Division of Nursing in Internal Medicine, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland.
Division of Surgical Procedures, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland.
Adv Exp Med Biol. 2020;1271:37-47. doi: 10.1007/5584_2019_477.
Adherence to therapy plays a key role in treatment optimization and clinical outcome in patients with chronic obstructive pulmonary disease (COPD). The adherence to inhaled medications is poor, ranging from 20% to 60%. In this study we searched Medline and PubMed literature regarding factors that could have an impact on therapy adherence in COPD patients, using the key words "COPD" or "chronic obstructive pulmonary disease" and "adherence". The search was limited to the English language article published between January 2013 and December 2019. Review papers, study protocols, and meta-analyses were excluded. The final material included 25 articles. The evaluation was performed using the Cochrane Review Manager guidelines. The 25 articles represented 29 countries from 5 continents. We assessed adherence to therapy and the impact of selected factors on the adherence in 27,660 COPD patients (60.9% of whom were male, mean age 64 years). The factors affecting adherence were broken down into three categories: sociodemographic, clinical, and psychological. There were two standardized instruments used in the analyzed studies: Test of Adherence to Inhalers (TAI) and self-reported Morisky Medication Adherence Scale (MMAS-8). We found that 46.3% of patients had a moderately good level of adherence to inhaled therapy (TAI range around 50 points), while 41.6% of patients had a high level of adherence to oral therapy. The nature of non-adherence was in most cases inadvertent rather than an erratic or deliberate demeanor (48.5% vs. 38.9% vs. 42.4%, respectively). We conclude that standardized instruments enable the prediction of adherence to therapy and should be used in clinical practice. The assessment of adherence is essential for undertaking interventions to counteract plausible non-adherence. Collaboration between an educator and a psychologist is required to evaluate the patient's motivation and to ensure his comprehension of treatment prescribed.
治疗依从性在慢性阻塞性肺疾病（COPD）患者的治疗优化和临床结局中起着关键作用。吸入药物的依从性很差，范围在 20%到 60%之间。在这项研究中，我们搜索了 Medline 和 PubMed 文献，使用“COPD”或“慢性阻塞性肺疾病”和“依从性”等关键词，寻找可能影响 COPD 患者治疗依从性的因素。搜索范围限于 2013 年 1 月至 2019 年 12 月期间发表的英文文章。排除综述文章、研究方案和荟萃分析。最终材料包括 25 篇文章。评估使用 Cochrane 评论经理指南进行。这 25 篇文章代表了来自五个大陆的 29 个国家。我们评估了 27660 名 COPD 患者（其中 60.9%为男性，平均年龄 64 岁）的治疗依从性和选定因素对依从性的影响。影响依从性的因素分为三类：社会人口统计学、临床和心理。在分析的研究中使用了两种标准化工具：吸入器依从性测试（TAI）和自我报告的 Morisky 药物依从性量表（MMAS-8）。我们发现，46.3%的患者对吸入治疗具有中等良好的依从性（TAI 范围在 50 分左右），而 41.6%的患者对口服治疗具有较高的依从性。不依从的性质在大多数情况下是无意的，而不是反复无常或故意的（分别为 48.5%、38.9%和 42.4%）。我们得出结论，标准化工具可以预测治疗依从性，应在临床实践中使用。评估依从性对于采取干预措施来对抗可能的不依从性至关重要。需要教育者和心理学家之间的合作，以评估患者的动机并确保他理解所开的治疗。
