Patient-centered care and its effect on outcomes in the treatment of asthma

Abstract

Patient-centered care may be pivotal in improving health outcomes for patients with asthma. In addition to increased attention in both research and clinical forums, recent legislation also highlights the importance of patient-centered outcomes research in the Patient Protection and Affordable Care Act. However, whether patient-centered care has been shown to improve outcomes for this population is unclear. To answer this question, we performed a systematic review of the literature that aimed to define current patient-focused management issues, characterize important patient-defined outcomes in asthma control, and identify current and emerging treatments related to patient outcomes and perspectives. We used a parallel search strategy via Medline®, Cochrane Central Register of Controlled Trials, CINAHL® (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO®, complemented with a reference review of key articles that resulted in a total of 133 articles; 58 were interventions that evaluated the effect on patient-centered outcomes, and 75 were descriptive studies. The majority of intervention studies demonstrated improved patient outcomes (44; “positive” results); none showed true harm (0; “negative”); and the remainder were equivocal (14; “neutral”). Key themes emerged relating to patients’ desires for asthma knowledge, preferences for tailored management plans, and simplification of treatment regimens. We also found discordance between physicians and patients regarding patients’ needs, beliefs, and expectations about asthma. Although some studies show promise regarding the benefits of patient-focused care, these methods require additional study on feasibility and strategies for implementation in real world settings. Further, it is imperative that future studies must be, themselves, patient-centered (eg, pragmatic comparative effectiveness studies) and applicable to a variety of patient populations and settings. Despite the need for further research, enough evidence exists that supports incorporating a patient-centered approach to asthma management, in order to achieve improved outcomes and patient health.

Integrating Patient-Centered Electronic Health Record Communication Training into Resident Onboarding: Curriculum Development and Post-Implementation Survey Among Housestaff

“…Patient-centered care has been found to positively impact a number of measures such as patient compliance, satisfaction, and health outcomes [ 14 ]. Given these important benefits, mandates such as the World Health Organization’s Global Strategy on People-Centered and Integrated Health Services have called for improved people-centered care that empowers, educates, and engages individuals and incorporates technology in an efficient and effective manner [ 15 ].…”

Therapeutic Inertia in Prescribing Biologics for Patients with Moderate-to-Severe Asthma: Workshop Summary

“…Patient-focused care enhances the patient–provider relationship by combining elements of education and evidence-based medical practice to focus on patients’ knowledge and understanding of their disease. 28 , 29 Incorporating patient-focused care is of high importance in managing chronic conditions like asthma and results in increased patient adherence to treatment management guidelines, and subsequent improved patient outcomes and quality of life. 29 In addition, integrating patient-centered outcomes in chronic disease management mitigates discordance between physicians and patients’ beliefs and expectations about asthma management by addressing patients’ knowledge of asthma, individual treatment plans, and simplified treatment regimens.…”

“… 28 , 29 Incorporating patient-focused care is of high importance in managing chronic conditions like asthma and results in increased patient adherence to treatment management guidelines, and subsequent improved patient outcomes and quality of life. 29 In addition, integrating patient-centered outcomes in chronic disease management mitigates discordance between physicians and patients’ beliefs and expectations about asthma management by addressing patients’ knowledge of asthma, individual treatment plans, and simplified treatment regimens. 29 , 30 For example, in the context of severe asthma, the ability to reduce the oral corticosteroids (OCS) maintenance dose or OCS bursts because of the negative side effects (weight gain, osteoporosis, infection risk, among others) is viewed as a high priority patient-centered outcome.…”

“… 29 In addition, integrating patient-centered outcomes in chronic disease management mitigates discordance between physicians and patients’ beliefs and expectations about asthma management by addressing patients’ knowledge of asthma, individual treatment plans, and simplified treatment regimens. 29 , 30 For example, in the context of severe asthma, the ability to reduce the oral corticosteroids (OCS) maintenance dose or OCS bursts because of the negative side effects (weight gain, osteoporosis, infection risk, among others) is viewed as a high priority patient-centered outcome. Most (not all) biologics have been proven to reduce OCS needs in the appropriately selected patient.…”

Conceptualisation of patient- and family-centred care for young adults with hearing loss and their family members

“…Additional quantitative investigation into the effects of PFCIs on parent and family member experiences of a young person's care are also warranted, to allow a better understanding of the effects of PFCIs on family trauma due to chronic health conditions. This review suggests that patient-and family-centred approaches are likely to improve outcomes for patients and families, reflecting similar reviews of PFCC, selfmanagement, and individualised care(Nolte & Osborne, 2013;Qamar, Pappalardo, Arora, & Press, 2011;Radhakrishnan, 2012), although the very small number of studies means that additional research is required. It also reflects the improvement in experiences of treatment and support, and reduced distress during treatment, predicted by the theoretical literature…”