Higher preference for participation in treatment decisions is associated with lower medication adherence in asthma patients

Objective: To investigate the interrelations between medication adherence, self-management, preference for involvement in treatment decisions and preference for information in asthma patients in primary care. Methods: One hundred and eighty-five patients from 43 practices completed a series of questionnaires, which included the 'Autonomy Preference Index' (API) [range = 0-100], the four-item Morisky self-report medication adherence questionnaire and structured questions about asthma severity, medication and self-management. Results: The mean (S.D.) for participation preference was 34.5 (15.3) whereas the mean (S.D.) for information preference was 91.1 (9.7). Higher participation preference was associated with stopping medication when feeling better (OR 1.03; 95%CI 1.01-1.06) or feeling worse (OR 1.02; 95%CI 1.0-1.05) but it was not related to asthma severity. Higher information preference was associated with non-adherence to medication (Spearman correlation coefficient 0.166; p = 0.035) as well as the wish to receive asthma education (p = 0.04) and usage of peak flow meter (p = 0.05). Conclusion: Participation preference was low in general. Higher preference for involvement may entail more motivation for self-management but also lower medication adherence. This may be explained by a continuous internal negotiation process to accept the potentially lifelong demands of the disease. Practice implications: Patients with lower medication adherence may possibly be addressed and empowered by their enhanced preference for participation in treatment decisions. Physicians offering to share treatment decisions may utilise the patients' participation preference to enhance medication adherence. Due to varying participation preferences, optimal patient preference matching, which involves more flexible use of different communication styles, may be necessary to improve outcomes. (C) 2007 Elsevier Ireland Ltd. All rights reserved.