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.

• Communication
• medication adherence
• motivational interviewing
• primary care
• satisfaction with consultation

Acknowledgements

The authors thank the patients and GPs who participated in the study and the research assistants who contributed to this study: Jade Jaffar, Marilyn Yee, Adriana Lince and Brock Patton. We also thank Maggie Brady, Dagmar Haller-Hester, Louise McDonnell, Tim Senior, Chee S. Koh and Daniel Hanna for input on MI support tools; Frances Usherwood, Jeffrey Ryan and Caroline Reddel for training video production.

Declaration of interest

Dr Foster has provided independent continuing medical education for GlaxoSmithKline, Pharmaceutical Society of Australia and AstraZeneca and has participated in an advisory board for Vertex Pharmaceuticals. Dr Smith has provided independent continuing medical education for Pharmaceutical Society of Australia. A/Prof. Reddel has participated in advisory boards and/or data monitoring and safety boards for AstraZeneca, GlaxoSmithKline, Merck and Novartis, has received consultancy fees and/or provided independent continuing medical education for Mundipharma, GlaxoSmithKline, AstraZeneca and Novartis, and has received unrestricted research grants from AstraZeneca and GlaxoSmithKline. Prof. Usherwood and Prof. Sawyer have no potential conflicts of interest to report with respect to this article. The authors alone are responsible for the content and writing of the paper.

Funding for this study was provided by NHMRC Australia. The Asthma Control Test was used with permission of GlaxoSmithKline and in accordance with conditions specified by GlaxoSmithKline under the terms of its license with the copyright holder, QualityMetric Incorporated. None of the above bodies had any role in the design, conduct, analysis or interpretation of the study, nor did they see the manuscript prior to submission.

Supplementary material available online