ASTIMLI HASTALARDA TEDAVİ UYUMSUZLUĞU SIKLIĞI VE NEDENLERİ

Yıl 2017, Cilt: 31 Sayı: 3, 125 - 133, 01.12.2017

Seçil Kepil Özdemir Selcan Özgüçlü

Öz

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

Öz

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.

Anahtar Kelimeler

Adherence, asthma, asthma treatment

Kaynakça

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