Physician-patient communication as a tool that can change adherence.

摘要

The article by Ponieman and colleagues confirms that many patients with asthma take less inhaled corticosteroid (ICS) than prescribed and that adherence is likely to be higher when patients are not worried about adverse effects or potential for dependency, believe that ICSs work best when used continuously, and are confident in their ability to do so. Importantly, these belief-correlates of adherence underscore the fact that most nonadherence is not the consequence of forgetting or misunderstanding but the result of a decision made by the patient about whether to follow the treatment plan. That decision is often influenced by the patient's perception of the risks associated with the disease and the risks and benefits introduced by the treatment. Other studies have similarly concluded that patient reluctance may be based on fears about medication adverse effects, a perception that the medication is not helping, concerns about long-term dependence on the medication, and the cost of the medication. In a study of parents of 67 children with asthma, increased concerns about risks of taking asthma medications were associated with lower adherence; fewer concerns combined with a perception of benefit from the child's medication were associated with higher adherence. Patients who do not perceive a positive benefit-to-risk advantage to their treatment are likely to be ambivalent and uncommitted to a daily treatment regimen. Evidence of this ambivalence is seen in the finding that more than half of 5,500 patients who filled an ICS prescription once did not return to refill within 12 months. As adherence decreases, symptom control, emergency department visits, and hospitalizations increase.