gms | German Medical Science

Background: The needs of patients with asthma in relation to their condition remain insufficiently understood and met. Insights into the patient characteristics associated with unmet needs are crucial in order to be able to identify patient subpopulations that may benefit most from addressing needs. Such information has the potential to inform the development of tailored patient-centred interventions.

Research question: To our knowledge, determinants of patients’ needs in asthma treatment have not been examined to date. We therefore aimed to address this knowledge gap.

Methods: Our study was based on survey data from 189 adults with asthma who reported that they have never been diagnosed with chronic obstructive pulmonary disease (COPD). Participants were recruited through various pathways (e.g., physicians, pharmacies and patient organisations). Needs were measured by the 13-item Patients’ Needs in Asthma Treatment (NEAT) questionnaire, which yields a total score and subscale-specific scores. The subscales are labelled “exacerbations”, “patient expertise”, “handling drugs”, and “drug effects”, respectively. The potential score range on each subscale and the total scale varies from 0.0 to 1.0 with higher scores indicating higher need. We considered the following variables as potential determinants of needs: younger age (i.e., ≤ 45 years versus > 45 years), sex (female versus male), high educational level (i.e. highest level of school education versus medium/low/none), a recent asthma diagnosis (i.e. ≤ 5 years ago versus > 5 years ago), and poor mental health [i.e. depression and/or anxiety versus neither, as measured by the Patient Health Questionnaire-4]. Associations were estimated by multivariable linear regression.

Results: Overall, we observed that age, mental health and the time period since the asthma diagnosis were independently associated with increased needs. The mean total need score, for instance, was higher in younger versus older participants (b = 0.13, 95% confidence interval [CI] = 0.05, 0.21), in those with poor mental health (b = 0.14, 95% CI = 0.04, 0.24) and in those diagnosed with asthma within the last 5 years versus >5 years (b = 0.13, 95% CI = 0.05, 0.21). Information on drug effects was an exception to this pattern as the need in that domain was solely determined by sex (i.e. being reduced in women, b = - 0.27, 95% CI = -0.44, -0.01).

Discussion: The present study provides novel evidence on patient characteristics that are associated with needs in asthma treatment. Our observations are in line with earlier findings, as suggested by a recent review of needs among patients with chronic diseases in German health care (Pieper D et al. BMC Health Serv Res 15: 407, 2015). Notably, that review did not include studies on asthma and was limited to information needs. Our findings thus expand that prior evidence to asthma and beyond information needs as the NEAT questionnaire covers a broader spectrum of needs.

Practical implications: If confirmed by future studies, our observations may assist health care professionals to identify asthma patients with potentially elevated needs based for instance on their age, sex, and the period of time since they received their asthma diagnosis. In addition, the insights from our study may help to inform the development of tailored interventions that aim to address the information, support and training needs of asthma patients.