Therapieadhärenz bei Asthma bronchiale

Zusammenfassung

Die Mitarbeit von Patienten mit einem Asthma ist schlecht. Nur ca. 50 % aller Patienten nehmen die ihnen verordnete Medikation wie vom Arzt verschrieben. Mit verschiedenen Maßnahmen, die von einfachen Ermahnungen, Schulungsmaßnahmen, Vereinfachung und Minimierung von Therapien und Tagesdosen über komplexe multidisziplinäre Interventionen reichen, wurde versucht, die Rate der Patientenmitarbeit zu steigern und die Arzt-Patientenbeziehung zu verbessern. Auch seitens des behandelnden Arztes existieren viele direkte und indirekte, die Patientenmitarbeit negativ beeinflussende Faktoren. Sowohl die auf den Patienten als auch auf den behandelnden Arzt bezogenen Maßnahmen zur Verbesserung der Patiente-Adhärenz haben allerdings häufig nur einen bescheidenen Langzeiterfolg. Zudem fehlt in den meisten Studien der Nachweis, dass eine Verbesserung der Therapie-Adhärenz tatsächlich auch zu einer klinischen Verbesserung führt. In dieser Übersicht werden die aktuelle Studienlage und die zu erwartenden Erfolgsaussichten der evaluierten Interventionen zum Thema vorgestellt.

Summary

An estimated 50% of all asthma patients do not take the medication as prescribed, i.e. are non-compliant. Numerous interventions have been done to improve patients' compliance have been evaluated in clinical studies, ranging from simple adjustments in the medication regimen to complex multidisciplinary interventions that address health system barriers and communication between patients and health care professionals. Beliefs or disbeliefs of health care professionals affect patients' compliance. Efforts to improve the adherence of physicians to asthma guidelines have been tested in numerous studies. Although several types of interventions are effective in improving compliance to medication for asthma, only a few indicated whether this success would actually result in clinical improvement. This review surveys the different options for enhancing compliance rates in patients with asthma.

Schlüsselwörter

Asthma - Management - Arzt-Patient-Beziehung - Applikationsform - Asthmaschulung - Compliance - Adhärenz

Key words

asthma - management - adherence - compliance - application form - education - training

Literatur

• 1 Andersen M, Kragstrup J, Sondergaard J. How conducting a clinical trial affects physician’s guideline adherence and drug preferences.  JAMA. 2006;  295 2759-2764
• 2 Balkrishnan R, Christensen D B. Inhaled corticosteroid nonadherence and immediate avoidable medical events in older adults with chronic pulmonary ailments.  J Asthma. 2000;  37 511-517
• 3 Bateman E D, Hurd S S, Barnes P J. et al . Global strategy for asthma management and prevention: GINA executive summary.  Eur Respir J. 2008;  31 143-178
• 4 Bender B, Milgrom H, Apter A. Adherence intervention research: what have we learned and what do we do next?.  J Allergy Clin Immunol. 2003;  112 489-494
• 5 Bender B, Milgrom H, Rand C, Ackerson L. Psychological factors associated with medication nonadherence in asthmatic children.  J Asthma. 1998;  35 347-353
• 6 Bender B G. Overcoming barriers to nonadherence in asthma treatment.  J Allergy Clin Immunol. 2002;  109 S554-S559
• 7 Bosley C M, Parry O T, Cochrane G M. Patient compliance with inhaled medication: does combining beta-agonists with corticosteroids improve compliance?.  Eur Respir J. 1994;  7 504-509
• 8 Buhl R, Berdel D, Criee C -P. et al . Leitlinie zur Diagnostik und Therapie von Patienten mit Asthma der Deutschen Atemwegsliga und der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e. V.  Pneumologie. 2006;  60 139-183
• 9 Cabana M D, Rand C S, Wu A W, Wilson M H, Abboud P A, Rubin H R. Why don’t patients follow clinical practice guidelines?- A framework for improvement.  JAMA. 1999;  282 1458-1465
• 10 Cabana M D, Slish K K, Evans D. et al . Impact of physician asthma care education on patient outcomes.  Pediatrics. 2006;  117 2149-2157
• 11 Cerveri I, Locatelli F, Zoia M C, Corsico A, Accordini S, de Marco R. International variations in the asthma treatment compliance. The results of the European Community Respiratory Health Survey (ECRHS).  Eur Respir J. 1999;  14 288-294
• 12 Chen E, Chim L S, Strunk R C, Miller G E. The role of the social environment in children and adolsecents with asthma.  Am J Respir Crit Care Med. 2007;  176 644-649
• 13 Coleman C I, Reddy P, Laster-Bradley N M, Dorval S, Munagala B, White C M. Effect of practitioner education on adherence to asthma treatment guidelines.  Ann Pharmacother. 2003;  37 956-961
• 14 Cote J, Bowie D M, Robichaud P, Parent J G, Battisti L, Boulet L P. Evaluation of two different educational interventions for adult patients consulting with an acute asthma exacerbation.  Am J Respir Crit Care Med. 2001;  163 1415-1419
• 15 Coutts J AP, Gibson N A, Paton J Y. Measuring compliance with inhaled medication in asthma.  Arch Dis Child. 1991;  67 332-333
• 16 Das G upta R, Guest J F. Factors affecting UK primary-care costs of managing patients with asthma over 5 years.  Pharmacoeconomics. 2006;  21 357-369
• 17 Davis R S, Bukstein D A, Luskin A T, Kailin J A, Goodenow G. Changing physician prescribing patterns through problem-based learning: an interactive, teleconference case-based education program and review of problem-based learning.  Ann Allergy Asthma Immunol. 2004;  93 237-242
• 18 van Es S M, Nagelkerke A F, Colland V T, Scholten R J, Bouter L M. An intervention programme using the ASE-model aimed at enhancing adherence in adolescents with asthma.  Patient Educ Couns. 2001;  44 193-203
• 19 Farber H J, Oliveria L. Trial of asthma education program in an inner-city pediatric emergency department.  Pediatr Asthma Allergy Immunol. 2004;  17 107-115
• 20 Fiese B H, Everhart R S. Medical adherence and childhood chronic illness: family daily management skills and emotional climate as emerging contributions.  Curr Opin Pediatr. 2006;  18 551-557
• 21 Fiese B H, Wamboldt F S, Anbar R B. Family asthma management routines: connections to medical adherence and quality of life.  J Pediatr. 2005;  146 171-176
• 22 Finkelstein J A, Lozano P, Shulruff R. et al . Self-reported physician practices for children with asthma: are national guidelines followed ?.  Pediatrics. 2000;  106 886-896
• 23 Gallefoss F, Bakke P S. How does patient education and self-management among asthmatics and patients with chronic obstructive pulmonary disease affect medication?.  Am J Respir Crit Care Med. 1999;  160 2000-2005
• 24 Gebert N, Hummeling R, Konning J. et al . Efficacy of a self-management program for childhood asthma – a prospective controlled study.  Patient Educ Couns. 1998;  35 213-220
• 25 Gillissen A. Managing asthma in the real world.  Int J Clin Pract. 2004;  58 592-603
• 26 Gillissen A, Büsch K, Juergens U R. Therapieadhärenz bei Asthma bronchiale: Definition – Einteilung – beeinflussende Faktoren.  Dtsch Med Wschr. 2007;  132 1281-1286
• 27 Giraud V, Roche N. Misuse of corticosteroid metered-dose inhaler is associated with decreased asthma stability.  Eur Respir J. 2002;  19 246-251
• 28 Haynes R B, McKibbon K A, Kanani R. Systematic review of randomised trials of interventions to assist patients to follow prescriptions for medications.  Lancet. 1996;  348 383-386
• 29 Haynes R, Ackloo E, Sahota N, McDonald H, Yao X. Interventions for enhancing medication adherence.  Database Syst Rev. 2008 ;  (2) ) , CD000011
• 30 Hernandez D V, Schmaling K B. Understanding and resolving adherence problems.  Clin Rev Allergy Immunol. 2004;  27 65-73
• 31 Ignacio-Garcia J -M, Pinto-Tenorio M, Chocrón-Giraldez M J. et al . Benefits of 3 yrs of an asthma education programme coupled with regular reinforcement.  Eur Respir J. 2002;  20 1095-1101
• 32 Joseph C LM, Peterson E, Havstad S. et al . A web-based, tailored asthma management program for urban african-american high school students.  Am J Respir Crit Care Med. 2007;  175 888-895
• 33 Kelloway J S, Wyatt R A, Adlis S A. Comparison of patients’ compliance with prescribed oral and inhaled asthma medications.  Arch Int Med. 1994;  154 1349-1352
• 34 Kripalani S, Yao X, Haynes B. Interventions to enhance medication adherence in chronic medical conditions.  Arch Int Med. 2007;  167 540-550
• 35 Krym V F, Crawford B, Macdonald R D. Compliance with guidelines for emergency management of asthma in adults: experience at a tertiary care teaching hospital.  CJEM. 2004;  6 321-326
• 36 Lemanek K L, Kamps J, Chung N B. Empirically supported treatments in pediatric psychology: regimen adherence.  J Pediatr Psychol. 2001;  26 253-275
• 37 Levy M L, Robb M, Allen J, Doherty C, Bland J M, Winter R J. A randomized controlled evaluation of specialist nurse education following accident and emergency department attendance for acute asthma.  Respir Med. 2000;  94 900-908
• 38 McPherson A C, Glazebrook C, Smyth A R. Education interventions-computers for delivering education to children with respiratory illness and to their parents.  Paediatr Resp Rev. 2005;  6 215-226
• 39 Milgrom H, Bender B, Ackerson L M, Bowry P, Smith B, Rand C S. Noncompliance and treatment failure in children with asthma.  J Allergy Clin Immunol. 1996;  98 1051-1057
• 40 Morice A H, Wrench C. The role of the asthma nurse in treatment compliance and self-management following hospital admission.  Respir Med. 2001;  95 851-856
• 41 Navaratnam P, Jayawant S S, Pedersen C A, Balkrishnan P. Physician adherence to the national asthma prescribing guidelines: evidence from national outpatient survey data in United States.  Ann Allergy Asthma Immunol. 2008;  100 216-221
• 42 Roghmann M C, Sexton M. Adherence to asthma guidelines in general practices.  J Asthma. 1999;  36 381-387
• 43 Sarrell E M, Mandelberg A, Cohen H A, Kahan E. Compliance of primary care doctors with asthma guidelines and related education programs: the employment factor.  IMAJ. 2002;  4 403-406
• 44 Sawyer S M. Action plans, self-monitoring and adherence: changing behaviour to promote better self-management.  MJA. 2002;  177 S72-S74
• 45 Schaffer S D, Tian L. Promoting adherence: effects of theory-based asthma education.  Clin Nurs Res. 2004;  13 69-89
• 46 Schmier J K, Leidy N K. The complexity of treatment adherence in adults with asthma: challenges and opportunities.  J Asthma. 1998;  35 455-472
• 47 Stoloff S W, Stempel D A, Meyer J, Stanford R H, Carranza R osenzweig JR. Improved refill persistence with fluticasone propionate and salmeterol in a single inhaler compared with other controller therapies.  J Allergy Clin Immunol. 2004;  113 245-251
• 48 Voshaar T, App E M, Berdel D. et al . Empfehlungen für die Auswahl von Inhalationssystemen zur Medikamentenverabreichung.  Pneumologie. 2002;  55 579-586
• 49 Warsi A, Wang P S, LaValley M P, Avom J, Solomon D H. Self-management education programs in chronic disease: a systematic review and methodological critique of the literature.  Arch Intern Med. 2004;  164 1641-1649
• 50 Weinberger M, Murray M D, Marrero D G. et al . Effictiveness of pharmacist care for patients with reactive airways disease: a randomized controlled trial.  JAMA. 2002;  288 1594-1602
• 51 Wise M, Gustafson D H, Sorkness C A. et al . Internet telehealth for pediatric asthma case management: integrating computerized and case manager features for tailoring a web-based asthma education program.  Health Promot Pract. 2007;  8 282-291