Higher preference for participation in treatment decisions is associated with lower medication adherence in asthma patients.
OBJECTIVE
To investigate the interrelations between medication adherence, self-management, preference for involvement in treatment decisions and preference for information in asthma patients in primary care.


METHODS
One hundred and eighty-five patients from 43 practices completed a series of questionnaires, which included the 'Autonomy Preference Index' (API) [range=0-100], the four-item Morisky self-report medication adherence questionnaire and structured questions about asthma severity, medication and self-management.


RESULTS
The mean (S.D.) for participation preference was 34.5 (15.3) whereas the mean (S.D.) for information preference was 91.1 (9.7). Higher participation preference was associated with stopping medication when feeling better (OR 1.03; 95%CI 1.01-1.06) or feeling worse (OR 1.02; 95%CI 1.0-1.05) but it was not related to asthma severity. Higher information preference was associated with non-adherence to medication (Spearman correlation coefficient 0.166; p=0.035) as well as the wish to receive asthma education (p=0.04) and usage of peak flow meter (p=0.05).


CONCLUSIONS
Participation preference was low in general. Higher preference for involvement may entail more motivation for self-management but also lower medication adherence. This may be explained by a continuous internal negotiation process to accept the potentially lifelong demands of the disease.


CONCLUSIONS
Patients with lower medication adherence may possibly be addressed and empowered by their enhanced preference for participation in treatment decisions. Physicians offering to share treatment decisions may utilise the patients' participation preference to enhance medication adherence. Due to varying participation preferences, optimal patient preference matching, which involves more flexible use of different communication styles, may be necessary to improve outcomes.
Schneider
Antonius
A
Department of General Practice and Health Services Research, University Hospital, University of Heidelberg, Vossstrasse 2, 69115 Heidelberg, Germany. antonius.schneider@med.uni-heidelberg.de
Wensing
Michel
M
Quinzler
Renate
R
Bieber
Christiane
C
Szecsenyi
Joachim
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005194:Family Practice; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D010358:Patient Participation; D017060:Patient Satisfaction; D012648:Self Care