title: General practitioner-delivered adherence counseling in asthma: feasibility and usefulness of skills, training and support tools.
abstract: OBJECTIVE
  Poor medication adherence contributes to uncontrolled asthma in primary care. Good doctor-patient communication around adherence increases patients' medication taking but general practitioners (GPs) often feel poorly equipped to provide effective adherence counseling. This study aimed to assess the feasibility and usefulness of adherence counseling training, skills and support tools for GPs.
  
  
  METHODS
  Twenty-five GPs enrolled in a 6-month cluster randomized-controlled trial of adherence interventions for asthma were randomized to an intervention delivering personalized adherence discussions. They received 2 hours training in delivering brief, motivational-interviewing-based adherence counseling and were provided with asthma-specific counseling support tools. At baseline, post-training and study end, GPs rated the training, reported confidence/frequency of using counseling skills and satisfaction with their consultations, and commented on support tools. Patients reported their barriers to adherence and rated their GPs empathy at baseline and at 6-months.
  
  
  RESULTS
  96% of GPs rated adherence counseling training as very/extremely useful. At the end of the study (17 ± 4 months) GPs' confidence in using counseling skills increased, as did the frequency they applied the skills and their satisfaction with consultations. GPs were positive about counseling support tools, stating that they were easy to use and facilitated covering more ground within single consultations. Half the GPs expressed some difficulty implementing counseling due to time constraints. Patients reported good GP empathy and no significant change in adherence barriers.
  
  
  CONCLUSIONS
  GPs valued counseling training and support tools. Although implementation was sometimes challenging, GPs reported increased frequency of use and confidence in applying adherence counseling skills, which persisted for 17 months.
authors.affiliation: a Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney , Sydney , Australia .
authors.forename: Juliet M
authors.initials: JM
authors.lastname: Foster
authors.affiliation: b Faculty of Pharmacy , University of Sydney , Sydney , Australia .
authors.forename: Lorraine
authors.initials: L
authors.lastname: Smith
authors.affiliation: c Department of General Practice , Sydney Medical School (Westmead), University of Sydney , Sydney , Australia .
authors.forename: Tim
authors.initials: T
authors.lastname: Usherwood
authors.affiliation: d Department of Paediatrics , Centre for Adolescent Health, Royal Children's Hospital , Parkville , Australia .|e Department of Paediatrics , University of Melbourne , Melbourne , Australia , and.|f Murdoch Children's Research Institute , Melbourne , Australia.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Sawyer
authors.affiliation: a Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney , Sydney , Australia .
authors.forename: Helen K
authors.initials: HK
authors.lastname: Reddel
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy*; D003142:Communication; D003376:Counseling / Q000193:education*; D005260:Female; D058005:General Practitioners / Q000193:education*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007318:Inservice Training; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D062405:Motivational Interviewing; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000458:organization & administration*; D016037:Single-Blind Method
keywords: Communication; medication adherence; motivational interviewing; primary care; satisfaction with consultation