Pritchard John N, Nicholls Clare
1 Respironics Respiratory Drug Delivery (UK) Ltd , a business of Philips Electronics UK Limited, Chichester, West Sussex, United Kingdom .
J Aerosol Med Pulm Drug Deliv. 2015 Apr;28(2):69-81. doi: 10.1089/jamp.2014.1163. Epub 2014 Dec 30.
Despite the availability of effective treatments for respiratory disorders, disease control is often suboptimal, due in part to the failure of patients to adhere to prescribed regimens, or to demonstrate competence with the often complex steps in the administration of inhaled medications. The cost of poor true adherence, a combined measure of adherence and inhaler competence, is considerable, both economically and in terms of health-related impact. While patient education is recognized as essential, there exist many barriers to healthcare professional-led monitoring and promotion of true adherence. Successful intervention remains a challenging task, dependent upon understanding and addressing the distinct issues associated with poor adherence and inhaler competence, and lessening the perceived burden on healthcare professionals. Electronic monitors provide an accurate and objective indication of adherence and may also be of value in assessing inhaler competence. The information provided by such devices is a helpful aid to understanding the challenging nature of true adherence, and may be crucial to the development and assessment of true adherence promoting interventions. This article provides a background to the impact of suboptimal adherence and inhaler competence, and the challenges associated with the promotion of true adherence, with an emphasis on respiratory therapies. Contemporary electronic monitors of adherence and inhaler competence are critically reviewed, and case studies of emerging technologies are provided to illustrate the use of innovative monitoring devices in the promotion of true adherence in practice. Potential future directions, including increased targeting and individualization, enhanced coordination of care, and a greater focus on inhaler competence are considered to be important additions to currently available technologies in this rapidly evolving field.
尽管有针对呼吸系统疾病的有效治疗方法，但疾病控制往往不尽人意，部分原因是患者未能坚持规定的治疗方案，或者在使用吸入药物的复杂步骤中表现出操作不熟练。真正依从性差（这是依从性和吸入器操作能力的综合指标）在经济和健康相关影响方面的代价都相当大。虽然患者教育被认为至关重要，但医疗保健专业人员主导的监测和促进真正依从性存在许多障碍。成功的干预仍然是一项具有挑战性的任务，取决于理解和解决与依从性差和吸入器操作能力相关的不同问题，并减轻医疗保健专业人员感受到的负担。电子监测器可提供准确、客观的依从性指标，在评估吸入器操作能力方面也可能有价值。此类设备提供的信息有助于理解真正依从性的挑战性本质，对于促进真正依从性干预措施的开发和评估可能至关重要。本文介绍了依从性欠佳和吸入器操作能力的影响背景，以及促进真正依从性所面临的挑战，重点是呼吸治疗。对当代依从性和吸入器操作能力电子监测器进行了批判性综述，并提供了新兴技术的案例研究，以说明创新监测设备在实践中促进真正依从性的应用。未来潜在的发展方向，包括更有针对性和个性化、加强护理协调以及更加关注吸入器操作能力，被认为是对这一快速发展领域现有技术的重要补充。
