherence, discordance occurred in half of cases. Implementation of objective adherence measures and effective communication are needed to improve patient-physician agreement.

No abstract

To maximize the impact of group education sessions and, by that, saving resources, it may be important to select patients likely to benefit from these sessions.

Sustainable development comprehends the balance between human activities and the environment. Today, more than ever, the need to act with respect for the environment and the urgency in recognizing that we belong to the planet, and not the other way around, have accelerated and generalized the demand for information about environmental sustainability, economic and social concerns, and the discussion about which Humanity should adopt paths to save the species. The United Nations 2030 Agenda recognizes access to information as a critical goal in the Sustainable Development Goal of promoting peaceful and inclusive societies, access to justice for all, and building effective, accountable, and inclusive institutions at all levels. In a global and inclusive society, people's access to information and the need to protect fundamental freedoms is necessarily the founding principle of the path to achieving global sustainability. The understanding of the world and society has always been founded on the study of the past, the knowledge of history, traditions, and memory. Only knowledge of memory allows us to know where we come from and to determine where we are going. Memory, which is nothing more than informational heritage, a generator agent of value and distinctive identity, is essential to create, distinguishing, and enriching socioeconomic activities based on the realities of the environment and local cultures towards socioeconomic and environmental sustainability and inclusion. In this paper, we intend to highlight the crucial role of information professionals in sustainable development, as they play unique and privileged roles in the preservation of people's identity and culture, as well as in the collection, research, processing, protection, promotion, enhancement, and transmission of information, which guarantee the viability of Humanity's cultural heritage and access to information as one of the goals of sustainable development.