Allergy Asthma Sinus Center, Madison and Milwaukee, Wisconsin.
Ann Allergy Asthma Immunol. 2016 Dec;117(6):613-619. doi: 10.1016/j.anai.2016.08.029.
Poor adherence to inhaled corticosteroid medication is a critical problem for asthma because it contributes to morbidity and mortality through poor asthma control, frequent asthma exacerbations, acute care visits, and oral corticosteroid use.
To discuss evidence-based, time-efficient strategies that can be adopted by most practitioners to try to increase patient adherence.
Asthma management guidelines and other key publications are used to enhance discussion.
Establishing patient-centered, collaborative care that permits effective patient-practitioner communication can improve adherence, thus leading to improved asthma outcomes. One critical strategy is shared decision making, in which the patient and the practitioner share relevant information, discuss risks vs benefits of various treatment options, express treatment preferences, deliberate the options, and agree on treatment. Asthma self-management education, which emphasizes self-efficacy, is also essential. The education necessary to provide those skills depends in part on consideration of the patient's health literacy. Practitioners also have at their disposal a variety of tips and techniques to improve communication and gather information not only at the patient-practitioner level but also at the practitioner-practitioner level, such as within a group practice or within a health care system.
To improve patient adherence, clinicians need to consider a variety of factors and implement strategies that directly target underlying issues. Strategies may include customizing and simplifying learning and intervention regimens, identifying barriers to adherence and addressing them, ensuring patient support structures are in place, and improving self-efficacy and health literacy.
吸入皮质类固醇药物依从性差是哮喘的一个关键问题，因为它通过控制不佳的哮喘、频繁的哮喘恶化、急性护理就诊和口服皮质类固醇的使用导致发病率和死亡率增加。
讨论大多数医生可以采用的基于证据、高效的策略，以尝试提高患者的依从性。
使用哮喘管理指南和其他关键出版物来加强讨论。
建立以患者为中心、协作的护理，可以促进有效的医患沟通，从而提高患者的依从性，进而改善哮喘结局。一个关键的策略是共同决策，即患者和医生共享相关信息，讨论各种治疗方案的风险与获益，表达治疗偏好，权衡选择，并就治疗达成一致。哮喘自我管理教育，强调自我效能，也是必不可少的。提供这些技能所需的教育部分取决于考虑患者的健康素养。医生还可以利用各种技巧和技术来改善沟通，并不仅在医患层面，而且在医生-医生层面收集信息，例如在一个团体实践或在一个医疗保健系统内。
为了提高患者的依从性，临床医生需要考虑多种因素，并实施直接针对根本问题的策略。策略可能包括定制和简化学习和干预方案，确定并解决依从性障碍，确保患者支持结构到位，以及提高自我效能和健康素养。
