Participants highlighted a number of points that they believed formed the basis of patient-focused care (Table 3). Patients are more likely to be motivated to follow treatment advice if they perceive the recommendations to be a common sense approach to maintaining health, and if they have a clear appreciation of the nature of their illness and an understanding of treatment risks and benefits. It is also important to consider that the management of chronic disease differs from that of an acute illness, so clinicians must be prepared to work in an ongoing partnership with patients to ensure that they are offered a clear rationale as to why inhaled corticosteroids are necessary, and to address their concerns about potential adverse effects. This approach, the basis of which is a detailed examination of patients’ perspectives on asthma and its treatment, and an open, nonjudgmental manner on the part of the clinician, is consistent with the idea of concordance. It also fits in with other recent initiatives, such as the “expert patient,” and shared decision making.
The challenge for clinicians is to ensure that the best-available information is communicated clearly to the patient, not so much to enhance adherence but, rather, to allow patients to make an informed decision that is not based on an erroneous set of beliefs. The partnership will be flawed if patients feel they are wasting their doctors’ time, if they feel they have not been listened to, or if they choose to not share certain key information; the consultation may not be concordant. To some extent, the ways in which asthma and ICS are viewed by patients also require “updating” to correct mistaken public prototypes and stereotypes of the condition. Even today, patients may view asthma as a stigma (eg, when using inhalers in public), and dealing with its potentially negative social image can be troublesome for children and adolescents. Reading here
Very few physicians believe that they received any education in communication or teaching skills in regard to patient-focused care. Only 38% of the participants in this meeting had received any skills training in this area; this is very low considering that most of the attendees are not only involved in educating patients but also other physicians. It was agreed by consensus that health-care providers need to develop multidisciplinary models that support physicians and coworkers in providing high-quality, patient-focused care. Health-care providers also need to develop their communication skills actively and, as much as possible, ensure continuity of care. Moreover, health-care providers need to reach a common ground with patients to achieve concordance on the goals of therapy and the management of asthma. In summary, the patient-focused consultation should involve communication regarding the patient’s expectations, beliefs, concerns, and personal circumstances, and achieve concordance regarding diagnosis, pathology, prognosis, and treatment.
Asthma is a complex disease that in many instances affects patients throughout their lives. The three Cs of patient-focused care—communication, continuity of care, and concordance (finding common ground)—are highly relevant to the effective treatment of pulmonary disease and should be a key component of asthma management.
Table 3—Patient-Focused Care: Some Key Points
|Empowerment of patients regarding their expectations for asthma management|
|Respect for patients’ beliefs|
|Flexible systems to cope with human factors (eg, forgetfulness, misunderstandings)|
|Individualized action plans which take into account patients’ therapeutic goals|
|Formal feedback from patients|