Leickly F E, Wade S L, Crain E, Kruszon-Moran D, Wright E C, Evans R
James Whitcomb Riley Hospital for Children, Indianapolis, IN 46202, USA.
Pediatrics. 1998 May;101(5):E8. doi: 10.1542/peds.101.5.e8.
The inability to adhere to a prescribed therapeutic program for the treatment of a chronic disease may be responsible in part for continued disease activity. This problem may be more of an issue in the treatment of asthma, a common, potentially lethal chronic condition in which the lack of symptoms may be interpreted as remission. Adherence was one of the key areas of interest for the National Cooperative Inner-City Asthma Study. The focus of this study was to identify those issues reported by families that could adversely affect their adherence to an asthma care program. The identification of barriers to adherence could then form the basis of a successful intervention program. This study describes barriers to adherence, asthma management behavior, and self-reported adherence.
Patients presenting during an acute attack of asthma at an emergency department (ED) were recruited for this study. The medical record of the ED encounter was abstracted and compared with information that was obtained during a baseline interview 3 to 5 weeks later. During the baseline interview, parents were asked about health care behaviors related to adherence.
There were 344 children 4 to 9 years of age living in inner city census tracts in the study. Four areas of adherence (medicine use, appointment-keeping, emergency actions, and asthma attack prevention) were investigated. The parental report of medications prescribed at the ED and the information on the abstracted ED report agreed 94.9% of the time for the beta-agonists, 86.8% for steroids, and 69.4% for cromolyn. Among respondents, 85.4% of parents reported that they are able to follow the ED recommendations almost all of the time; side effects of medicines were a concern for 81.1% of caretakers who were adherent and for 89.5% of caretakers who were nonadherent. Doubts regarding the usefulness of medications occurred in 34.4% of those considered adherent and 54.2% who admitted nonadherence. Medications were forgotten some of the time by 45.2% of the children, and 52.8% tried to get out of taking medicine. Appointments for follow-up care were kept by 69% of those given an appointment in the ED, by an estimated 60.0% of those who were told specifically to call for an appointment, and by an estimated 25.2% of those who were neither given an appointment nor told specifically to make one. Only one third of parents report that they were able to keep the child away from known asthma triggers nearly all of the time. Approximately half avoided allergens; however, only 37.5% reported avoidance of cigarette smoke. The use of preventive medicines occurred in 23.5%. Using a medicine and taking the child to a physician were reported as the first or second action during an acute attack of asthma by 72.1% of respondents.
Adherence to an asthma-management program involves a number of areas: medication, appointment-keeping, prevention, and applying an emergency plan of action. Barriers to adherence may exist in one or all four of these areas, leading to ineffective control of asthma. Recommendations are made for improving the patient-physician partnership to improve adherence.
无法坚持按照规定的治疗方案治疗慢性病，可能在一定程度上导致疾病持续活动。在哮喘治疗中，这个问题可能更为突出，哮喘是一种常见的、可能致命的慢性病，其症状的缺乏可能被视为病情缓解。坚持治疗是全国城市内部哮喘合作研究的关键关注领域之一。本研究的重点是确定家庭报告的那些可能对其坚持哮喘护理方案产生不利影响的问题。确定坚持治疗的障碍，进而可为成功的干预方案奠定基础。本研究描述了坚持治疗的障碍、哮喘管理行为以及自我报告的坚持情况。
招募在急诊科（ED）哮喘急性发作期间就诊的患者参与本研究。提取急诊就诊的病历，并与3至5周后基线访谈期间获得的信息进行比较。在基线访谈中，询问家长与坚持治疗相关的医疗保健行为。
本研究中有344名4至9岁的儿童居住在城市中心普查区。调查了四个坚持治疗的方面（用药、预约就诊、应急措施和预防哮喘发作）。家长报告的在急诊科开具的药物与提取的急诊报告中的信息，β受体激动剂的一致性为94.9%，类固醇为86.8%，色甘酸为69.4%。在受访者中，85.4%的家长报告他们几乎总能遵循急诊科的建议；药物副作用是81.1%坚持治疗的照料者和89.5%不坚持治疗的照料者所关心的问题。34.4%被认为坚持治疗的人和54.2%承认不坚持治疗的人对药物的有效性存在疑虑。45.2%的儿童有时会忘记用药，52.8%的儿童试图逃避服药。在急诊科预约了后续护理的人中，69%的人按时就诊，估计被告知要打电话预约的人中60.0%的人按时就诊，估计既未被预约也未被告知要预约的人中25.2%的人按时就诊。只有三分之一的家长报告说他们几乎总能让孩子远离已知的哮喘触发因素。大约一半的人避免接触过敏原；然而，只有37.5%的人报告避免接触香烟烟雾。预防性药物的使用率为23.5%。72.1%的受访者报告说，在哮喘急性发作期间，使用药物并带孩子去看医生是首要或次要行动。
坚持哮喘管理方案涉及多个方面：用药、预约就诊、预防和实施应急行动计划。这些方面中的一个或全部可能存在坚持治疗的障碍，导致哮喘控制不佳。为改善患者与医生的合作关系以提高坚持治疗率提出了建议。
