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ЗАКЛЮЧЕНИЕ

Эффективность обучающих инициатив для больных БА изучена наиболее полно. Компоненты оптимальной образовательной программы для пациентов с астмой включают знания о болезни и проводимой терапии; средства контроля терапии; психосоциологические навыки существования с хронической болезнью; план действия. Методы обучения навыкам оптимального самоуправления должны быть изучены и проверены на использование в общей системе здравоохранения. Медицинские работники сталкиваются с проблемой ограниченного времени и отсутствия помещения для обучения больных БА. Чтобы охватить оптимальным обучением всех больных, необходимы изменения в политике и финансировании здравоохранения.

Поскольку многие варианты подходов к формированию навыков самоуправления приводят к сходным результатам, они могут быть выбраны на основании предпочтений врача и пациента. Пациентам с тяжелой астмой целесообразно использовать основные методы мониторирования болезни, в то время как для больных среднетяжелой и интермиттирующей астмой возможны иные варианты, однако они должны быть изучены и проверены. Должны быть разработаны методы представления критической информации и навыков людям с низким уровнем грамотности. Необходимо проводить дальнейшие исследования, чтобы выявить взаимосвязь между обучением, оптимальным режимом ведения, отношениями врач - больной, приверженностью и результатами лечения.

В отличие от астмы, целесообразность обучения навыкам самоуправления больных ХОБЛ четко не определена. Наибольшее внимание должно быть уделено этой растущей группе хронических больных. Новые и более усовершенствованные методы самоведения обострений ХОБЛ должны быть ориентированы на распознавание симптомов и определенные стратегии управления симптомами, а не только на назначение антибиотиков и пероральных ГКС.

Данные о методах формирования приверженности крайне скудны. Только небольшое число исследований, проведенных в соответствии со строгими стандартами, представляет несколько стратегий подобной работы среди хронических больных. Многие из предложенных методов слишком сложны, отнимают много времени и дорогостоящи, что затрудняет их использование в общей системе здравоохранения. Даже если эти методы успешны, не удается определить компоненты, которые больше всего повлияли на рост приверженности.

Недавнее заключение о том, что она связана с социальными и экономическими различиями, заставляет искать новые подходы к решению этой проблемы. Пока вопрос всеобщей доступности квалифицированной медицинской помощи не будет решен, низкая приверженность и, как следствие, скудные результаты лечения сохранятся в определенных группах населения. Еще одно направление научного поиска - исследование способов, позволяющих нацелить пациентов на эффективное лечение, поскольку представление о потенциальной выгоде и неблагоприятных эффектах поддается корректировке.

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