Compliance, adherence, and concordance - Implications for asthma treatment
Compliance, adherence, and concordance - Implications for asthma treatment
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DOI：
10.1378/chest.130.1_suppl.65s
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发表时间：
2006-07-01
期刊：
影响因子：
9.6
通讯作者：
Horne, Rob
中科院分区：
文献类型：
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作者：
Horne, Rob
哮喘的良好结局不仅取决于药物的可用性，还取决于患者的适当使用：最佳的“自我管理”。“在哮喘中，预防性药物的依从性低与住院率和死亡率较高有关。许多患者选择不服用药物，因为他们认为这是不必要的，或者因为他们担心潜在的不良反应。大约三分之一的哮喘患者对吸入性皮质类固醇（ICS）的不良反应有强烈的担忧。这些担忧不仅与ICS副作用引起的局部症状有关，还包括对未来的更抽象的担忧，因为人们认为定期使用ICS会导致长期不良反应或依赖。我们需要更有效的方法来引发和解决患者对ICS的担忧。开发具有更高安全性的ICS选择仍然是一个关键目标。然而，理想的解决方案不仅仅是药理学。我们还需要更有效的方式来向患者传达相对的益处和风险，以促进知情的依从性。临床医生必须准备好与患者持续合作，以确保向他们提供关于ICS必要性的明确理由，并解决他们对潜在不良反应的担忧。这种方法基于对患者对哮喘及其治疗的观点的详细检查，以及临床医生的开放，非判断性的方式，与一致性的想法是一致的。
Good-quality outcomes in asthma hinge not just on the availability of medications but also on their appropriate use by patients: optimal "self-management." In asthma, low rates of adherence to prophylactic (preventer) medication are associated with higher rates of hospitalization and death. Many patients choose not to take their medication because they perceive it to be unnecessary or because they are concerned about potential adverse effects. Approximately one third of asthma patients have strong concerns about adverse effects from inhaled corticosteroids (ICS). These concerns are not just related to the experience of local symptoms attributed to ICS side effects, but also include more abstract concerns about the future, arising from the belief that regular use of ICS will result in adverse long-term effects or dependence. We need more effective ways of eliciting and addressing patients' concerns about ICS. The development of ICS options with an improved safety profile remains a key objective. However, the ideal solution is not just pharmacologic. We also need more effective ways of communicating the relative benefits and risks to patients in order to facilitate informed adherence. Clinicians must be prepared to work in an ongoing partnership with patients to ensure that they are offered a clear rationale as to why ICS are necessary and to address their concerns about potential adverse effects. This approach, based on a detailed examination of patients' perspectives on asthma and its treatment, and an open, nonjudgmental manner on the part of the clinician, is consistent with the idea of concordance.