ASSESSING ASTHMA MANAGEMENT FROM INTERVIEWS OF PATIENTS AND FAMILY PHYSICIANS

Directed self-care is recommended in asthma. Adequate patient educatio n and follow-up are nevertheless necessary to optimize outcomes. We co mpared the agreement between detailed information on asthma history an d management, collected from the patient and the family physician, to validate the files of physicians and to assess patients' knowledge, at titude, and behavior concerning asthma. A sample of 54 asthma patients were interviewed in detail about use of medications and self-care pra ctice; 36 family physicians (FPs) were interviewed concerning asthma t herapy, history, and attitudes of the same patients. Forty-eight perce nt of the patients expressed negative attitudes toward inhaled cortico steroids, for reasons of safety or lack of efficacy. Less than 20% of the patients made regular use of a peak flow meter. Eighty-three perce nt of the patients usually obtained prescriptions for asthma therapy f rom their FP, but on average, only 40% of these prescriptions were pro vided during visits specific to asthma. FPs were not optimally informe d of actual treatments and outcomes and had poor perception of patient s' attitudes toward treatment. Nonetheless, in about 30% of the patien ts, FPs identified risk factors for adverse outcome, such as depressio n and family conflicts. A majority of interviewed patients had a negat ive perception of anti-inflammatory therapy, specifically relating to issues of safety and efficacy. Peak flow meters were seldom used and t herapy was commonly prescribed outside visits specific to asthma. Desp ite being centrally involved in the care of asthma patients, FP did no t optimally assess therapy and outcomes. The findings suggest suboptim al education and health status in this asthma population.