Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Curr Opin Pulm Med. 2013 Nov;19(6):687-91. doi: 10.1097/MCP.0b013e3283659f45.
As new medications continue to come to market to improve health in individuals with cystic fibrosis (CF), patient adherence is increasingly more important to address. Currently, adherence for pulmonary medications is approximately 50% for people with CF. There has been recent research that has demonstrated that poor adherence is linked to worse health outcomes. This review summarizes recent research on the impact of adherence on lung health and highlights future areas of research and clinical practice to address this growing need.
Recent research has indicated that nonadherence is associated with increased hospitalizations and pulmonary exacerbations, lower baseline lung function, and longer length of stays. However, most of the research has been done using pharmacy refill records as an objective measure of adherence. Electronic monitoring of medications provides more detailed information about patterns of use, which can directly inform clinical care. Furthermore, there have been few published clinical trials evaluating behavioral interventions to promote adherence.
Given the recent research linking adherence to lung health outcomes, there is a growing need to measure and evaluate adherence in clinical care. As new medications are approved for CF, methods to monitor adherence also need to be developed and approved. Clinicians need to continue to assess barriers to adherence to be able to individually tailor interventions to a patient's needs.
随着新的药物不断上市以改善囊性纤维化 (CF) 患者的健康状况,患者的依从性越来越受到重视。目前,CF 患者对肺部药物的依从性约为 50%。最近的研究表明,依从性差与更差的健康结果有关。这篇综述总结了最近关于依从性对肺部健康影响的研究,并强调了未来研究和临床实践的领域,以满足这一日益增长的需求。
最近的研究表明,不依从与住院和肺部恶化、较低的基线肺功能和更长的住院时间有关。然而,大多数研究都是使用药房补充记录作为依从性的客观衡量标准。药物的电子监测提供了关于使用模式的更详细信息,可以直接为临床护理提供信息。此外,很少有关于评估促进依从性的行为干预的临床试验发表。
鉴于最近的研究将依从性与肺部健康结果联系起来,在临床护理中测量和评估依从性的需求日益增长。随着新的 CF 药物获得批准,也需要开发和批准监测依从性的方法。临床医生需要继续评估依从性的障碍,以便能够根据患者的需求量身定制干预措施。