依从性干预项目对哮喘患者的用药依从性障碍、哮喘控制和日常活动/能力的影响
2010/12/31
摘要
目的：本研究评价关注于用药依从性的哮喘患者干预项目对依从性障碍、哮喘控制和日常活动/能力的影响。
方法：东南部公立学校系统中≥18岁的、有≥1次哮喘主诉的、有≥1次哮喘治疗的患者入选本研究。在干预前和干预措施实施6个月后，采用ASK-20、哮喘控制检测（ACT）和生产力问卷进行检测。干预措施包括在两次阐述依从性障碍的外拨电话中，使用基线状态下ASK-20结果来生成患者特异性的、关于依从性障碍的主诉和照护管理者使用的谈话焦点。患者通过3次邮寄资料进行宣教。ASK-20是一个简要的、自我主诉的工具，用于鉴别患者特异性用药依从性障碍，改善供给者/患者交流有关依从性话题。
结果：入选的112名患者中，87名完成本项目(77.7%)。参与者平均年龄为48.2岁(SD = 10.5)，大部分为女性(86.2%)和白人(64.4%)。出现哮喘的年数为17.5 年(SD = 14.7)。有超过1/3(36.8%)的患者哮喘超过20年。干预措施与依从性障碍数量下降(3.8 to 2.8; p = .0021)相关，与哮喘控制改善（通过哮喘控制患者的百分数增加来反应，哮喘控制指ACT评分>19）(50.0% to 64.6%;P=0.0285)相关。同时，观察到因哮喘导致的家务或学习受限天数显著下降(p =0.0059)和因哮喘导致的家庭、社会或娱乐活动天数显著下降(p =0.0185)。大部分参与者(95%)认为该项目较好、很好或优秀。
结论：整合有临床评价工具（如ASK-20）、旨在鉴别药物治疗非依从的危险因素和开发患者特异性干预措施的项目，有助于减少哮喘患者依从性障碍，改善疾病控制和患者的日常活动。
（苏楠 审校）
J Asthma. 2010 Dec;47(10):1072-1077. Epub 2010 Nov 1.
Impact of an Adherence Intervention Program on Medication Adherence Barriers, Asthma Control, and Productivity/Daily Activities in Patients With Asthma.
Park J, Jackson J, Skinner E, Ranghell K, Saiers J, Cherney B.
GlaxoSmithKline, Research Triangle Park, North Carolina, U.S.A.
Abstract
Objective. This study evaluated the impact of an asthma patient intervention program, with a focus on medication adherence on adherence barriers, asthma control, and productivity/daily activities.
Methods. Patients ≥18 years old who were employed by a large Southeastern public school system, had ≥1 medical claim for asthma, and were taking ≥1 asthma medication were invited to participate in the study. The ASK-20, the Asthma Control Test (ACT), and a productivity questionnaire were administered before and after a 6-month period of intervention that involved the use of baseline ASK-20 results to create patient-specific reports on adherence barriers and talking points for care managers to use during the two outbound telephone calls addressing barriers identified. Patients also received three educational mailings. The ASK-20 is a brief, self-reported instrument developed to identify patient-specific barriers to medication adherence and to improve provider/patient communication about adherence. Results. Of 112 individuals who enrolled, 87 completed the program (77.7%). Participants’ mean age was 48.2 years (SD = 10.5), and most were female (86.2%) and white (64.4%). The mean number of years with asthma was 17.5 (SD = 14.7); approximately one third (36.8%) of participants had had asthma for >20 years. The intervention was associated with a significant reduction in the number of adherence barriers (3.8 to 2.8; p = .0021) as well as improvement in asthma control as reflected in an increase in the percentage of participants with controlled asthma defined as having an ACT score > 19 (50.0% to 64.6%; p = .0285). Significant reductions in the mean number of days that housework or schoolwork was limited by asthma (p = .0059) and the mean number of days that family, social, or recreational activities were missed or limited because of asthma (p = .0185) were also observed. The majority of the participants (95%) rated the program as being good, very good, or excellent. Conclusion. Programs incorporating a clinical assessment tool such as the ASK-20 for identifying a broad range of risk factors for nonadherence and for developing patient-specific intervention may reduce adherence barriers and improved disease control and ability to perform daily activities in patients with asthma.
J Asthma. 2010 Dec;47(10):1072-1077. Epub 2010 Nov 1.
目的：本研究评价关注于用药依从性的哮喘患者干预项目对依从性障碍、哮喘控制和日常活动/能力的影响。
方法：东南部公立学校系统中≥18岁的、有≥1次哮喘主诉的、有≥1次哮喘治疗的患者入选本研究。在干预前和干预措施实施6个月后，采用ASK-20、哮喘控制检测（ACT）和生产力问卷进行检测。干预措施包括在两次阐述依从性障碍的外拨电话中，使用基线状态下ASK-20结果来生成患者特异性的、关于依从性障碍的主诉和照护管理者使用的谈话焦点。患者通过3次邮寄资料进行宣教。ASK-20是一个简要的、自我主诉的工具，用于鉴别患者特异性用药依从性障碍，改善供给者/患者交流有关依从性话题。
结果：入选的112名患者中，87名完成本项目(77.7%)。参与者平均年龄为48.2岁(SD = 10.5)，大部分为女性(86.2%)和白人(64.4%)。出现哮喘的年数为17.5 年(SD = 14.7)。有超过1/3(36.8%)的患者哮喘超过20年。干预措施与依从性障碍数量下降(3.8 to 2.8; p = .0021)相关，与哮喘控制改善（通过哮喘控制患者的百分数增加来反应，哮喘控制指ACT评分>19）(50.0% to 64.6%;P=0.0285)相关。同时，观察到因哮喘导致的家务或学习受限天数显著下降(p =0.0059)和因哮喘导致的家庭、社会或娱乐活动天数显著下降(p =0.0185)。大部分参与者(95%)认为该项目较好、很好或优秀。
结论：整合有临床评价工具（如ASK-20）、旨在鉴别药物治疗非依从的危险因素和开发患者特异性干预措施的项目，有助于减少哮喘患者依从性障碍，改善疾病控制和患者的日常活动。
（苏楠 审校）
J Asthma. 2010 Dec;47(10):1072-1077. Epub 2010 Nov 1.
Impact of an Adherence Intervention Program on Medication Adherence Barriers, Asthma Control, and Productivity/Daily Activities in Patients With Asthma.
Park J, Jackson J, Skinner E, Ranghell K, Saiers J, Cherney B.
GlaxoSmithKline, Research Triangle Park, North Carolina, U.S.A.
Abstract
Objective. This study evaluated the impact of an asthma patient intervention program, with a focus on medication adherence on adherence barriers, asthma control, and productivity/daily activities.
Methods. Patients ≥18 years old who were employed by a large Southeastern public school system, had ≥1 medical claim for asthma, and were taking ≥1 asthma medication were invited to participate in the study. The ASK-20, the Asthma Control Test (ACT), and a productivity questionnaire were administered before and after a 6-month period of intervention that involved the use of baseline ASK-20 results to create patient-specific reports on adherence barriers and talking points for care managers to use during the two outbound telephone calls addressing barriers identified. Patients also received three educational mailings. The ASK-20 is a brief, self-reported instrument developed to identify patient-specific barriers to medication adherence and to improve provider/patient communication about adherence. Results. Of 112 individuals who enrolled, 87 completed the program (77.7%). Participants’ mean age was 48.2 years (SD = 10.5), and most were female (86.2%) and white (64.4%). The mean number of years with asthma was 17.5 (SD = 14.7); approximately one third (36.8%) of participants had had asthma for >20 years. The intervention was associated with a significant reduction in the number of adherence barriers (3.8 to 2.8; p = .0021) as well as improvement in asthma control as reflected in an increase in the percentage of participants with controlled asthma defined as having an ACT score > 19 (50.0% to 64.6%; p = .0285). Significant reductions in the mean number of days that housework or schoolwork was limited by asthma (p = .0059) and the mean number of days that family, social, or recreational activities were missed or limited because of asthma (p = .0185) were also observed. The majority of the participants (95%) rated the program as being good, very good, or excellent. Conclusion. Programs incorporating a clinical assessment tool such as the ASK-20 for identifying a broad range of risk factors for nonadherence and for developing patient-specific intervention may reduce adherence barriers and improved disease control and ability to perform daily activities in patients with asthma.
J Asthma. 2010 Dec;47(10):1072-1077. Epub 2010 Nov 1.
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哮喘控制检测的有效性和可靠性证据：来自希腊的研究
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儿童和青少年难治性哮喘患者的行为问题
