Exploratory study of language paediatricians use to promote adherence to long-term controller medication in children with asthma

Tom Koole; A Debbie C Jaarsm; Paul L P Brand

doi:10.1016/j.aller.2019.12.001

Exploratory study of language paediatricians use to promote adherence to long-term controller medication in children with asthma

Allergol Immunopathol (Madr). 2020 Mar-Apr;48(2):116-123. doi: 10.1016/j.aller.2019.12.001. Epub 2020 Feb 25.

Authors

Tom Koole¹, A Debbie C Jaarsm², Paul L P Brand³

Affiliations

¹ University of Groningen, the Netherlands; School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa.
² Lifelong Learning, Education and Assessment Research Network (LEARN), Centre for Education Development and Research in Health Professions, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands.
³ Lifelong Learning, Education and Assessment Research Network (LEARN), Centre for Education Development and Research in Health Professions, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands; Isala Academy, Department of Medical Education and Faculty Development, Isala Hospital, Zwolle, the Netherlands. Electronic address: p.l.p.brand@isala.nl.

PMID: 32111407
DOI: 10.1016/j.aller.2019.12.001

Abstract

Introduction and objectives: Although patient centred communication is associated with patients' daily medication adherence, the exact communication phenomena promoting high treatment adherence remain elusive.

Patients and methods: We used conversation analysis of videotaped follow-up consultations of seven outpatients (4-13 years of age) with chronic asthma and their caregivers, consulting two paediatric respiratory physicians in a practice in which high treatment adherence has been documented, to explore the language paediatricians use to promote their patients' adherence to daily controller medication.

Results: Starting the consultation with the patient's (and caregivers') agenda commonly resulted in presentation of issues new to the physician. Information was mostly provided in response to patient/caregiver questions, prompting the delivery of specific information tailored to the patient's and caregivers' needs. Although patients and caregivers showed resistance in response to unsolicited information and advice, they always accepted the doctor's explicit request for agreement with proposed treatment. The doctor's description of favourable treatment results in most patients prompted caregivers' willingness to accept treatment proposals.

Conclusions: Paediatricians with a documented success in achieving adherence to controller medication in their patients with asthma tend to start consultations with the patient's agenda, provide information in response to questions, offer reassurance on overall treatment effectiveness, and seek explicit agreement with a treatment proposal.

Keywords: Adherence; Communication; Medication adherence; Paediatrics; Patient centered communication; Shared decision making.

Publication types

Observational Study

MeSH terms

Administration, Inhalation
Adolescent
Adrenal Cortex Hormones / administration & dosage
Anti-Asthmatic Agents / therapeutic use*
Asthma / drug therapy*
Child
Child, Preschool
Decision Making, Shared*
Female
Humans
Language
Male
Medication Adherence / psychology*
Parents
Patient Education as Topic / methods
Pediatricians
Physician-Patient Relations*

Substances

Adrenal Cortex Hormones
Anti-Asthmatic Agents