The Science Journal of the American Association for Respiratory Care
BACKGROUND: Clinical observations and qualitative research suggest that persistent beliefs, feelings and attitudes of people with asthma may relate to their relationship with a primary care physician. We postulated that a constructive ?partnership? between patient and physician would facilitate a shift in behavioural characteristics - as measured by Asthma NavigatorTM (AN) questionnaire - from those associated with greater risk to those associated with lesser risk. We designed a program - Asthma PartnershipsTM (AP) to explore this approach. METHOD: Thirty general medical practitioners (GPs) in each of three Australian cities participated in a 3-hour training session, which focused on qualitative findings about patients attitudes, beliefs and feelings related to asthma and the application to physician-patient communication of techniques that facilitate successful behaviour change. Using insights drawn from qualitative research findings and the AN screening instrument, each GP then enrolled five ?at-risk? patients with asthma into a ?Partnership?, in which patient and GP worked through a process of behaviour change. AN ?factor-dimension T? (FDT) scores were used to rate patient beliefs, attitudes, and behaviours at enrolment and exit.
Results: Among the first 100 patients (age range 16-76 years, 65% female) who completed Partnerships (average 9 months of ?usual care? contacts), AN FDT scores increased - indicating risk reduction - among those in Stream 1 (p = NS), Stream 2 (p < 0.001) and Stream 3 (p < 0.05) at entry. This shift correlated with reductions in hospitalisation, non-compliance with preventer medications, frequency of symptoms, nocturnal asthma, and restrictions on lifestyle and activity. Asthma Navigator factor-dimension T scores in 100 Asthma Partnerships patients
|AN FDT score||n at entry||n at exit||% change||Comment|
|0 to 54.99||29||15||-48%||Streams 1 & 2|
|55 to 65.99||40||29||-27%||Stream 3|
|67 to 100||31||56||81%||Stream 4|
|60 to 100||49||74||51%||Optimal range|
CONCLUSION: Completion of an Asthma Partnership had a statistically significant positive impact on beliefs, attitudes, and behaviours associated with asthma risk in patients with higher risk profiles at entry. This, in turn, correlated with positive changes in clinical measures of asthma risk and asthma control.