Patient-Focused Care: Adherence

Patient-Focused Care: AdherenceIn asthma, there is evidence that a patient-focused approach can be learned and applied to improve both parents’ view of physicians’ behavior and health outcomes. Clark et al evaluated the long-term impact of an interactive physician seminar based on the principles of patient self-regulation, clinician behavior, children’s use of asthma services, and parents’ evaluations of physician performance. The seminar focused on the development of physician communication and teaching skills, and used the therapeutic recommendations from the National Asthma Education and Prevention Program guidelines. Follow-up assessment of 34 physicians completing the program and 33 control subjects was accomplished by self-administered surveys, telephone interviews with parents of their patients, and review of patients’ medical records. Figure 2 shows the impact of the education program on physician behavior approximately 2 years after intervention. fully

Program physicians were more likely to provide written plans and guidance to patients and to have a protocol to track the patient education provided. In addition, parents’ views of physicians’ behavior was significantly improved vs controls (Fig 3). The number of hospital admissions was significantly reduced in the program group (effect estimate, — 1.3, p = 0.03), and there was a nonsignificant decrease in emergency department visits, scheduled visits, and follow-up visits. There was no significant difference between program physicians and control subjects in the amount of time spent with patients (25.9 min and 29.0 min, respectively). An updated analysis of this study indicated that children from low-income families (<$20,000/annum) had improved asthma outcomes, with a reduction in emergency department visits (p = 0.001) and asthma hospitalizations (p < 0.001) vs a low-income control group. This is a key study, as it shows that it is possible to develop physicians’ skills in patient-focused care and provide them with the tools to overcome the barriers to this approach. This study also demonstrated that a patient-focused approach improved the management of asthma patients, parents’ view of physicians’ performance, and health outcomes without requiring more time for consultations or more scheduled visits or follow ups.

Figure-2

Figure 2. Physician education in communication and teaching skills has a positive impact on physician behavior in asthma management. Adapted from Clark et al.

Figure-3

Figure 3. The net estimate of effect of the impact of physician education in communication and teaching skills on parents’ perception of physician behavior in asthma management vs a control group. There was a net improvement in all measures for the intervention, all of which except ‘spends enough time with us’ was statistically significant. Adapted from Clark et al.

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