BACKGROUND: Certain psychosocial variables are relatively unexplored as possible predictors of asthma outcomes. OBJECTIVE: To determine if asthma self-efficacy, depressive symptoms, and unrealistic expectations predict urgent care use and change in health-related quality of life measured by the Asthma Quality of Life Questionnaire and the SF-36 during 2 years. RESEARCH DESIGN: Prospective cohort study in a primary care internal medicine practice at a tertiary care center in New York City. PATIENTS: Adults with moderate asthma who were fluent in either English or Spanish. MEASUREMENTS: At enrollment patients were interviewed in-person and completed a series of questionnaires including the Asthma Quality of Life Questionnaire (AQLQ), the SF-36, the Asthma Self-efficacy Scale, the Geriatric Depression Scale, and open-ended questions regarding their expectations of treatment. Patients also completed the AQLQ and SF-36 at various time intervals throughout the study and were interviewed by telephone every 3 months to record recent hospitalizations, emergency department visits and nonroutine office visits for asthma. RESULTS: A total of 224 patients were followed for a mean of 23.8 months. In hierarchical analysis, independent predictors of lower AQLQ scores were less self-efficacy, more depressive symptoms, expecting to be cured of asthma, requiring methylxanthines, being Hispanic or black, and having difficult or very difficult access to asthma care (all at P <0.05). Similar predictors were found for lower SF-36 scores. Another outcome, use of urgent care, was required by 60% of patients during the study period. Predictors of using urgent care were having more depressive symptoms, expecting a cure, being female, requiring oral beta-agonists, and having a history of prior hospitalizations for asthma (all at P <0.05). CONCLUSIONS: Less asthma self-efficacy, more depressive symptoms, and unrealistic expectations predict worse asthma outcomes. These relatively unexplored patient-centered variables in asthma are potentially modifiable and may offer new ways to intervene to improve asthma outcomes.
BACKGROUND: Certain psychosocial variables are relatively unexplored as possible predictors of asthma outcomes. OBJECTIVE: To determine if asthma self-efficacy, depressive symptoms, and unrealistic expectations predict urgent care use and change in health-related quality of life measured by the Asthma Quality of Life Questionnaire and the SF-36 during 2 years. RESEARCH DESIGN: Prospective cohort study in a primary care internal medicine practice at a tertiary care center in New York City. PATIENTS: Adults with moderate asthma who were fluent in either English or Spanish. MEASUREMENTS: At enrollment patients were interviewed in-person and completed a series of questionnaires including the Asthma Quality of Life Questionnaire (AQLQ), the SF-36, the Asthma Self-efficacy Scale, the Geriatric Depression Scale, and open-ended questions regarding their expectations of treatment. Patients also completed the AQLQ and SF-36 at various time intervals throughout the study and were interviewed by telephone every 3 months to record recent hospitalizations, emergency department visits and nonroutine office visits for asthma. RESULTS: A total of 224 patients were followed for a mean of 23.8 months. In hierarchical analysis, independent predictors of lower AQLQ scores were less self-efficacy, more depressive symptoms, expecting to be cured of asthma, requiring methylxanthines, being Hispanic or black, and having difficult or very difficult access to asthma care (all at P <0.05). Similar predictors were found for lower SF-36 scores. Another outcome, use of urgent care, was required by 60% of patients during the study period. Predictors of using urgent care were having more depressive symptoms, expecting a cure, being female, requiring oral beta-agonists, and having a history of prior hospitalizations for asthma (all at P <0.05). CONCLUSIONS: Less asthma self-efficacy, more depressive symptoms, and unrealistic expectations predict worse asthma outcomes. These relatively unexplored patient-centered variables in asthma are potentially modifiable and may offer new ways to intervene to improve asthma outcomes.
Authors: Kathleen W Wyrwich; Andrea M Ireland; Prakash Navaratnam; Hendrik Nolte; Davis F Gates Journal: Qual Life Res Date: 2010-12-24 Impact factor: 4.147
Authors: Margaret G E Peterson; Theodore J Gaeta; Robert H Birkhahn; José L Fernández; Carol A Mancuso Journal: J Asthma Date: 2012-06-28 Impact factor: 2.515
Authors: Ronald M Epstein; Peter Franks; Cleveland G Shields; Sean C Meldrum; Katherine N Miller; Thomas L Campbell; Kevin Fiscella Journal: Ann Fam Med Date: 2005 Sep-Oct Impact factor: 5.166
Authors: Andrea J Apter; Xingmei Wang; Daniel Bogen; Ian M Bennett; Rebecca M Jennings; Laura Garcia; Tamie Sharpe; Carmen Frazier; Thomas Ten Have Journal: Patient Educ Couns Date: 2009-02-13