Management of patients with asthma and COPD: monitoring quality of life and the relationship to subsequent GP interventions

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Abstract
Objectives. The aim of this study was to investigate the feasibility of systematic monitoring of patients' quality of life and its relationship to GPs' interventions concerning management of asthma and chronic obstructive pulmonary disease (COPD). Methods. A cross-sectional study on patients' self-reported quality of life in relation to GPs' subsequent interventions during consultation was performed. Fourteen GPs at six general practices in The Netherlands monitored 175 patients aged 18 years and older with asthma and COPD. Directly before each planned follow-up consultation, patients completed a self-report questionnaire (27 items, five dimensions) about their quality of life; GPs reviewed the monitoring scores during consultation and recorded their diagnostic and therapeutic interventions. The relationship between patients' perceived quality of life and GPs' medication prescription, smoking cessation advice, patient education and counselling was analysed. Results. During 15 months, 175 patients underwent 537 consultations. In 57% of the consultations, patients reported impairments in their quality of life. This information was significantly associated with subsequent GP interventions (chi-square = 0.05), especially with providing patient education and counselling. Multivariate logistic regression analyses showed that reported physical complaints were positively associated with changes in medication prescription [odds ratio (OR) 1.7; 95% confidence interval (CI) 1.0–2.8] and with education about the control regimen (OR 1.9; 95% CI 1.1–3.3). Reported emotional complaints were related to extra follow-up appointments (OR 4.3; 95% CI 1.5–12.8) and to counselling (OR 7.3; 95% CI 2.9–18.3). In general, more advanced age was related to less patient education. Patients' and GPs' opinions about the quality of life monitoring were positive. Conclusions. Information about quality of life of patients, gathered systematically and routinely directly before consultation, could be integrated into a complex medical decision-making process; scores were related to various therapeutic interventions.