哮喘联盟

   摘要
   背景：哮喘需要个体化的治疗和悉心的管理来控制、预防症状和急性发作的产生。最好的治疗依赖于药物和吸入装置的选择。然而，经济的压力可能会导致患者为了节约成本在药物和装置中只选择一项进行更换以降低费用。
   目的：本综述旨在研究已发表的文献来确定更换哮喘患者药物或装置是否对临床和经济造成负面影响。
   材料和方法：在MEDLINE文献库中（2001年9月13日～2011年）进行检索，确认关注以下内容的英文文献：在哮喘患者中，换用药物或吸入装置的直接影响，由固定剂量联合治疗改变为通过分离吸入器的单药治疗的直接影响；更换治疗的间接影响亦被评估。
   结果：证据表明，在哮喘患者中，不同意更换药物和装置与多种负面影响相关，包括患者个体和组织层面的影响。降低依从性的影响因素可能影响症状控制，导致医疗资源使用增加和生活质量降低。
   讨论：应将不同意更换治疗的后果和支持更换治疗的观点（不考虑患者是否因非药物因素/预算因素而同意更换）进行仔细的权衡，例如初始成本的潜在降低，可能与后续额外的医疗保健需求相关。
   结论：基于持续增加的降低费用和有效配置有限的医疗成本的压力，确保药物治疗依从性的额外投资可能通过降低医疗保健服务而带来更大的节省。相反，购置成本的节省可能导致更多花费，因为哮喘控制不佳会引起医疗保健服务的增加。
 

（苏楠 审校）
Int J Clin Pract. 2013 Sep;67(9):904-10. doi: 10.1111/ijcp.12202. Epub 2013 Jun 16.

 

Potential negative consequences of non-consented switch of inhaled medications and devices in asthma patients.

Björnsdóttir US, Gizurarson S, Sabale U.
 

ABSTRACT
BACKGROUND:Asthma requires individually tailored and careful management to control and prevent symptoms and exacerbations. Selection of the most appropriate treatment is dependent on both the choice of drugs and inhaler device; however, financial pressures may result in patients being switched to alternative medications and devices in an attempt to reduce costs.
AIM:This review aimed to examine the published literature in order to ascertain whether switching a patient's asthma medications or device negatively impacts clinical and economic outcomes.
MATERIALS AND METHODS:A literature search of MEDLINE (2001-13 September 2011) was conducted to identify English-language articles focused on the direct impact of switching medications and inhaler devices and switching from fixed-dose combination to monocomponent therapy via separate inhalers in patients with asthma; the indirect impacts of switching were also assessed.
RESULTS:Evidence showed that non-consented switching of medications and inhalers in patients with asthma can be associated with a range of negative outcomes, at both individual and organisational levels. Factors that reduce adherence may lead to compromised symptom control resulting in increased healthcare resource utilisation and poorer patient quality of life.
DISCUSSION:The consequences of a non-consented switch should be weighed carefully against arguments supporting an inhaler switch without the patient's consent for non-medical/budgetary reasons, such as potential reductions in initial acquisition costs, which may be associated with subsequent additional healthcare needs.
CONCLUSION:Given the increasing pressure for reduced costs and efficient allocation of limited healthcare resources, an additional investment in ensuring high medication adherence may lead to greater savings due to a potentially decreased demand for healthcare services. In contrast, savings achieved in acquisition costs may result in a greater net loss due to increased healthcare consumption caused by decreased asthma control.
 

Int J Clin Pract. 2013 Sep;67(9):904-10. doi: 10.1111/ijcp.12202. Epub 2013 Jun 16.