title: Impact of the physician's participatory style in asthma outcomes and patient satisfaction.
abstract: OBJECTIVE
  To identify factors associated with asthma patients' perceptions of the propensity of pulmonologists to involve them in treatment decision-making, and its association with asthma outcomes.
  
  
  METHODS
  Cross-sectional observational study performed from June 1995 to December 1997.
  
  
  METHODS
  Pulmonary unit of a university teaching hospital.
  
  
  METHODS
  Adult patients with asthma (n = 128).
  
  
  RESULTS
  By patient self-report, mean physician's participatory decision-making (PDM) style score was 72 (maximum 100, 95% CI 65, 79). PDM scores were significantly correlated (P < .0001) with the duration of clinic visits (r = .63), patient satisfaction (r = .53), duration of tenure of doctor-patient relationship (r = .37), and formal education (r = .22, P = .023). Significantly higher PDM style scores were reported when visits lasted longer than 20 minutes and when a patient had a >6-month relationship with a particular doctor. PDM scores were also significantly correlated with possession of a written asthma action plan (r = .54, P < .0001), days affected by asthma (r = .36, P = .0001), asthma symptoms (r = .23, P = .017), and preferences for autonomy in asthma management decisions (r = .28, P = .0035). Those with PDM scores <50 reported significantly lower quality of life for all domains of a disease-specific instrument and the Short-Form 36 health survey version 1.0. In multiple regression analysis, PDM style was associated with the length of the office visit and the duration of tenure of the physician-patient relationship (R2 = 0.47, P = .0009). The adjusted odds ratio, per standard deviation decrease in PDM scores, for an asthma hospitalization was 2.0 (95% CI 1.2, 3.2) and for rehospitalization was 2.5 (95% CI 1.2, 4.2).
  
  
  CONCLUSIONS
  Patients' report of their physician's PDM style is significantly associated with health-related quality of life, work disability, and recent need for acute health services. Organizational factors, specifically longer visits and more time seeing a particular physician, are independently associated with more participatory visits. This has significant policy implications for asthma management.
authors: Department of Medicine, University of Adelaide, The Queen Elizabeth Hospital, Woodville, South Australia. robert.adams@adelaide.edu.au
authors: R J
authors: RJ
authors: Adams
authors: B J
authors: BJ
authors: Smith
authors: R E
authors: RE
authors: Ruffin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D010358:Patient Participation; D017060:Patient Satisfaction; D010465:Perception; D010817:Physician-Patient Relations; D016896:Treatment Outcome