AcademyHealth Annual Research Meeting
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)
June 28, 2005
Co-investigators
z
Sarah B. Wackerbarth, PhD, University of
Kentucky
z
Arch G. Mainous, III, PhD, Medical
University of South Carolina
z
Renee V. Girdler, MD, University of
Louisville
z
Dennis E. Doherty, MD, University of
Kentucky
Funding
Background
z UK
z Asthma
NIH K30 Therapeutics and
Translational Research Training
Program
z Agency
for Healthcare Research and
Quality (AHRQ)
– 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
Background
z U.S.
z Continuity
asthma statistics 2002
– 14 million (6.8%) noninstitutionalized adults
diagnosed and still have asthma
of care
– Ongoing relationship with the same
health care practitioner over time
– 12.6 million asthma-related visits to officebased physicians
– 1.9 million hospital emergency dept visits
NCHS www.cdc.gov/nchs
Margaret Love, Sarah Wackerbarth, et al.
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AcademyHealth Annual Research Meeting
June 28, 2005
Background
Background
z Continuity
z An
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
Research Objective
To better understand the physicianpatient relationship from the
perspective of persons with asthma,
through the application of qualitative
research methods
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.
Study Design
z Qualitative,
focus group study
– Six focus groups held in 2004
– 3 - 7 patients per group
– Audiotaped, prompted discussion
Study Design
Study Design
z Adult
z Examples
asthma patients (age>18 years)
of focus group prompts:
– UK Pulmonary & Critical Care Medicine
– Why would a relationship over time with the
same health care professional be especially
important to people who have asthma?
– Lexington community
– What if you can’t see your regular doctor…?
– Word of mouth
– What else is important in your relationships
with health care professionals?
– UK Family Medical Center
Margaret Love, Sarah Wackerbarth, et al.
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AcademyHealth Annual Research Meeting
Analysis
z Thematic
June 28, 2005
Participants
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
z 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
– Saturation reached after 6 focus groups
Results
Quality / Outcomes
z Quality
z Discovered
/ healthcare outcomes
z Interpersonal
z Relationship
process / interaction
qualities / shared
history
diagnosis
– Figured it out
– Finally one day a doctor told me, ‘No,
you have mild asthma.’
Quality / Outcomes
Quality / Outcomes
z Successful
z Reliable
treatment
– Finally got help.
/ assumes responsibility for
care
– They’ve tried something new on me and
it’s worked for me.
– There constantly.
– I appreciate my doctor helping me get to
the point that we handled the balance of
medications.
– I pick up the telephone and call my
doctor and he’ll meet me at the hospital.
Margaret Love, Sarah Wackerbarth, et al.
– Will take care of me.
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AcademyHealth Annual Research Meeting
June 28, 2005
Quality / Outcomes
Interpersonal Interaction
z Tailors
z Straightforward
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. (-)
communication
– I appreciate the doctor being up front
with me.
z Explains
– He explains things in a way that even I
can understand.
Interpersonal Interaction
Interpersonal Interaction
z Talking
z Respect
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. (-)
and responsiveness
– Condescending. (-)
– And it’s real dismissive. (-)
– …respect my pain, treat me as an
adult…
Interpersonal Interaction
Relationship / History
z Comfortable
z “Knows”
– Feel at ease with him
– Concerned
– Caring
– Compassionate
Margaret Love, Sarah Wackerbarth, et al.
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.
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AcademyHealth Annual Research Meeting
June 28, 2005
Relationship / History
Relationship / History
z Mutual
z Continuity
trust
avoids starting over
– I trust her.
– It takes time away from your visit… (-)
– If Doctor X tells me something, or
advises me, I’ve taken that to heart.
– … and you know what does work, and
they want to try something new… (-)
– Mutual trust that I am not going to
bother them just for the little bitty
things.
Limitations
Implications and Next Steps
z Small
z
number of participants
z Kentucky
– When patients seek care at multiple locations
(PCP, specialists, UTCs, EDs)
only
z Self-reported
How to meet asthma patients’ concerns?
outcomes
– When continuity of care with individual
clinicians difficult to maintain
z
Future research…
– Does addressing their concerns improve
health outcomes?
Margaret Love, Sarah Wackerbarth, et al.
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