Abstract
REALISE Asia—an online questionnaire-based study of Asian asthma patients—identified five patient clusters defined in terms of their control status and attitude towards their asthma (categorised as: ‘Well-adjusted and at least partly controlled’; ‘In denial about symptoms’; ‘Tolerating with poor control’; ‘Adrift and poorly controlled’; ‘Worried with multiple symptoms’). We developed consensus recommendations for tailoring management of these attitudinal–control clusters. An expert panel undertook a three-round electronic Delphi (e-Delphi): Round 1: panellists received descriptions of the attitudinal–control clusters and provided free text recommendations for their assessment and management. Round 2: panellists prioritised Round 1 recommendations and met (or joined a teleconference) to consolidate the recommendations. Round 3: panellists voted and prioritised the remaining recommendations. Consensus was defined as Round 3 recommendations endorsed by >50% of panellists. Highest priority recommendations were those receiving the highest score. The multidisciplinary panellists (9 clinicians, 1 pharmacist and 1 health social scientist; 7 from Asia) identified consensus recommendations for all clusters. Recommended pharmacological (e.g., step-up/down; self-management; simplified regimen) and non-pharmacological approaches (e.g., trigger management, education, social support; inhaler technique) varied substantially according to each cluster’s attitude to asthma and associated psychosocial drivers of behaviour. The attitudinal–control clusters defined by REALISE Asia resonated with the international panel. Consensus was reached on appropriate tailored management approaches for all clusters. Summarised and incorporated into a structured management pathway, these recommendations could facilitate personalised care. Generalisability of these patient clusters should be assessed in other socio-economic, cultural and literacy groups and nationalities in Asia.
Highlights
The success of treatment in any chronic disease is highly dependent on patient behaviour, their attitude towards the prescribed management approach and subsequent adherence to prescribed treatment regimens
● Non-judgmental consultation friend style. Main findings This modified e-Delphi procedure illustrates the range of clinical management approaches required to tailor support for patients with different attitudinal–control profiles in routine care
Identifying patients’ attitudes is critical to successfully managing the complexities of asthma in the widely heterogeneous population that presents in routine daily care
Summary
The success of treatment in any chronic disease is highly dependent on patient behaviour, their attitude towards the prescribed management approach and subsequent adherence to prescribed treatment regimens. Successful management of symptoms includes practical trigger avoidance and implementation of (evidence-based) therapy to maximise its potential for benefit and minimise the risk of harm. Multi-national, population-based studies suggest that only a minority of the 17.5 million of people with asthma in Asia (and over 300 million people globally)[1] achieve good control.[1,2,3,4] The cost of poor control is high, both in terms of patients’ quality of life[5,6] and their demand on healthcare resources,[7,8,9,10] in Asia where equitable access to affordable, quality care continues to be a challenge. It is important to identify the attitudinal determinants of asthma control, especially potentially modifiable factors, and to intervene with affordable, targeted approaches.[11 ] REALISE Asia
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