Factors associated with knowledge of self-management of worsening asthma in primary care patients: a cross-sectional study

Abstract

Objective: Self-management is important for asthma control. We examined associations of patient-and healthcare-related factors with self-reported knowledge of self-management of worsening asthma. Methods: Two asthma patient cohorts from 2012 (n ¼ 527) and 2015 (n ¼ 915) were randomly selected from 54 primary health care centers (PHCC) in central Sweden. Data were collected using patient questionnaires and questionnaires to the PHCCs. Logistic regression analyzed associations of relevant variables with knowledge of self-management of worsening asthma. Results: In total, 63% of patients reported moderate to complete knowledge of selfmanagement procedures. The adjusted OR for moderate to complete knowledge relative to high education level was 1.38 [95% CI 1.03-1.85)]; for physician continuity 2.19 (95% CI 1.62-2.96); for a written action plan 11.9 (95% CI 6.16-22.9); for Step 2 maintenance treatment 1.53 (95% CI 0.04-2.24); and 2.07 (95% CI 1.44-2.99) for Step 3. An asthma/COPD nurse visit within the previous 12 months was associated with greater knowledge in women but not in men (p for interaction ¼ 0.042). Smoking [OR 0.56 (95% CI 0.34-0.95)], co-morbidities 1 [OR 0.68 (95% CI 0.49-0.93)], and self-rated moderate/severe disease [OR 0.68 (95% CI 0.51-0.90)] were associated with low self-management knowledge. Conclusion: Self-reported knowledge of self-management procedures was associated with a higher educational level, physician continuity, a written action plan, advanced treatment and, in women, visiting an asthma/COPD nurse. The results reinforce the importance of implementing guidelines of patient access to a specific physician, a written action plan, and structured education by an asthma/COPD nurse.

Impact of pharmacist-led educational intervention on knowledge of self-management among asthmatic patients: a prospective cohort study

“…Despite well-documented evidence of the positive impact of asthma self-management programmes in achieving the desired patient outcomes and reducing healthcare costs, it is unfortunately rarely implemented in routine clinical practice 1 2 5…”

“…Asthma has over many years become one of the major health concerns affecting millions of people 1 and is defined as a chronic, non-communicable inflammatory disorder of the airways, which affects 334 million people worldwide with an alarming prediction of an increase in 100 million more by the year 2025. 1 2 Considering the most leading causes of disease which burdens society, asthma ranks 28th, causing approximately 1000 people to die every day around the globe. In addition, it ranks 16th among the leading causes of years of life lived with a disability and its prevalence is still rising in underdeveloped countries.…”

Factors associated with self-assessed asthma severity

“…", is not always consistent with the physician's assessment using standardized measures (7). However, the patient's perspective is important, as we also reported that self-assessed moderate or severe asthma is more notably associated with lower selfmanagement skills than poor asthma control, as measured by standardized questionnaires and history of exacerbations (8).…”

Outcomes associated with higher relational continuity in the treatment of persons with asthma or chronic obstructive pulmonary disease: A systematic review

“…We identified 2824 unique references, of which 36 articles were read in full text. Sixteen articles fulfilled the inclusion criteria, 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 of which one 25 was later excluded because of an unacceptable risk of bias. Of the 15 included articles, 14 were based on observational data, mainly retrospective cohort studies, and one 24 was a randomized controlled study.…”

“…Three studies investigated various patient assessments of experience of received care, self-management of disease and quality of life. 20 , 23 , 24 The assessment of continuity of care was only partially relevant and the results were presented in various ways. All results were, however, consistent in their findings that higher relational continuity of care showed a positive association with experience, communication and participation 20 , self-management of the disease 23 and health-related quality of life.…”