Long-Term Effects of Negotiated Treatment Plans on Self-Management Behaviors and Satisfaction with Care Among Women with Asthma

Abstract

Objective. To examine characteristics of women with negotiated treatment plans, factors that contribute to newly forming a treatment plan, and the impact of plans on asthma management, and their satisfaction with care over 2 years. Methods. Data came from telephone interviews with 324 women with asthma at baseline, 12 and 24 months. The effect of having a negotiated treatment plan on medication adherence, asking the physician questions about asthma, asthma management self-efficacy, and satisfaction with care was assessed over 24 months. Data were analyzed using mixed models. Analyses controlled for patient characteristics. Results. Thirty-eight percent of participants reported having a negotiated treatment plan at three time points. Seeing an asthma specialist (χ²(1) = 24.07, p < .001), was associated with having a plan. Women who did not have a negotiated treatment plan at baseline, but acquired one at 12 or 24 months, were more likely to report greater urgent office visits for asthma (odds ratio (OR) = 1.37, 95% confidence interval (CI) = 1.07–1.61). No associations were observed between having a plan and urgent healthcare use or symptom frequency. When adjusting for household income, level of asthma control, and specialty of the caregiving provider, women who did not have a negotiated treatment plan (OR = 0.28, 95% CI = 0.09–0.79) and those with a plan at fewer than three time points (OR = 0.30, 95% CI = 0.11–0.83) were less likely to report medication adherence and satisfaction with their care (regression coefficient (standard error) = –0.65 (0.17), p < .001). No differences in asthma management self-efficacy or asking the doctor questions about asthma were observed. Conclusion. Women with asthma who had a negotiated treatment plan were more likely to see an asthma specialist. In the long-term, not having a treatment plan that is developed in partnership with a clinician may have an adverse impact on medication use and patient views of clinical services.

• clinical guidelines
• outcomes
• patient satisfaction
• shared decision-making
• treatment plans

Acknowledgments

The authors thank the University of Michigan Center for Statistical Consultation and Research for their assistance with the analysis and Megan Jensen, Pin-Pin Song, and Edward Tsai for their assistance with formatting this manuscript.

Declaration of Interest

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

This research was supported by grant 1 R18 HL60884–01 from the Division of Lung Diseases of the National Heart, Lung, and Blood Institute. The authors have no financial interests or disclosures to report.