ANN ARBOR---Good communication between patient and doctor is as important to staying out of the hospital as getting the right asthma medicine, a new study by a University of Michigan researcher shows.
Noreen M. Clark, dean and professor of the School of Public Health at U-M, discusses her findings in this month's issue of Pediatrics, a publication of the American Academy of Pediatrics.
"We know more about treating asthma than ever before, but at the same time there are more people hospitalized for asthma than ever before and the death rate for asthma has increased. Prevalence of asthma has also risen close to 70 percent in the last decade-and-a-half. Around 5,000 people die each year,'' she said.
Clark recently completed a research project in which 80 physicians underwent training on how to communicate and educate patients about asthma. Clark's research team studied 650 asthma patients to determine the effect communication had on patient outcomes.
"Asthma patients have to manage their disease day to day. With good instruction and self confidence, patients can take control of their disease. The key is having good instruction from the physician,'' she said.
Physicians who participated in the training were more likely to address patients' fears about medicines and review written instructions with patients. Parents of children treated by program physicians had more confidence in their ability to manage their child's disease at home.
Clark found that patients of physicians who participated in the communication training programs spent less time in the doctor's office---approximately five minutes less per visit. Also, they had fewer nonemergency (asthma) office visits.
She also noted that physicians tended to treat only episodes of bronchospasm of patients, instead of treating the underlying inflammation. National guidelines for management of asthma call for treating inflammation. After receiving communications training, doctors were more inclined to treat the underlying inflammation and they improved their overall communication skills with patients.
In many cases, that means using anti-inflammatory medicine, usually an inhaled corticosteriod. This study revealed that children treated with inhaled corticosteriods (and seen by physicians who had communications training) had significantly fewer symptoms and fewer follow-up office visits, nonemergency physician office visits, emergency department visits and hospitalizations.
"This project was designed to try to get physicians to use what we know about asthma and patient behavior,'' Clark said. The patient also has to be willing to manage the disease. Often, patients don't believe the disease is serious until they have a serious episode; others don't have confidence in the regimen the physician has prescribed; others are under the impression they must live with symptoms every day when in reality, if the disease is managed properly, they should not have symptoms.
Clark, an award-winning researcher who has studied asthma for 20 years, said this study may influence managed care providers to provide the kind of physician training examined in this study. "This study has demonstrated very clearly that it requires communication and education to get positive patient outcomes,'' she said.
Asthma is the most common chronic respiratory condition in the United States, and the number of cases has increased during the past five years. A recent analysis of the disease's economic impact concluded it costs $6.2 billion a year---and more than half of that results from hospitalizations and emergency room visits.