Shared Treatment Decision Making Improves Adherence and Outcomes in Poorly Controlled Asthma
Shared Treatment Decision Making Improves Adherence and Outcomes in Poorly Controlled Asthma
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DOI：
10.1164/rccm.200906-0907oc
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发表时间：
2010-03-15
影响因子：
24.7
通讯作者：
Vollmer, William M.
中科院分区：
文献类型：
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作者：
Wilson, Sandra R.;Strub, Peg;Vollmer, William M.
基本原理：坚持哮喘控制药物治疗效果不佳的结果差的treatment outcomes.Objectives：比较控制药物的依从性和临床结果在612例成人控制不良的哮喘随机两种不同的治疗决策模型之一或通常care.Methods：在共享决策（SDM），nonphysician临床医生和患者协商的治疗方案，适应患者的目标和偏好。在临床医生决策中，在没有明确引出患者目标/偏好的情况下规定治疗。其他相同的干预协议都提供了哮喘教育，并涉及两个人和三个简短的电话encounters.Measurements和主要结果：再填充坚持测量使用连续药物收购（CMA）指数的总天数的供应，每年收购除以365天。累积控制药物剂量以倍氯米松罐当量测量。在第1年的随访中，与常规护理相比，SDM导致：控制器依从性明显更好（CMA，0.67 vs. 0.46; P < 0.0001）和长效β-激动剂依从性（CMA，0.51 vs. 0.40; P = 0.0225）;累积控制药物剂量较高（罐当量，10.9 vs. 5.2; P < 0.0001）;临床结局（哮喘相关生活质量、医疗保健使用、急救药物使用、哮喘控制和肺功能）明显更好。在第2年，与常规护理相比，SDM导致急救药物使用显著减少，这是该年唯一可用的临床结局。与临床医生决策相比，SDM导致：控制器依从性显著更好（CMA，0.67 vs. 0.59; P = 0.03）和长效β受体激动剂依从性（CMA，0.51 vs. 0.41; P = 0.0143）;累积控制剂剂量较高（CMA，10.9比9.1; P = 0.005）;和定量，但不显着，更好的结果对所有的临床measurement.Conclusions：谈判患者的治疗决定显着提高坚持哮喘药物治疗和临床结局。
Rationale: Poor adherence to asthma controller medications results in poor treatment outcomes.Objectives: To compare controller medication adherence and clinical outcomes in 612 adults with poorly controlled asthma randomized to one of two different treatment decision-making models or to usual care.Methods: In shared decision making (SDM), nonphysician clinicians and patients negotiated a treatment regimen that accommodated patient goals and preferences. In clinician decision making, treatment was prescribed without specifically eliciting patient goals/preferences. The otherwise identical intervention protocols both provided asthma education and involved two in-person and three brief phone encounters.Measurements and Main Results: Refill adherence was measured using continuous medication acquisition (CMA) indices the total days' supply acquired per year divided by 365 days. Cumulative controller medication dose was measured in beclomethasone canister equivalents. In follow-up Year 1, compared with usual care, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.46; P < 0.0001) and long-acting p-agonist adherence (CMA, 0.51 vs. 0.40; P = 0.0225); higher cumulative controller medication dose (canister equivalent, 10.9 vs. 5.2; P < 0.0001); significantly better clinical outcomes (asthma-related quality of life, health care use, rescue medication use, asthma control, and lung function). In Year 2, compared with usual care, SDM resulted in significantly lower rescue medication use, the sole clinical outcome available for that year. Compared with clinician decision making, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.59; P = 0.03) and long-acting beta-agonist adherence (CMA, 0.51 vs. 0.41; P = 0.0143); higher cumulative controller dose (CMA, 10.9 vs. 9.1; P = 0.005); and quantitatively, but not significantly, better outcomes on all clinical measures.Conclusions: Negotiating patients' treatment decisions significantly improves adherence to asthma pharmacotherapy and clinical outcomes.