Montreal Behavioural Medicine Centre, Montreal, Quebec, Canada.
Respir Med. 2012 Sep;106(9):1211-25. doi: 10.1016/j.rmed.2012.06.001. Epub 2012 Jul 5.
Adherence to inhaled corticosteroids (ICS) remains poor among asthmatics, yet little is known about the efficacy of interventions to improve adherence. Implementing the Chronic Care Model (CCM) components among patients with respiratory disorders has been associated with an improvement in outcomes, yet little is known about its effects on ICS adherence in asthmatics.
We conducted a systematic review to assess the efficacy of interventions to improve ICS adherence among adult-asthmatics, and whether the use of CCM components (i.e., teaching self-management skills, providing decision support, delivery system design, and clinical information systems) resulted in greater ICS adherence.
All English language articles testing the efficacy of an intervention including ICS medication on outcome from MEDLINE and PsychINFO databases through Aug-2010 were reviewed. Interventions were categorized based on the inclusion of CCM components. We standardized treatment effects to obtain effect-size's (ES's) and we combined the ES's of studies according to the number of CCM components included in their interventions.
Eighteen studies met inclusion criteria. Inclusion of a greater number of CCM components within interventions was associated with stronger effects on ICS adherence outcomes, with interventions featuring one, two, and four CCM components having medium (ES = 0.29; 95%CI, 0.16-0.42), large (0.53; 0.40-0.66), and very-large (0.83; 0.69-0.98) effects respectively.
Findings provide support for using the CCM as a framework for the design and implementation of interventions to improve adherence among adult-asthmatics.
哮喘患者吸入皮质类固醇（ICS）的依从性仍然很差，但对于改善依从性的干预措施的疗效知之甚少。在患有呼吸系统疾病的患者中实施慢性护理模式（CCM）的各个组成部分与改善结果有关，但对于其对哮喘患者 ICS 依从性的影响知之甚少。
我们进行了系统评价，以评估改善成年哮喘患者 ICS 依从性的干预措施的疗效，以及使用 CCM 组成部分（即教授自我管理技能、提供决策支持、交付系统设计和临床信息系统）是否会导致 ICS 依从性更高。
通过 MEDLINE 和 PsychINFO 数据库，对截至 2010 年 8 月测试干预措施（包括 ICS 药物）对结果的影响的所有英语文章进行了回顾。根据纳入 CCM 组成部分的情况对干预措施进行分类。我们对治疗效果进行了标准化，以获得效果大小（ES），并根据干预措施中纳入的 CCM 组成部分的数量来合并研究的 ES。
有 18 项研究符合纳入标准。干预措施中纳入更多的 CCM 组成部分与 ICS 依从性结果的影响更强相关，具有一个、两个和四个 CCM 组成部分的干预措施具有中等（ES = 0.29；95%CI，0.16-0.42）、大（0.53；0.40-0.66）和非常大（0.83；0.69-0.98）的效果。
这些发现为使用 CCM 作为设计和实施干预措施以提高成年哮喘患者依从性的框架提供了支持。
