Impact of the physician's participatory style in asthma outcomes and patient satisfaction.
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.
Adams
R J
RJ
Department of Medicine, University of Adelaide, The Queen Elizabeth Hospital, Woodville, South Australia. robert.adams@adelaide.edu.au
Smith
B J
BJ
Ruffin
R E
RE
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