Patient factors and medication guideline adherence among older women with asthma
Patient factors and medication guideline adherence among older women with asthma
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DOI：
10.1001/archinte.162.15.1761
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发表时间：
2002-08-12
影响因子：
--
通讯作者：
Camargo, CA
中科院分区：
文献类型：
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作者：
Barr, RG;Somers, SC;Camargo, CA
背景：哮喘指南已经很完善，但往往遵循得很差。老年人依从性的决定因素可能与年轻人不同，而且啤酒的特性也没有得到很好的描述。目的：评估患有哮喘的老年女性对哮喘药物指南的遵守情况，并评估依从性的预测因素，重点关注哮喘特征、合并症医疗条件、工作相关因素、社会支持、护理和情绪健康。方法：我们评估了护士健康研究参与者对国家哮喘教育和预防计划药物指南的遵守情况，这些参与者报告了医生对哮喘的诊断并再次确认结果：在护士健康研究的 121700 名参与者中，有 5107 名报告医生诊断的哮喘符合纳入标准。 1998 年，平均 +/-SD 年龄为 63 +/- 7 岁。轻度持续性哮喘患者遵守哮喘药物指南的比例为 57%，中度持续性哮喘为 55%，重度持续性哮喘为 32% (P=.001)。在多变量分析中，不依从性与严重哮喘、年龄增加、社会经济地位较低、目前吸烟、哮喘早期发作以及合并症的数量有关。社会隔离、护理和情绪健康的衡量标准与不依从性无关。结论：老年女性的哮喘治疗不足，即使是医疗保健专业人员也是如此。高龄和严重哮喘的女性尤其面临风险。鉴于老年女性哮喘死亡率增幅最大，需要进一步研究来检查医生对这一弱势群体的处方模式和患者信念。
Background: Asthma guidelines are well established but often followed poorly. Determinants of adherence among older persons may differ from younger persons and have not beers well characterized.Objectives: To assess adherence to asthma medication guidelines among older women with asthma and evaluate predictors of adherence with emphasis on asthma characteristics, comorbid medical conditions, work-related factors, social supports, caregiving, and emotional well-being.Methods: We assessed adherence to the National Asthma Education and Prevention Program medication guidelines among participants in the Nurses' Health Study who reported a physician diagnosis of asthma and reconfirmed the diagnosis on a separate questionnaire, excluding those with chronic obstructive pulmonary disease.Results: Among 121700 participants in the Nurses' Health Study, 5107 reported physician-diagnosed asthma meeting inclusion criteria. Mean +/-SD age was 63 +/- 7 years in 1998. Adherence with asthma medication guidelines was 57% for mild persistent, 55% for moderate persistent, and 32% for severe persistent asthma (P=.001). In multivariate analysis, nonadherence was associated with severe asthma, increasing age, lower socioeconomic status, current smoking, earlier onset of asthma, and number of comorbid medical conditions. Measures of social isolation, caregiving, and emotional well-being were not associated with nonadherence.Conclusions: Asthma is undertreated among older women, even those who are health care professionals. Women with advanced age and severe asthma were particularly at risk. Given that the greatest increase in asthma mortality has occurred among older women, further research is needed to examine physician prescribing patterns and patient beliefs in this vulnerable population.