Department of Allergy, Kaiser Permanente Medical Center, San Diego and Los Angeles, Calif; Department of Research and Evaluation, Kaiser Permanente Medical Center, San Diego and Los Angeles, Calif.
Department of Allergy, Kaiser Permanente Medical Center, San Diego and Los Angeles, Calif; Department of Research and Evaluation, Kaiser Permanente Medical Center, San Diego and Los Angeles, Calif.
J Allergy Clin Immunol Pract. 2013 May-Jun;1(3):280-8. doi: 10.1016/j.jaip.2013.03.001. Epub 2013 Apr 13.
Asthma medication adherence is related to better asthma outcomes, but identification of suboptimal patient adherence behavior is not standardized in clinical settings.
[corrected] The purpose of this study was to develop a practical questionnaire that reflects nonadherence risk and identifies potential adherence barriers.
A questionnaire that included 20 potential adherence questions was completed by 420 adult patients with asthma who filled a prescription for an inhaled corticosteroid (ICS) and a short-acting beta agonist (SABA) in the previous 6 months. Questions without substantial floor or ceiling effects that were significantly related to self-reported low adherence or previous ICS canister dispensings were identified. Internal consistency reliability was tested by Cronbach α. Relationships of these questions to Asthma Control Test scores, future percent of days covered for ICS dispensings, and future asthma exacerbations and SABA dispensings were determined.
Five final questions were identified: following "my medication plan," forgetting, not "needing" the medications, side effects, and cost. Low internal consistency reliability (<0.50) suggested items should not be summarized by a single score. All five questions were related to Asthma Control Test scores. Following the medication plan, forgetting, and not needing medication were significantly related to prospective percent of days covered. Side effects were related to subsequent SABA and oral corticosteroid dispensings, and cost was significantly related to oral corticosteroid dispensings.
We identified five questions related to other measures of adherence and to asthma control that can be used clinically to identify patients at risk of nonadherence and the specific adherence barriers involved.
哮喘药物的依从性与更好的哮喘结果有关，但在临床环境中，识别患者的不依从行为并不规范。
本研究旨在开发一种实用的问卷，反映不依从的风险，并识别潜在的依从障碍。
420 名成年哮喘患者在过去 6 个月内开了吸入皮质类固醇（ICS）和短效β激动剂（SABA）处方后，完成了一份包含 20 个潜在依从性问题的问卷。没有实质性的地板或天花板效应的问题，且与自我报告的低依从性或以前的 ICS 罐分配显著相关，这些问题被识别出来。通过 Cronbach α 测试内部一致性可靠性。这些问题与哮喘控制测试评分、未来 ICS 分配的天数百分比、未来哮喘加重和 SABA 分配的关系。
确定了五个最终问题：遵循“我的用药计划”、忘记、不需要药物、副作用和费用。低内部一致性可靠性（<0.50）表明，这些项目不应该用一个单一的分数来总结。所有五个问题都与哮喘控制测试评分有关。遵循用药计划、忘记和不需要药物与前瞻性天数覆盖率显著相关。副作用与随后的 SABA 和口服皮质类固醇分配有关，而费用与口服皮质类固醇分配显著相关。
我们确定了五个与其他依从性措施和哮喘控制相关的问题，可以在临床上用于识别有不依从风险的患者和涉及的具体依从障碍。
