Patient Experience of Asthma Management in Primary Care

Abstract

Background: Asthma morbidity remains a significant national public health problem in the US. Despite the proven value of daily inhaled corticosteroids in controlling asthma, poor adherence is widely acknowledged Most asthma is managed by primary care clinicians in outpatient settings. Effective communication between patients and their clinicians is an essential component of the therapeutic partnership, which is necessary to insure that patients use medications appropriately. Poor patient-clinician communication is independently associated with poor adherence. Purpose: We sought to better understand patient-clinician collaboration by examining the experiences of adult patients with asthma working with their clinicians to control asthma within the healthcare system. Methodology: The study sample included 104 adult patients with persistent asthma participating in a clinical trial on asthma monitoring. The sample was primarily Medicaid insured and none had received formal asthma education. All were seen by primary care clinicians in clinics of an academic medical center. This qualitative, post-hoc analysis examined the patients' perceptions of their asthma-related healthcare. Data were derived from semi-structured interviews during monthly visits over one year of study participation. Findings: Several constraints and barriers were identified by patients, which hindered their ability to achieve asthma control. Half of patients (50%) reported that comorbid conditions often took priority over discussions about asthma during primary healthcare visits; 59% reported difficulties adhering to the prescribed asthma treatment plan. Other frequent barriers included inability to contact their clinician during periods of worsening asthma (32%), social constraints (30%), and barriers to medication access (19%); and 37% found the outpatient healthcare system unresponsive to their needs. Summary Concluding Statement: These findings underscore the need for system-wide interventions that promote and support therapeutic patient-clinician relationships. Patient barriers to participation in healthcare must be reduced to achieve long-term success in management of chronic diseases, such as asthma.