在COPD中,指导方针对齐和药物一致性
Meredith A Case1, Eric P Boorman1, Elizabeth Ruvalcaba1
1Division of Pulmonary and Critical Care Medicine (M. A. C., e. P. B., E. R., N. N. H., N. P., and M. N. E.), Johns Hopkins University School of Medicine, Baltimore, MD; and the Division of Pulmonary and Critical Care Medicine (M. T. V.), Christiana Care Health System, Wilmington, DE.
CHEST pulmonary
|April 22, 2024
概括
提供者-患者药物协议在COPD护理中很低,通常是由于过度使用吸入类皮质类固醇和未报告的药物. 这影响了疾病管理,并突出了沟通差距.
科学领域:
- 肺部医学 肺部医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 提供者遵守COPD临床指导方针是不理想的.
- 成功的患者-提供者沟通对于符合指南的护理和药物一致性至关重要.
- 药物一致率及其对COPD的临床影响尚未得到充分了解.
研究的目的:
- 评估COPD患者护理中的指导方针一致性和药物一致性.
- 确定与疾病管理不良结果相关的患者特异因素.
主要方法:
- 在COPD研究 (2017-2023) 中对药物坚持性研究的二次分析.
- 根据全球慢性阻塞性肺病倡议 (GOLD) 阶段对参与者进行分类.
- 分类药物治疗方案与2017年GOLD指南保持一致或不保持一致,并指出过度使用/过少使用.
- 在提供者和患者报告之间确定药物一致性.
- 使用后勤回归来评估与对齐和一致性相关的因素.
主要成果:
- 51%的提供者方案符合指导方针; 86%的未符合方案涉及吸入性皮质类固醇 (ICS) 的过度使用.
- 38%的患者报告了与提供者不同的治疗方案,主要是由于未报告的药物.
- 较大的症状负担,缺乏肺病学家,认知障碍和黑人种族与错位和/或不一致有关.
结论:
- 在COPD管理中,指导准则的错误调整和药物不一致是普遍存在的.
- 过度使用ICS和未报告的药物对这些问题作出了重大贡献.
- 患者层面的因素强调了需要改善患者-提供者沟通,以提高COPD临床结果的必要性.
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