School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Woolcock Institute of Medical Research, Clinical Management Group, University of Sydney, Sydney, Australia.
J Allergy Clin Immunol Pract. 2013 Sep-Oct;1(5):446-54. doi: 10.1016/j.jaip.2013.06.015. Epub 2013 Aug 30.
In the past decade, rapid technological developments have advanced electronic monitoring devices (EMD) for asthma inhalers beyond simple recording of actuations to providing adherence promotion features and detailed information about patterns of medication use. This article describes currently available EMDs, discusses their utility and limitations in assessing adherence, and describes the potential for EMD-based adherence promotion interventions in clinical settings. To date, the main use of EMDs has been in clinical research. In selected populations, simple EMD-based adherence interventions, delivered either through clinician-to-patient feedback about medication use or by direct-to-patient reminders for missed doses, can significantly improve adherence. Further work is now needed to determine the impact of EMDs on clinical outcomes and their cost-effectiveness and feasibility for different clinical settings, including in disadvantaged populations. If this evidence can be provided, then the use of EMDs could expand into the management of asthma in populations with high health care costs, eg, severe asthma. In the future, medication monitoring could help distinguish poor treatment response from poor adherence, guide prescribing decisions, and prompt providers to discuss barriers to adherence; electronic health records may provide the gateway for integrating medication-use monitoring into digital chronic care management.
在过去的十年中，哮喘吸入器的电子监测设备（EMD）技术发展迅速，不仅可以简单地记录使用次数，还可以提供用药依从性促进功能和详细的用药模式信息。本文介绍了目前可用的 EMD，讨论了它们在评估依从性方面的实用性和局限性，并描述了基于 EMD 的依从性促进干预在临床环境中的潜力。迄今为止，EMD 的主要用途是在临床研究中。在特定人群中，通过向患者反馈用药情况或直接向患者发送漏服剂量提醒等简单的 EMD 基于的依从性干预措施，可以显著提高依从性。现在需要进一步研究确定 EMD 对临床结果的影响及其在不同临床环境中的成本效益和可行性，包括在弱势群体中。如果能够提供这些证据，那么 EMD 的使用范围可能会扩大到高医疗成本人群（例如严重哮喘）的哮喘管理中。未来，药物监测可以帮助区分治疗反应不佳和依从性不佳，指导处方决策，并促使提供者讨论依从性障碍；电子健康记录可能为将药物使用监测纳入数字慢性护理管理提供途径。
