哮喘药物治疗依从性的障碍:风俗及环境的重要性
2018/06/04
摘要
目的：哮喘结局在不同人群中存在显著差异。少数民族或种族患者的控制性药物依从性较低，这可能是导致少数民族和非少数民族哮喘发病率差异的原因。本综述的目的是确定导致这种药物使用模式不足的问题，包括个体、患者与医务人员之间的沟通和系统的问题，并讨论可能的干预策略。
数据源：数据来自多个来源，包括药房、医疗记录报告、观察性研究和临床试验。
研究选择：筛选出分析了种族和民族差异而引起哮喘药物依从性模式差异的研究。
结果：有明确的证据表明，少数民族和种族患者哮喘控制药物使用不足包括处方接受、处方执行及获得药物后的使用情况等方面。个体因素如对药物信心和抑郁症状在其中具有重要作用。患者与医务人员之间的交流也与之相关，包括对补充和替代医学（CAM）运用的相关讨论的有限性，因英语水平有限而导致患者与护理人员之间交流困难，以及对文化差异所隐含的偏见等。系统问题（例如，保险状况，医疗费用）和社会背景因素（例如暴力）也为此带来了挑战。充分利用患者力量的文化知情策略和培训医务人员文化知情交流策略有望成为干预措施。
结论：控制性药物使用的差异非常普遍。在最大哮喘负担的群体中找出这些差异的根源是建立干预方法以加强疾病管理的关键步骤。
Barriers to medication adherence in asthma: the importance of culture and context
Elizabeth，et al, Ann Allergy Asthma Immunol, 2018 Mar 26. Abstract
Abstract
OBJECTIVE：Significant disparities exist in asthma outcomes. Racial and ethnic minorities have lower controller medication adherence, which may contribute to differences in asthma morbidity between minority and non- minority groups. The objective of this review is to identify individual, patient-provider communication, and systems issues that contribute to this pattern of medication underuse and to discuss potential strategies for intervention.
DATA SOURCES：Data were gathered from numerous sources, including reports of pharmacy and medical records,observational studies, and trials.
Study Selection. Studies analyzed factors contributing to patterns of asthma medication adherence that differ by race and ethnicity.
RESULTS：There is clear evidence of underuse of asthma controller medications among racial and ethnic minorities in prescription receipt, prescription initiation, and medication use once obtained. Individual factors such as medication beliefs and depressive symptoms play a role. Provider communication is also relevant, including limited discussion of Complementary and Alternative Medicine (CAM) use, difficulties communicating with patients and caregivers with limited English proficiency (LEP), and implicit biases regarding cultural differences. Systems issues (e.g., insurance status, cost) and social context factors (e.g. exposure to violence) also present challenges. Culturally-informed strategies that capitalize on patient strengths and training providers in culturally-informed communication strategies hold promise as intervention approaches.
CONCLUSION：Disparities in controller medication use are pervasive. Identifying the sources of these disparities is a critical step toward generating intervention approaches to enhance disease management among the groups that bear the greatest asthma burden.
目的：哮喘结局在不同人群中存在显著差异。少数民族或种族患者的控制性药物依从性较低，这可能是导致少数民族和非少数民族哮喘发病率差异的原因。本综述的目的是确定导致这种药物使用模式不足的问题，包括个体、患者与医务人员之间的沟通和系统的问题，并讨论可能的干预策略。
数据源：数据来自多个来源，包括药房、医疗记录报告、观察性研究和临床试验。
研究选择：筛选出分析了种族和民族差异而引起哮喘药物依从性模式差异的研究。
结果：有明确的证据表明，少数民族和种族患者哮喘控制药物使用不足包括处方接受、处方执行及获得药物后的使用情况等方面。个体因素如对药物信心和抑郁症状在其中具有重要作用。患者与医务人员之间的交流也与之相关，包括对补充和替代医学（CAM）运用的相关讨论的有限性，因英语水平有限而导致患者与护理人员之间交流困难，以及对文化差异所隐含的偏见等。系统问题（例如，保险状况，医疗费用）和社会背景因素（例如暴力）也为此带来了挑战。充分利用患者力量的文化知情策略和培训医务人员文化知情交流策略有望成为干预措施。
结论：控制性药物使用的差异非常普遍。在最大哮喘负担的群体中找出这些差异的根源是建立干预方法以加强疾病管理的关键步骤。
(中国医科大学附属第一医院呼吸与危重症医学科 李文扬 摘译 杨冬 审校)
(Elizabeth，et al, Ann Allergy Asthma Immunol, 2018 Mar 26. Abstract )
(Elizabeth，et al, Ann Allergy Asthma Immunol, 2018 Mar 26. Abstract )
Barriers to medication adherence in asthma: the importance of culture and context
Elizabeth，et al, Ann Allergy Asthma Immunol, 2018 Mar 26. Abstract
Abstract
OBJECTIVE：Significant disparities exist in asthma outcomes. Racial and ethnic minorities have lower controller medication adherence, which may contribute to differences in asthma morbidity between minority and non- minority groups. The objective of this review is to identify individual, patient-provider communication, and systems issues that contribute to this pattern of medication underuse and to discuss potential strategies for intervention.
DATA SOURCES：Data were gathered from numerous sources, including reports of pharmacy and medical records,observational studies, and trials.
Study Selection. Studies analyzed factors contributing to patterns of asthma medication adherence that differ by race and ethnicity.
RESULTS：There is clear evidence of underuse of asthma controller medications among racial and ethnic minorities in prescription receipt, prescription initiation, and medication use once obtained. Individual factors such as medication beliefs and depressive symptoms play a role. Provider communication is also relevant, including limited discussion of Complementary and Alternative Medicine (CAM) use, difficulties communicating with patients and caregivers with limited English proficiency (LEP), and implicit biases regarding cultural differences. Systems issues (e.g., insurance status, cost) and social context factors (e.g. exposure to violence) also present challenges. Culturally-informed strategies that capitalize on patient strengths and training providers in culturally-informed communication strategies hold promise as intervention approaches.
CONCLUSION：Disparities in controller medication use are pervasive. Identifying the sources of these disparities is a critical step toward generating intervention approaches to enhance disease management among the groups that bear the greatest asthma burden.
上一篇：
使用混合模型作为映射工具方法的进展: 在哮喘患者中将 AQLQ-S 与 EQ-5D-5L 和 HUI3进行映射
下一篇：
在乡村学校通过远程医疗进行的哮喘教育项目结果
