George Johnson, Kong David C M, Stewart Kay
Department of Pharmacy Practice, Victorian College of Pharmacy, Monash University, Parkville, VIC, Australia.
Int J Chron Obstruct Pulmon Dis. 2007;2(3):253-62.
The management of COPD is complex and patient adherence to treatment recommendations is known to be poor. In this paper the methods used for evaluating adherence in COPD are compared. Self-reporting has satisfactory reliability and offers a cheap, simple and easy method for assessing adherent behaviors. Unlike the objective measures of adherence such as electronic monitoring, self-reporting helps in identifying the reasons for nonadherence, which in turn would be useful in addressing adherence issues. Patients do not follow their treatment recommendations either intentionally or unintentionally. Intentional deviations are driven by patient beliefs and experiences about illness and treatment, which are in turn influenced by social and cultural factors. Unintentional deviations are often due to cognitive impairment and lack of routines. Factors associated with adherence in COPD have been explained using the Becker-Maiman model. Strategies for overcoming nonadherence have to be formulated based on the nature and reasons for nonadherence. In the event of unintentional nonadherence, the use of adherence aids like Dosette boxes, calendar packs and reminders should be promoted. Understanding patient beliefs and experiences, patient education focusing on the pathology of COPD and the role of treatment, periodic monitoring and reinforcement are critical for overcoming the barriers of intentional nonadherence.
慢性阻塞性肺疾病（COPD）的管理较为复杂，而且已知患者对治疗建议的依从性较差。本文对评估COPD患者依从性的方法进行了比较。自我报告具有令人满意的可靠性，并且提供了一种廉价、简单且易于操作的评估依从行为的方法。与诸如电子监测等依从性的客观测量方法不同，自我报告有助于确定不依从的原因，这反过来又有助于解决依从性问题。患者不遵循治疗建议可能是有意或无意的。有意的偏差是由患者对疾病和治疗的信念及经历所驱动的，而这些信念和经历又受到社会和文化因素的影响。无意的偏差通常是由于认知障碍和缺乏规律所致。COPD依从性相关因素已使用贝克尔 - 迈曼模型进行了解释。必须根据不依从的性质和原因制定克服不依从的策略。对于无意的不依从情况，应推广使用如药盒、日历包和提醒器等依从性辅助工具。了解患者的信念和经历、针对COPD病理及治疗作用的患者教育、定期监测和强化对于克服有意不依从的障碍至关重要。
