title: Outcomes associated with a negotiated asthma treatment plan.
abstract: Negotiated treatment plans are increasingly recommended in asthma clinical care. However, limited data are available to indicate whether this more patient-engaged process results in improved health outcomes. The aim of this study was to determine the associations between the presence of a negotiated treatment plan and the outcomes related to adherence to the medical regimen, symptom control, and health care use. The focus of the study was on women, the subgroup of adult patients, who are most vulnerable for negative asthma outcomes. Data were collected by telephone interview and medical record review from 808 women diagnosed with asthma at baseline, first year, and second year follow-up. Associations were examined between the presence of a negotiated treatment plan at baseline and subsequent asthma outcomes. Women with a negotiated treatment plan reported more adherent to prescribed asthma medicines (odds ratio (OR) = 2.41, 95% confidence interval (CI) = (1.82, 3.19)) and those with a plan and using oral steroids at baseline had less oral steroid use at follow-up (OR = 0.21, 95% CI = (0.05, 0.93)). Women with a negotiated plan also had more days (17%, 95% CI = (8, 27)) and nights (31%, 95% CI = (16, 48)) with symptoms than those without such a plan. No differences in hospitalizations, emergency department visits, or urgent physician office visits were noted between the groups. Patients with higher education levels were more likely to have a negotiated treatment plan. Negotiated treatment plans appear to have achieved greater adherence to prescribed asthma medicines and less need for oral steroids but were not related to fewer symptoms of asthma or reductions in urgent health care use. Additional strategies may be needed to reduce symptom and health services utilization outcomes.
authors: Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI 48109, USA. nmclark@umich.edu
authors: Noreen M
authors: NM
authors: Clark
authors: Yi-An
authors: YA
authors: Ko
authors: Z Molly
authors: ZM
authors: Gong
authors: Timothy R
authors: TR
authors: Johnson
mesh_terms: D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D017008:Negotiating; D010347:Patient Care Planning; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D016903:Drug Monitoring
chemical_list: D018927:Anti-Asthmatic Agents