Patient adherence in COPD.
Patient adherence in COPD.
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DOI：
10.1136/thx.2007.086041
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发表时间：
2008-09
期刊：
影响因子：
10
通讯作者：
Bartlett SJ
中科院分区：
文献类型：
--
作者：
Bourbeau J;Bartlett SJ
慢性阻塞性肺疾病（COPD）患者的治疗依从性对于优化疾病管理至关重要。与其他慢性病一样，依从性差很常见，导致发病率、医疗保健支出、住院率和可能的死亡率增加，以及不必要的治疗升级和生活质量下降。例子包括过度使用，使用不足，改变时间表和剂量的药物，继续吸烟和缺乏锻炼。依从性受患者对其疾病的感知、治疗或药物的类型、患者提供者沟通的质量和社会环境的影响。当患者认为治疗将改善疾病管理或控制，或预期与不依从相关的严重后果时，他们更有可能坚持治疗。提供者在帮助患者了解疾病的性质、治疗的潜在益处、解决对潜在不良反应和事件的担忧以及鼓励患者发展自我管理技能方面发挥着关键作用。对于临床医生来说，重要的是要探索患者的信念和对治疗安全性和益处的担忧，因为许多患者怀有不言而喻的恐惧。复杂的方案和多药疗法也有助于次优的依从性。本综述讨论了COPD患者依从性相关问题，评估了目前为提高依从性所做的努力，并强调了提高医疗服务提供者和患者依从性的机会。
Patient adherence to treatment in chronic obstructive pulmonary disease (COPD) is essential to optimise disease management. As with other chronic diseases, poor adherence is common and results in increased rates of morbidity, healthcare expenditures, hospitalisations and possibly mortality, as well as unnecessary escalation of therapy and reduced quality of life. Examples include overuse, underuse, and alteration of schedule and doses of medication, continued smoking and lack of exercise. Adherence is affected by patients’ perception of their disease, type of treatment or medication, the quality of patient provider communication and the social environment. Patients are more likely to adhere to treatment when they believe it will improve disease management or control, or anticipate serious consequences related to non-adherence. Providers play a critical role in helping patients understand the nature of the disease, potential benefits of treatment, addressing concerns regarding potential adverse effects and events, and encouraging patients to develop self-management skills. For clinicians, it is important to explore patients’ beliefs and concerns about the safety and benefits of the treatment, as many patients harbour unspoken fears. Complex regimens and polytherapy also contribute to suboptimal adherence. This review addresses adherence related issues in COPD, assesses current efforts to improve adherence and highlights opportunities to improve adherence for both providers and patients.