Lindsay John T, Heaney Liam G
Centre for Infection and Immunity, Queens University Belfast, Belfast, UK.
Patient Prefer Adherence. 2013 Apr 19;7:329-36. doi: 10.2147/PPA.S38208. Print 2013.
Nonadherence to prescribed treatment is an important cause of difficult asthma. Rates of nonadherence amongst asthmatic patients have been shown to range between 30% and 70%. This is associated with poor health care outcomes and increased health care costs. There is no such thing as a "typical" nonadherent patient. The reasons driving nonadherence are multifactorial. Furthermore, adherence is a variable behavior and not a trait characteristic. Adherence rates can vary between the same individual across treatments for different conditions. There is no consistent link between socioeconomic status and nonadherence, and although some studies have shown that nonadherence is more common amongst females, this is not a universal finding. The commonly held perception that better adherence is driven by greater disease severity has been demonstrated to not be the case, in both pediatric and adult patients. Identification of nonadherence is the first step. If adherence is not checked, it is likely that poor adherence will be labeled as refractory disease. Failure to identify poor adherence may lead to inappropriate escalation of therapy, including the potential introduction of complex biological therapies. Surrogate measures, such as prescription counting, are not infallible. Nonadherence can be difficult to identify in clinical practice, and a systematic approach using a variety of tools is required. Nonadherence can be successfully addressed. Therefore, assessment of adherence is of paramount importance in difficult asthma management, in order to reduce exacerbations and steroid-related side effects as well as hospital and intensive care admissions, health care cost, and inappropriate treatment escalation. In this paper, we present an overview of the literature surrounding nonadherence in difficult asthma. We explore the facts and myths surrounding the factors driving nonadherence as well as how it can be identified and addressed.
不遵医嘱治疗是难治性哮喘的一个重要原因。哮喘患者的不遵医嘱率已显示在30%至70%之间。这与不良的医疗保健结果及增加的医疗保健成本相关。不存在“典型”的不遵医嘱患者。导致不遵医嘱的原因是多方面的。此外，遵医嘱是一种可变行为而非特质特征。同一个人在针对不同病症的治疗中，遵医嘱率可能会有所不同。社会经济地位与不遵医嘱之间没有一致的关联，尽管一些研究表明不遵医嘱在女性中更为常见，但这并非普遍现象。普遍认为病情越严重遵医嘱程度越高，然而在儿科和成年患者中，事实并非如此。识别不遵医嘱是第一步。如果不检查遵医嘱情况，很可能会将不良的遵医嘱行为归类为难治性疾病。未能识别出不良的遵医嘱行为可能会导致不适当的治疗升级，包括可能引入复杂的生物疗法。诸如清点处方等替代措施并非绝对可靠。在临床实践中，不遵医嘱可能难以识别，需要采用多种工具的系统方法。不遵医嘱问题可以得到成功解决。因此，在难治性哮喘管理中，评估遵医嘱情况至关重要，以便减少病情加重、类固醇相关副作用以及住院和重症监护病房收治情况、医疗保健成本和不适当的治疗升级。在本文中，我们概述了有关难治性哮喘中不遵医嘱的文献。我们探讨了围绕导致不遵医嘱的因素的事实与误解，以及如何识别和解决这一问题。
