PSYCHOLOGIC FACTORS AND PATIENT ADHERENCE - 03/09/11
Résumé |
Clinical practice guidelines have been issued to assist physicians in choosing the most appropriate and effective medications to improve patient outcomes.33 Most of these guidelines explicitly acknowledge that the success of medical therapy depends on the efficacy of the recommended treatment and the patient's adherence with that regimen. Adherence may be defined as the extent to which the patient's actual practice corresponds to the prescribed regimen.75 For ambulatory patients, adherence constitutes the link between medical process and treatment outcome.75 The goals of asthma management set down by two Expert Panel Reports under the auspices of the National Heart, Lung, and Blood Institute (NHLBI) are to (1) treat the patient with the least aggressive therapy sufficient to prevent chronic symptoms and exacerbations, (2) maintain normal activity and normal or near-normal lung function, (3) avoid missing school or work, and (4) eliminate sleep disruption.51, 52 The recommended treatment is organized around four components: (1) step-wise pharmacologic therapy adjusted to the severity of the patient's disease, (2) use of objective measures of lung function, (3) environmental control, and (4) patient education to advance a partnership among the patient, family, and clinicians.51, 52 The intent of the final component is to promote adherence fundamental to the success of the other three components. Accordingly, the step-wise approach to therapy recommended by these Expert Panel Reports can only succeed if there is adequate adherence by both physicians and patients.
The goals of the Expert Panels are not being met (Table 1). Asthma continues to be a leading cause of preventable hospitalization in the United States with 470,000 admissions and more than 5000 deaths a year.55 Fewer than half of the children who need emergency room treatment28 and adults who require hospitalization35 receive the anti-inflammatory therapy advocated by the Expert Panel Report-2,52 a deplorable neglect given that the use of low-dose inhaled corticosteroids is associated with a decreased risk of death from asthma (Figure 1).73
Estimates of adherence rates to therapeutic recommendations in long-term medical regimens range between 50% and 65%.46 For children with asthma, the average medication adherence rate of 48% was found in a review of 10 studies,20 and similar findings have been reported for adult patients.59, 69 One publication demonstrates that adolescents with diabetes who agree to participate in studies have a higher rate of adherence than those who do not.61 The accepted figures for adherence, though disappointing, may be overly optimistic.
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Vol 21 - N° 3
P. 589-604 - août 2001 Retour au numéro
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- STEROID-RESISTANT ASTHMA
- Joseph D. Spahn, Ronina Covar
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