title: Long-term effects of negotiated treatment plans on self-management behaviors and satisfaction with care among women with asthma.
abstract: OBJECTIVE
  To examine characteristics of women with negotiated treatment plans, factors that contribute to newly forming a treatment plan, and the impact of plans on asthma management, and their satisfaction with care over 2 years.
  
  
  METHODS
  Data came from telephone interviews with 324 women with asthma at baseline, 12 and 24 months. The effect of having a negotiated treatment plan on medication adherence, asking the physician questions about asthma, asthma management self-efficacy, and satisfaction with care was assessed over 24 months. Data were analyzed using mixed models. Analyses controlled for patient characteristics.
  
  
  RESULTS
  Thirty-eight percent of participants reported having a negotiated treatment plan at three time points. Seeing an asthma specialist (χ(2)(1) = 24.07, p < .001), was associated with having a plan. Women who did not have a negotiated treatment plan at baseline, but acquired one at 12 or 24 months, were more likely to report greater urgent office visits for asthma (odds ratio (OR) = 1.37, 95% confidence interval (CI) = 1.07-1.61). No associations were observed between having a plan and urgent healthcare use or symptom frequency. When adjusting for household income, level of asthma control, and specialty of the caregiving provider, women who did not have a negotiated treatment plan (OR = 0.28, 95% CI = 0.09-0.79) and those with a plan at fewer than three time points (OR = 0.30, 95% CI = 0.11-0.83) were less likely to report medication adherence and satisfaction with their care (regression coefficient (standard error) = -0.65 (0.17), p < .001). No differences in asthma management self-efficacy or asking the doctor questions about asthma were observed.
  
  
  CONCLUSIONS
  Women with asthma who had a negotiated treatment plan were more likely to see an asthma specialist. In the long-term, not having a treatment plan that is developed in partnership with a clinician may have an adverse impact on medication use and patient views of clinical services.
authors.affiliation: Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI 48109-2029, USA.
authors.forename: Minal R
authors.initials: MR
authors.lastname: Patel
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Valerio
authors.forename: Mary R
authors.initials: MR
authors.lastname: Janevic
authors.forename: Z Molly
authors.initials: ZM
authors.lastname: Gong
authors.forename: Georgiana
authors.initials: G
authors.lastname: Sanders
authors.forename: Lara J
authors.initials: LJ
authors.lastname: Thomas
authors.forename: Noreen M
authors.initials: NM
authors.lastname: Clark
mesh_terms: D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D010347:Patient Care Planning; D017060:Patient Satisfaction
chemical_list: D018927:Anti-Asthmatic Agents