De Nunzio Cosimo, Presicce Fabrizio, Lombardo Riccardo, Trucchi Alberto, Bellangino Mariangela, Tubaro Andrea, Moja Egidio
Department of Urology, Ospedale Sant'Andrea, "Sapienza" University of Rome, Rome, Italy.
Unit of Clinical Psychology, Department of Health Sciences, University of Milan, San Paolo Hospital, Milan, Italy.
BMC Urol. 2018 Jun 26;18(1):62. doi: 10.1186/s12894-018-0376-x.
Even though evidence based medicine, guidelines and algorithms still represent the pillars of the management of chronic diseases (i.e: hypertension, diabetes mellitus), a patient centred approach has been recently proposed as a successful strategy, in particular to improve drug adherence. Aim of the present review is to evaluate the unmet needs in LUTS/BPH management and the possible impact of a patient centered approach in this setting.
A National Center for Biotechnology Information (NCBI) PubMed search for relevant articles published from January 2000 until December 2016 was performed by combining the following MESH terms: patients centred medicine, patient centered care, person centered care, patient centered outcomes, value based care, shared decision making, male, Lower Urinary Tract Symptoms, Benign Prostatic Hyperplasia, treatment. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). All studies reporting on patient centred approach, shared decision making and evidence-based medicine were included in the review. All original article, reviews, letters, congress abstracts, and editorials comments were included in the review. Studies reporting single case reports, experimental studies on animal models and studies not in English were not included in the review.
Overall 751 abstracts were reviewed, out of them 87 full texts were analysed resulting in 36 papers included. The evidence summarised in this systematic review confirmed how a patient centred visit may improve patient's adherence to medication. Although a patient centred model has been rarely used in urology, management of Low Urinary Tract Symptoms (LUTS) and Benign Prostatic Obstruction (BPO) may represent the perfect ground to experiment and improve this approach. Notwithstanding all the innovations in LUTS/BPO medical treatment, the real life picture is far from ideal.
Recent evidence shows a dramatical low drug adherence and satisfaction to medical treatment in LUTS/BPH patients. A patient centred approach may improve drug adherence and some unmet needs in this area, potentially reducing complications and costs. However further well designed studies are needed to confirm this data.
尽管循证医学、指南和算法仍是慢性病（如高血压、糖尿病）管理的支柱，但最近有人提出以患者为中心的方法是一种成功策略，特别是在提高药物依从性方面。本综述的目的是评估下尿路症状/良性前列腺增生（LUTS/BPH）管理中未满足的需求以及这种以患者为中心的方法在该领域可能产生的影响。
通过组合以下医学主题词（MESH），在国家生物技术信息中心（NCBI）的PubMed数据库中检索2000年1月至2016年12月发表的相关文章：以患者为中心的医学、以患者为中心的护理、以人为本的护理、以患者为中心的结果、基于价值的护理、共同决策、男性、下尿路症状、良性前列腺增生、治疗。我们遵循系统评价和Meta分析的首选报告项目（PRISMA）。所有报告以患者为中心的方法、共同决策和循证医学的研究均纳入本综述。所有原创文章、综述、信函、会议摘要和编辑评论均纳入本综述。报告单病例报告、动物模型实验研究以及非英文研究不纳入本综述。
共检索到751篇摘要，其中87篇全文进行了分析，最终纳入36篇论文。本系统评价总结的证据证实，以患者为中心的就诊可能会提高患者的药物依从性。尽管以患者为中心的模式在泌尿外科很少使用，但下尿路症状（LUTS）和良性前列腺梗阻（BPO）的管理可能是试验和改进这种方法的理想领域。尽管LUTS/BPO医学治疗有诸多创新，但实际情况远非理想。
最近的证据表明，LUTS/BPH患者的药物依从性和对医疗治疗的满意度极低。以患者为中心的方法可能会提高药物依从性，并满足该领域一些未满足的需求，有可能减少并发症和成本。然而，需要进一步设计良好的研究来证实这些数据。
