Features of asthma management: quantifying the patient perspective

Abstract

BackgroundIn the management of asthma, features of care important to patients may not be fully appreciated. This study quantifies the importance of different features of asthma management from the patient perspective. This may assist in the development of personalised management strategies.MethodsWe used the technique of discrete choice experiment (DCE). Patients over 18 years of age with asthma, prescribed and taking medicine at step 3 of the UK guidelines were recruited from 15 general (family) practices in three areas of the UK. 147 evaluable questionnaires were returned from a total of 348 sent out. The outcome measures were the relative importance to patients of features of asthma management and the impact of changes in asthma management, as measured by utility shift between the features tested.ResultsThe largest shift in mean utility values was recorded in "number of inhalers" and "use of inhaled steroid". Use of a personal asthma action plan was ranked next highest.ConclusionThis study suggests that adults with moderate or severe asthma would trade some improvements in symptom relief in favour of, for example, simpler treatment regimens that use as few inhalers as possible and a lower dose of inhaled steroid.

Understanding patients with asthma and COPD: insights from a European study

“…This confirms that (in the absence of symptoms) low adherence to regular medications is an issue, and without properly designed educational strategies the achievement of optimal asthma control may become an elusive goal. 9,10,20,21 Nevertheless, patients' propensity to take control of their own therapy may be exploited to implement strategies that should lead to a guided involvement of patients in self-monitoring and self-management of their condition, as suggested by guidelines. 3 Indeed, previous studies have shown that patients are able to recognise deteriorating asthma control but that they usually adjust their medication in an inappropriate manner.…”

“…The high percentage of respondents who declared that regular treatments which provide immediate benefits reinforce the need to take the medication confirms the results of previous studies in asthma patients. 19,21 Of concern is the fact that almost half of the respondents were not aware of exchanges of information between GPs and specialists regarding the management of their condition. If such a perception is reality, the opportunity for conflicting messages is significant.…”

Unravelling the concept of consumer preference: Implications for health policy and optimal planning in primary care

“…Individuals are commonly presented with choice scenarios, described in terms of unique characteristics and asked to express choices and preferences, from which the value of different aspects of care and the willingness to make trade-offs can be determined [10]. For example, research using these methods to examine consumer preference for different health management regimes has shown when given the choice of any treatment, consumers with chronic knee pain prefer physiotherapy over surgery [2]; sufferers of angina prefer medication over invasive treatments [14]; asthma sufferers will trade some improvements in symptom relief for simple treatment regimes such as use of inhalers [15]; while in the case of management of non-metastatic prostate cancer consumers are willing to trade-off some life expectancy to avoid negative sideeffects of treatment and impact on energy levels [16]. It has also been shown that consumers often have a preference for a familiar rather than unknown physician [17], and are willing to pay for a thorough examination from a familiar physician [18].…”

Asthma Worsenings: Approaches to Prevention and Management from the Asthma Worsenings Working Group

“…Approximately three-quarters of patients expressed concerns about using ICS therapy and 81% hoped to decrease their use. A discrete choice experiment conducted in adults with moderate to severe asthma found that patients wanted no more than one or two inhalers and that they wanted the lowest dose of ICS possible and were willing to trade off or accept occasional symptoms to take fewer doses (61). Participants also identified a simple treatment regimen as most important, even more important than symptom control.…”