Concordance of opinions between patients and physicians and their relationship with symptomatic control and future risk in patients with moderate–severe asthma

Abstract

IntroductionDifferences between the opinions of patients and physicians on the impact of asthma are common. We hypothesised that patient–physician discordance may negatively affect asthma outcome.MethodsA total of 2902 patients (61% women, mean age 47 years) with moderate–severe asthma and 231 physicians participated in a prospective study. At the baseline visit, data on demographics, clinical variables, degree of asthma control according to the Asthma Control Test (ACT), basic spirometry and the Hospital Anxiety and Depression Scale (HADS) were collected and an ad hoc questionnaire was completed that allowed the degree of concordance between doctors and patients to be assessed. A scheduled telephone call after 3 months was used to elicit the ACT score and the future risk of asthma. At the final visit at 6 months, the following data were recorded: ACT score, spirometry, HADS score and an ad hoc questionnaire to assess the agreement between the doctor and the patient. Changes in study variables according to patient–physician concordance or discordance were analysed.ResultsThe rate of patient–physician discordance was 27.2%, with overestimation of disease impact by the physician in 12.3% and underestimation in 14.9%. Patient–physician opinion discordance, particularly in the case of physicians underestimating the impact of asthma, showed worse results with statistically significant differences in ACT score, a higher percentage of patients with poor asthma control and lower HADS scores. The need for hospital and emergency department admissions was also higher.ConclusionPatient–physician opinion discordance may be contributing to lower symptomatic control and increased future risk, with a higher impact when physicians underestimate the impact of asthma on their patients.

Patient-physician discrepancy in the perception of immune-mediated inflammatory diseases: rheumatoid arthritis, psoriatic arthritis and psoriasis. A qualitative systematic review of the literature

“…Previous studies have reported that discordance is also associated with a lower likelihood of remission in patients with RA and PsA [36]; greater joint destruction and functional impairment in RA [37], and higher Disease Activity Score (DAS28) and C-Reactive Protein (CRP) after the 24 weeks of disease-modifying therapy in early RA [38]. This association between discrepancy and worse clinical outcomes has also been described in other diseases such as asthma [39].…”

Development and initial validation of the Asthma Severity Scoring System (ASSESS)

“…For example, other studies of asthma control and asthma functional status have shown that concordance between objective and judgment-based assessments is often poor and might even worsen in patients receiving higher step-based therapy. [25][26][27][28] Asthma severity determination is also discordant between physicians in both primary care 29 and specialist 30 settings. Objective measures, such as ASSESS, have potential to mitigate the increasing costs of asthma severity in both the United States 31,32 and elsewhere 33,34 through comprehensive assessment of treatment responses and, ultimately, elimination of unnecessary treatment in patients who do not benefit.…”

Comparison of adverse events associated with different spacers used with non-extrafine beclometasone dipropionate for asthma

“…It is very likely that the range and extent of ICS-related adverse events, as experienced by patients, are underestimated. 9,12,39 The short duration of clinical trials and the stringent inclusion criteria often limit the quality and quantity of data on adverse events. 40,41 Similarly, patient-perceived ICS-associated adverse events may not be detected during routine clinical practice as patients are often reluctant to discuss their concerns about medication with their physicians.…”