Asthma Patients and the
Patient-Practitioner
Relationship: A Qualitative
Study of Continuity of Care
Margaret M. Love, PhD
Family Practice and Community Medicine
University of Kentucky (UK)
Co-investigators

Sarah B. Wackerbarth, PhD, University of
Kentucky

Arch G. Mainous, III, PhD, Medical
University of South Carolina

Renee V. Girdler, MD, University of
Louisville

Dennis E. Doherty, MD, University of
Kentucky
Funding

UK NIH K30 Therapeutics and
Translational Research Training
Program

Agency for Healthcare Research and
Quality (AHRQ)
Background

Asthma
– Chronic respiratory disease
characterized by episodes or attacks of
inflammation and narrowing of small
airways in response to asthma
‘triggers.’
NCHS www.cdc.gov/nchs
Background

U.S. asthma statistics 2002
– 14 million (6.8%) noninstitutionalized adults
diagnosed and still have asthma
– 12.6 million asthma-related visits to officebased physicians
– 1.9 million hospital emergency dept visits
NCHS www.cdc.gov/nchs
Background

Continuity of care
– Ongoing relationship with the same
health care practitioner over time
Background

Continuity of care is associated with
positive health-related outcomes
– Higher patient satisfaction
– Greater medication adherence
– Reduced health services utilization
– Decreased likelihood of emergency dept
(ED) use and future hospitalization
Background

An ongoing relationship with the
same physician is highly valued by
patients… especially by asthma
patients.
– Love & Mainous. J Fam Pract; 1999.
– Love, Mainous, Talbert, & Hager. J Fam Pract; 2000.
Research Objective
To better understand the physicianpatient relationship from the
perspective of persons with asthma,
through the application of qualitative
research methods
Study Design

Qualitative, focus group study
– Six focus groups held in 2004
– 3 - 7 patients per group
– Audiotaped, prompted discussion
Study Design

Adult asthma patients (age>18 years)
– UK Family Medical Center
– UK Pulmonary & Critical Care Medicine
– Lexington community
– Word of mouth
Study Design

Examples of focus group prompts:
– Why would a relationship over time with the
same health care professional be especially
important to people who have asthma?
– What if you can’t see your regular doctor…?
– What else is important in your relationships
with health care professionals?
Analysis

Thematic analysis of transcripts
– What do patients like about their health
care professional or their care?
– 2 investigators reviewed independently,
identified themes, discussed, combined
– “Open” coding
– Saturation reached after 6 focus groups
Participants

26 participants
– 20 female
– 22 white
– 20 aged 41-60 years
– 18 group or private insurance
– 14 college educated
– 15 from UK Family Medical Center
Results

Quality / healthcare outcomes

Interpersonal process / interaction

Relationship qualities / shared
history
Quality / Outcomes

Discovered diagnosis
– Figured it out
– Finally one day a doctor told me, ‘No,
you have mild asthma.’
Quality / Outcomes

Successful treatment
– Finally got help.
– They’ve tried something new on me and
it’s worked for me.
– I appreciate my doctor helping me get to
the point that we handled the balance of
medications.
Quality / Outcomes

Reliable / assumes responsibility for
care
– There constantly.
– Will take care of me.
– I pick up the telephone and call my
doctor and he’ll meet me at the hospital.
Quality / Outcomes

Tailors care
– I feel like I just have to stand up and
say, ‘Look. That just doesn’t go for me.
This is what works.’ (-)
– He came in and treated me with a
preconceived notion. (-)
Interpersonal Interaction

Straightforward communication
– I appreciate the doctor being up front
with me.

Explains
– He explains things in a way that even I
can understand.
Interpersonal Interaction

Talking and listening
– He would sit there and talk to me, ask
me what was going on.
– And I don’t know that I feel that I’ve
been heard yet. (-)
Interpersonal Interaction

Respect and responsiveness
– Condescending. (-)
– And it’s real dismissive. (-)
– …respect my pain, treat me as an
adult…
Interpersonal Interaction

Comfortable
– Feel at ease with him
– Concerned
– Caring
– Compassionate
Relationship / History

“Knows” patient
– ... knows my history… knows what
things trigger with me and what doesn’t
trigger.
– … knows me… knows how to handle
me.
– They know I don’t call unless I’m pretty
well down.
Relationship / History

Mutual trust
– I trust her.
– If Doctor X tells me something, or
advises me, I’ve taken that to heart.
– Mutual trust that I am not going to
bother them just for the little bitty
things.
Relationship / History

Continuity avoids starting over
– It takes time away from your visit… (-)
– … and you know what does work, and
they want to try something new… (-)
Limitations

Small number of participants

Kentucky only

Self-reported outcomes
Implications and Next Steps

How to meet asthma patients’ concerns?
– When patients seek care at multiple locations
(PCP, specialists, UTCs, EDs)
– When continuity of care with individual
clinicians difficult to maintain

Future research…
– Does addressing their concerns improve
health outcomes?