哮喘加重对药物依从性的影响。
Effect of an Asthma Exacerbation on Medication Adherence.
机构信息
Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo; Department of Asthma, Allergy, and Immunology, Permanente Medical Group, Denver, Colo.
Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo.
出版信息
J Allergy Clin Immunol Pract. 2023 Jan;11(1):248-254. doi: 10.1016/j.jaip.2022.10.014. Epub 2022 Oct 22.
BACKGROUND
Few studies have looked at the effect of an asthma exacerbation on asthma medication adherence.
OBJECTIVE
To measure asthma medication adherence in the 12 months after an asthma exacerbation and the influence of care type (specialist vs primary care provider) as well as social economic status on adherence.
METHODS
We measured portion of days covered (PDC) during the 12 months before and after an exacerbation in a cohort of patients with asthma who were aged 18 years and older. Subanalyses looked at PDC in those who had more than one exacerbation after the sentinel exacerbation, by type of care received (primary care, allergist or pulmonologist, or no care) during both periods and by socioeconomic status (SES), defined as the lower quartile of annual income for the group.
RESULTS
In a cohort of 1,697 patients, PDC improved significantly (from 0.44 to 0.53; P < .001) after an asthma exacerbation. Improvement in PDC was even greater (from 0.45 to 0.57; P < .001) if they had more than one exacerbation after the sentinel exacerbation. Being seen by a specialist after the exacerbation but not before it, resulted in the greatest improvement in PDC (0.17 mean change). Patients not seen by a specialist either before the exacerbation or after had a mean change of just 0.07. Those with a lower SES had an overall lower PDC before the exacerbation (0.37 vs 0.43) but saw a similar improvement in the PDC compared with those in a higher SES (0.09 vs 0.10).
CONCLUSIONS
An asthma exacerbation is associated with a significant and sustained effect on medication adherence.
背景
很少有研究关注哮喘加重对哮喘药物依从性的影响。
目的
测量哮喘加重后 12 个月内的哮喘药物依从性，并研究护理类型（专科医生与初级保健医生）以及社会经济地位对依从性的影响。
方法
我们在年龄在 18 岁及以上的哮喘患者队列中，测量了在加重前 12 个月和加重后 12 个月内的部分天数覆盖率（PDC）。亚分析观察了在加重后发生多次加重的患者中，在这两个时期接受的护理类型（初级保健、过敏症或肺病专家或无护理）以及社会经济地位（SES）的 PDC，SES 定义为该组年收入的较低四分位数。
结果
在 1697 名患者的队列中，哮喘加重后 PDC 显著改善（从 0.44 提高到 0.53；P<0.001）。如果在加重后发生多次加重，PDC 的改善更大（从 0.45 提高到 0.57；P<0.001）。在加重后而不是加重前看专科医生，可使 PDC 改善最大（平均变化 0.17）。在加重前或加重后均未看专科医生的患者，平均变化仅为 0.07。SES 较低的患者在加重前的总体 PDC 较低（0.37 对 0.43），但与 SES 较高的患者相比，他们的 PDC 改善相似（0.09 对 0.10）。
结论
哮喘加重与药物依从性的显著和持续改善有关。
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