Factors associated with knowledge of self-management of worsening asthma in primary care patients: a cross-sectional study

Abstract

Objective

Self-management is important for asthma control. We examined associations of patient- and healthcare-related factors with self-reported knowledge of self-management of worsening asthma.

Methods

Two asthma patient cohorts from 2012 (n = 527) and 2015 (n = 915) were randomly selected from 54 primary health care centers (PHCC) in central Sweden. Data were collected using patient questionnaires and questionnaires to the PHCCs. Logistic regression analyzed associations of relevant variables with knowledge of self-management of worsening asthma.

Results

In total, 63% of patients reported moderate to complete knowledge of self-management procedures. The adjusted OR for moderate to complete knowledge relative to high education level was 1.38 [95% CI 1.03–1.85)]; for physician continuity 2.19 (95% CI 1.62–2.96); for a written action plan 11.9 (95% CI 6.16–22.9); for Step 2 maintenance treatment 1.53 (95% CI 0.04–2.24); and 2.07 (95% CI 1.44–2.99) for Step 3. An asthma/COPD nurse visit within the previous 12 months was associated with greater knowledge in women but not in men (p for interaction = 0.042). Smoking [OR 0.56 (95% CI 0.34–0.95)], co-morbidities ≥1 [OR 0.68 (95% CI 0.49–0.93)], and self-rated moderate/severe disease [OR 0.68 (95% CI 0.51–0.90)] were associated with low self-management knowledge.

Conclusion

Self-reported knowledge of self-management procedures was associated with a higher educational level, physician continuity, a written action plan, advanced treatment and, in women, visiting an asthma/COPD nurse. The results reinforce the importance of implementing guidelines of patient access to a specific physician, a written action plan, and structured education by an asthma/COPD nurse.

Keywords:

• Self-management
• asthma
• primary care
• education level
• patient-specific physician
• written action plan
• asthma/COPD nurse

Acknowledgments

We thank all participating primary health care centers.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

The PRAXIS study was supported by grants from the county councils of the Uppsala–Örebro Health Care region, the Swedish Heart and Lung Association, the Swedish Asthma and Allergy Association, the Bror Hjerpstedts Foundation, the Center for Clinical Research, Dalarna, the Uppsala–Örebro Regional Research Council, and by Region Örebro County through ALF research funding.