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

Ann Allergy Asthma Immunol. 2001 Mar;86(3):263-71. doi: 10.1016/S1081-1206(10)63296-6.


Objectives: To identify factors associated with asthma patients' perceptions 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 December 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 participatory 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 tenure 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 relationship with a particular doctor. PDM scores were also significantly correlated with possession of a written asthma action plan (r = .54, P < .0001), days affected 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 of the physician-patient relationship (R2 = 0.47, P = .0009). The adjusted odds ratio, per standard deviation decrease in PDM scores, for an asthma hospitalization 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 significantly associated with health-related quality of life, work disability, and recent need for acute health services. Organizational factors, specifically longer visits and more time seeing a particular physician, are independently associated with more participatory visits. This has significant policy implications for asthma management.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Asthma / diagnosis
  • Asthma / psychology*
  • Asthma / therapy*
  • Cross-Sectional Studies
  • Disease Management
  • Female
  • Health Status
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Office Visits
  • Patient Participation*
  • Patient Satisfaction*
  • Perception
  • Physician-Patient Relations*
  • Treatment Outcome