Original articleDoctor–patient relationship: A resource to improve respiratory diseases management☆
Introduction
One of the lately top considered objectives of World Health Organization is the optimization of patients-doctors relationship. Above all, almost nothing has been made to investigate the patients' level of satisfaction in terms of respiratory assistance. The meaning of satisfaction is to be considered as the integration of clinical management, doctor-patients relationship and public health administration. As reported by Koning et al. in their study on asthma and COPD patients, patients' viewpoints on good medical care have rarely been studied and often only the care provider opinion has been considered [1]. However as nowadays commonly happens, health care organizations, such as hospitals and health institutions, use patient care ratings to evaluate the quality of assistance delivered within the organization. Measuring satisfaction is a common procedure in our society, used to improve performance delivery both in industry and health services too, thus the patient's evaluations of care, although variable among providers, are generally high [2], [3]. As a consequence, in presence of respiratory patients, although care reports and ratings are important indicators of patients' subjective experiences with the health care system, the relationship between these perceptions and technical quality of care is not of minor importance. In fact, Chang et al. demonstrated that in a general setting the assessment of quality care should include both patient evaluations and independent assessments of technical quality [4]. Technical quality is one of most important aspects in diagnostic and follow up procedures regarding respiratory disease and should be of patients concern as well. Both guidelines for asthma and chronic obstructive pulmonary disease (COPD) [5], [6] emphasize, along with other statement [7] too, the importance of including patients' perspective in the management of their respiratory illness. In particular, the adherence to inhalatory therapy represents the best goal to obtain in obstructive respiratory diseases. Although the results of clinical trials claim that asthma control can be reached in most patients [5], epidemiological evidence suggests that many asthmatic subjects have poorly controlled disease, with a significant gap between the treatment goals and the level of asthma control [8], [9], [10]. The management of COPD is likely to become more complex in a population that is rapidly aging. Health care systems are more and more challenged to offer affordable and human care models, based on the best current evidences [11]. To reduce the social impact of COPD, one of the most interesting questions is related to the ideal timing of treatment limitation. One of the difficulties with the intervention in mild and moderate COPD is that patients might have some troubles with adherence to long-term drugs [12]. Therefore, in presence of these complex questions and problems, we promoted the possibility to perform a study on patients' perception about their respiratory disease. This Italian survey was designed to evaluate the patients' level of knowledge about medical assistance, respiratory therapy and to highlight the critical points of lung diseases management.
Section snippets
Methods
Sampling methodology followed a probabilistic model defined as levels and clusters to give a statistically correct representation of an entire population. Forty-six Pulmonology Institutions were selected on the basis of Italian resident population (Fig. 1). Within each Italian region were identified provinces with morphological differences (coast, plain, mountain), minimizing the overlap of service areas, due to the proximity of local provinces. In this way we obtained a representative sample
Results
The number of interviewed patients was 1166 (54% males and 46% females), the mean age was 60 years (54% from 18 to 59 and 46% from 60 to over 70). The majority of patients with an age higher than 50 years old had a low educational level and was retired (Table 2). All reported data were referred to a patient's answer. As reported in Table 3 the most important respiratory symptoms reported were: dyspnoea (69%), chronic phlegm (28%), snoring (18%), and cough (13%). All patients reported a minimum of
Discussion
This is the first Italian survey that considered the patient's viewpoint about management, knowledge and therapy adherence on respiratory diseases. Our study demonstrated a clear and interesting picture of various features about the respiratory patients in real life. These results are very important considering that our society has entered a postmodern era in which economical, philosophical and technological advances have transformed medicine, doctoring and the doctor-patient relationship [14].
Learning points
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The importance of consumer involvement at all levels of the health services is widely recognized.
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There has been little research examining which factors may influence patient acceptance and participation of chronic respiratory diseases. So, our survey represents an interesting key to understand the clinical approach in a real life setting.
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A good patient-physician relationship represents the most important point for a successful management in respiratory diseases population.
Conflict of interest statement
The authors report no relationships or financial interest with any entity that would pose a conflict of interest.
Acknowledgment
The authors thanks all Italian Lung Unit involved in this national survey. Also the authors are indebted to Pierdanio Forni for programming and logistical support too. This study was promoted by FIMPST (Federazione Italiana contro le Malattie Polmonari Sociali e la Tubercolosi), SIMeR (Società Italiana di Medicina Respiratoria), AIPO (Associazione Italiana Pneumologi Ospedalieri) and FIMMG (Federazione Italiana Medici di Medicina Generale).
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Grant Support: Funding for this research was provided by an unrestricted grant of TEVA Italia.