Seçil KEPİL ÖZDEMİR, Selcan ÖZGÜÇLÜ

ASTIMLI HASTALARDA TEDAVİ UYUMSUZLUĞU SIKLIĞI VE NEDENLERİ

Amaç: Astım kontrolünün sağlanamamasının önemli nedenlerinden biri hastaların tedaviye uyumsuzluğudur. Bu çalışmada astımlı hastalarda tedavi uyumsuzluğu sıklığı ve nedenlerini araştırmak amaçlandı. Yöntem ve Gereç: Çalışmaya en az üç aydır astım tanısı olan ve düzenli kontrol edici tedavi önerilen 103 astımlı hasta alındı. Hastaların son üç ay içindeki tedavi uyumu hasta bildirimleri ve eczane kayıtları kullanılarak değerlendirildi. Hastanın alması gereken kontrol edici ilacın ≥%80’ini alması durumu ‘‘tam uyum’’, <%80’ini alması ise ‘‘tedavi uyumsuzluğu’’ olarak sınıflandı. Tedavi uyumsuzluğu olması durumunda nedenler sorgulandı. Bulgular: Hasta bildirimine dayalı tedavi uyumsuzluğu sıklığı %47.6, eczane kayıtlarına dayalı tedavi uyumsuzluğu sıklığı %48.5 saptandı. Hasta bildirimleri ve eczane kayıtları birlikte değerlendirildiğinde tedavi uyumsuzluğu sıklığı %56.3 bulundu. En sık bildirilen tedavi uyumsuzluğu nedenleri ‘‘İlacımı almayı unutuyorum’’ (%43.1), ‘‘İlaç yan etkilerinden korkuyorum’’ (%39.7), ‘‘Dü- zenli ilaç kullanmam gerektiğini düşünmüyorum’’ (%29.3) idi. Tedavi uyumsuzluğu olan hastaların %75.9’unda bilinçli uyumsuzluk, %43.1’inde düzensiz uyumsuzluk, %22.4’ünde istemsiz uyumsuzluk saptandı. Ek atopik hastalık varlığı ve GINA kriterlerine göre tam kontrol oranları, tedavi uyumu iyi olan grupta, tedavi uyumsuzluğu olan gruba göre daha yüksek bulundu. Sonuç: Astım hastalarının yarısından fazlasında kontrol edici tedaviye uyumsuzluk mevcuttur. Tedavi uyumunun, hem hastaya sorularak hem de eczane kayıtlarının incelenmesi gibi objektif bir yöntemle değerlendirilmesi, tedavi uyumsuzluğunun saptanma oranlarını arttırmaktadır.

Anahtar Kelimeler:

Astım, astım tedavisi, uyum

THE FREQUENCY AND REASONS OF TREATMENT NONADHERENCE IN PATIENTS WITH ASTHMA

Aim: An important reason for poor asthma control is nonadherence to treatment. The aim of this study was to explore treatment nonadherence rates and reasons in patients with asthma. Material and Methods: The study included 103 patients with a diagnosis of asthma for at least three months, in whom regular controller treatment was recommended. Treatment adherence during the last three months was evaluated based on self-reports and pharmacy records. The status of receiving ≥80% of the required controller medication was classified as ‘‘complete adherence’’, while receiving <80% was classified as ‘‘ treatment nonadherence’’. In case of nonadherence the reasons were questioned. Results: The frequency of treatment nonadherence based on patients self-reports and pharmacy records was 47.6% and 48.5%, respectively. When patients self-reports and pharmacy records were evaluated together, the frequency of treatment nonadherence was 56.3%. The most frequent reasons for treatment non-adherence were ‘‘I forget to take my medication’’ (43.1%), ‘‘I am afraid of medication side effects’’ (39.7%), and ‘‘I do not think that I should use regular medication’’ (29.3%). Intelligent nonadherence was detected in 75.9%, erratic nonadherence in 43.1%, and unwitting nonadherence in 22.4% of the nonadherent patients. Presence of atopic comorbid diseases and well control according to GINA criteria were more frequent in patients with good adherence compared to patients with nonadherence. Conclusion: More than half of the patients with asthma show treatment nonadherence. Assessment of treatment adherence both by asking the patient and by an objective method like examining pharmacy records increases detection rates of treatment nonadherence.

Keywords:

Adherence, asthma, asthma treatment,

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