Asthma patients breathe easier when they share disease-management decisions with clinicians

Millions of Americans suffer from asthma, but only about half regularly take their medications at therapeutically effective doses. How can we improve these numbers?

Kaiser Permanente Center for Health Research (CHR) investigators report on research that found one easy and effective way to help patients with poorly controlled asthma: quite simply, let them share in the decision-making process to manage their disease. Patients who did so fared better than those who followed an identical treatment protocol but were not involved in their treatment decisions.

Recently published in the American Journal of Respiratory and Critical Care Medicine, these are the findings of the BOAT (Better Outcomes of Asthma Treatment) study, coauthored by TCHR’s researchers Drs. Sonia Buist and William Vollmer, led by Drs. Sandra Wilson and Peg Straub of the Palo Alto Medical Foundation Research Institute, and including Permanente Medical Group colleagues from Hawaii, San Francisco, and Oakland.

Researchers randomized 612 patients with poorly controlled asthma into three groups: a usual-care group and two intervention groups with identical treatment protocols—one with shared decision-making (SDM) and one with clinician decision-making (CDM). The intervention protocols provided asthma education and involved two initial in-person meetings and three brief phone calls over the next year with a care manager. The only difference between the two groups was that, with CDM, treatment was prescribed without specifically eliciting patient goals and preferences; in SDM, care managers and patients negotiated a treatment regimen that accommodated patient goals and preferences.

The investigators kept track of refill adherence to medications and measured outcomes such as asthma-related quality of life, health care utilization, rescue medication use, asthma control, and lung function. After one year, compared to both usual care and CDM, SDM significantly improved adherence to asthma-controller medications and long-acting beta agonists. In outcomes, both SDM and CDM showed improvements over usual care. While the intervention lasted only a year, improvements in medication adherence persisted: by the study’s second year, SDM patients still used significantly less rescue medication than those in the usual-care arm. Outcomes weren’t measured for year two.

According to the National Heart, Lung and Blood Institute at NIH, one in 10 Americans will be diagnosed with asthma in their lifetime—that’s more than 30 million people. TCHR’s study tells us that we can improve outcomes dramatically for many people with this far-reaching disease. Not only would shared decision-making have a tremendous impact on the health of millions of Americans with asthma, it could also reduce associated health care costs. Today asthma accounts for a half million hospitalizations annually and comes with a price tag of nearly $20 billion every year in this country. We have vast room for improvement, and the clinician-patient relationship is a great place to start.

Kaiser Permanente’s Center for Health Research, founded in 1964, is a non-profit research institution whose mission is advancing knowledge to improve health. It has research sites in Portland OR; Honolulu, HI; and Atlanta, GA. www.kpchr.org

Kaiser Permanente is America’s leading integrated health care organization. Founded in 1945, the organization serves the health needs of more than 8.7 million people nationwide. Nearly 480,000 people in Oregon and Southwest Washington receive their health care from Kaiser Permanente.  www.kaiserpermanente.org