背景:患者对维持药物治疗的依从性对于改善哮喘的临床结局至关重要,并且是推荐的治疗策略的指导因素。以前,APPARENT研究评估了患者和医生对哮喘护理的看法;在这里,一项事后分析旨在确定与良好依从性和治疗处方模式相关的患者因素.
方法:APPARENT1和2是对阿根廷的2866名哮喘成年人和1883名医生进行的横断面在线调查,澳大利亚,巴西,加拿大,中国,法国,意大利,墨西哥,菲律宾在2020-2021年。综合数据评估了对维持药物的依从性,治疗目标,使用哮喘行动计划,以及医生的治疗模式和偏好。多变量逻辑回归模型评估了患者特征与治疗处方(由医生)和患者治疗依从性之间的关联。
结果:患者和医生对治疗目标和依从性的评估不同,短效β2激动剂(SABA)处方以及维持和缓解治疗(MART)的报告也是如此。年龄较大,患者报告的严重程度和使用缓解药物与更好的依从性相关。患者报告的SABA与MART的处方与家庭吸烟有关,严重或控制不良的哮喘,生活在中国或菲律宾。
结论:结果显示,患者和医生的治疗目标和治疗依从性之间存在重要的脱节,这表明需要提高患者对维持药物治疗依从性的策略,专注于患有轻度疾病的年轻患者。尽管依从性良好,但使用高度缓解剂可能表明疾病控制不佳。考虑到患者特征的个性化护理以及在动机沟通和共享决策方面的医师培训可以改善患者管理和结果。
BACKGROUND: Patient adherence to maintenance medication is critical for improving clinical outcomes in asthma and is a recommended guiding factor for treatment strategy. Previously, the APPaRENT studies assessed patient and physician perspectives on asthma care; here, a post-hoc analysis aimed to identify patient factors associated with good adherence and treatment prescription patterns.
METHODS: APPaRENT 1 and 2 were cross-sectional online surveys of 2866 adults with asthma and 1883 physicians across Argentina, Australia, Brazil, Canada, China, France, Italy, Mexico, and the Philippines in 2020-2021. Combined data assessed adherence to maintenance medication, treatment goals, use of asthma action plans, and physician treatment patterns and preferences. Multivariable logistic regression models assessed associations between patient characteristics and both treatment prescription (by physicians) and patient treatment adherence.
RESULTS: Patient and physician assessments of treatment goals and adherence differed, as did reporting of short-acting β2-agonist (SABA) prescriptions alongside maintenance and reliever therapy (MART). Older age and greater patient-reported severity and reliever use were associated with better adherence. Patient-reported prescription of SABA with MART was associated with household smoking, severe or poorly controlled asthma, and living in China or the Philippines.
CONCLUSIONS: Results revealed an important disconnect between patient and physician treatment goals and treatment adherence, suggesting that strategies for improving patient adherence to maintenance medication are needed, focusing on younger patients with milder disease. High reliever use despite good adherence may indicate poor disease control. Personalised care considering patient characteristics alongside physician training in motivational communication and shared decision-making could improve patient management and outcomes.