Impact of the physician's participatory style in asthma outcomes and patient satisfaction

Objectives: To identify factors associated with asthma patients' perception s of the propensity of pulmonologists to involve them in treatment decision -making, and its association with asthma outcomes. Design: Cross-sectional observational study performed from June 1995 to Dec ember 1997. Setting: Pulmonary unit of a university teaching hospital. Patients: Adult patients with asthma (n = 128). Measurements and Results: By patient self-report, mean physician's particip atory decision making (PDM) style score was 72 (maximum 100, 95% CI 65, 79) , PDM scores were significantly correlated (P < .0001) with the duration of clinic visits (r = .63), patient satisfaction (r = .53), duration of tenur e of doctor-patient relationship (r = .37), and formal education (r = .22, P = .023). Significantly higher PDM style scores were reported when visits lasted longer than 20 minutes and when a patient had a >6-month relationshi p with a particular doctor. PDM scores were also significantly correlated w ith possession of a written asthma action plan (r = .54, P < .0001), days a ffected by asthma (r = .36, P = .0001), asthma symptoms (r = .23, P = .017) , and preferences for autonomy in asthma management decisions (r = .28, P = .0035). Those with PDM scores <50 reported significantly lower quality of life for all domains of a disease-specific instrument and the Short-Form 36 health survey version 1.0. In multiple regression analysis, PDM style was associated with the length of the office visit and the duration of tenure o f the physician-patient relationship (R-2 = 0.47, P = .0009). The adjusted odds ratio, per standard deviation decrease in PDM scores, for an asthma ho spitalization was 2.0 (95% CI 1.2, 3.2) and for rehospitalization was 2.5 ( 95% CI 1.2, 4.2). Conclusions: Patients' report of their physician's PDM style is significant ly associated with health-related quality of life, work disability, and rec ent need for acute health services. Organizational factors, specifically lo nger visits and more time seeing a particular physician, are independently associated with more participatory visits. This has significant policy impl ications for asthma management.