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UBC Theses and Dissertations

Medication adherence among adult asthma patients : investigating the role for shared decision-making Pollard, Samantha


Background: Shared decision-making (SDM) has been suggested as a means to improve communication between patients and their healthcare providers, with the purposes of improving multiple asthma-related health outcomes. Despite mounting evidence that suggests potential benefits attributable to SDM, clinical uptake has been slow. Objectives: The purpose of this dissertation is to ascertain the role of SDM in asthma management, to determine the extent to which SDM is currently being implemented into regular asthma care, and to suggest clinical implementation strategies that may facilitate SDM implementation in BC. Methods: This project consists of a) a systematic review of physician attitudes toward SDM, b) a comprehensive narrative literature review to describe the proposed role of SDM in asthma, c) a population level analysis to explore variation in adherence to controller medication, as well as d) an online survey of 117 adult asthma patients living in BC. Results: Results of this work show that in general a) physicians support the use of SDM in various clinical practice scenarios, b) there is a clear role for SDM in treating asthma patients with the goal of reducing the burden of controller medication non-adherence, and c) adherence to controller medications is sub-optimal, with little variation being explained at the population level. The patient survey (d) provided additional insight into this research agenda by showing that while patients prefer to be actively involved in treatment decision-making, there is substantial variation in the extent to which asthma patients are being engaged in their care. Furthermore, multiple predictors of adherence that can be addressed during the clinical encounter (e.g. medication-related concerns) were shown to impact self-reported treatment adherence. Conclusions: The results of this project provide further support for the use of SDM in regular care of asthma patients. I conclude by highlighting the importance of addressing issues related to adherence in an individual and ongoing basis, the value of increasing awareness about the use of SDM, and the potentially valuable role of engaging non-physician caregivers in future SDM implementation efforts. These findings may guide future research investigations regarding SDM uptake and efforts to reduce the disease burden of asthma.

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