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Nava LF, Duarte TTDP, Lima WLD, Magro MCDS. Monitoramento avançado de enfermagem: pacientes de risco na atenção primária. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo avaliar o efeito do monitoramento de enfermagem avançado em relação ao usual para identificação do risco cardiovascular e renal, adesão medicamentosa e prática de exercícios na atenção primária à saúde. Método estudo quantitativo, quase-experimental desenvolvido na Atenção primária. Em relação a intervenção, foram consultas de enfermagem trimestrais de monitoramento avançado e laboratorial trimestral. Para coleta de dados, aplicou-se questionário sociodemográfico, escala Morisky e Questionário Internacional de Atividade Física. Resultados sexo feminino predominou nos dois grupos intervenção e controle (62,79% vs. 76,74%). O percentual de pacientes sem risco cardiovascular do grupo intervenção superou o grupo controle da consulta 1 para consulta 3, (0,00% - 25,58% vs. 6,98 - 2,33). Adesão medicamentosa máxima, ao longo do tempo, foi superior no grupo intervenção comparado ao grupo controle (48,8% vs. 23,3%). O risco cardiovascular dos usuários interferiu na atividade física de forma significativa no grupo intervenção e controle (p=0,0261 vs. 0,0438). Conclusões e implicações para a prática a monitorização avançada possibilitou uma melhor identificação de pacientes de risco e orientações aos pacientes hipertensos e diabéticos com risco cardiovascular e renal, o que favoreceu o monitoramento avançado e contribuiu ao autogerenciamento da prática de exercícios e adesão medicamentosa, a partir de consultas de enfermagem.
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Drummond ED, Simões TC, Andrade FBD. An evaluation of non-adherence to pharmacotherapy for chronic diseases and socioeconomic inequalities in Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200080. [PMID: 32696928 DOI: 10.1590/1980-549720200080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/16/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate non-adherence to pharmacotherapy for chronic diseases and to investigate the existence of socioeconomic inequalities related to this outcome in Brazil. METHODS This was a cross-sectional study based on data from the National Survey on Access, Use and Promotion of the Rational Use of Medicines (PNAUM). The study population corresponded to individuals aged 18 years or older with a medical diagnosis of at least one chronic disease and an indication for pharmacological treatment. The dependent variable was non-adherence to chronic disease pharmacotherapy measured by less than 80% adherence to drug therapy. Socioeconomic inequality related to non-adherence was assessed by absolute (SII) and relative (RII) inequality indices, calculated by logistic regression analyses. RESULTS The prevalence of non-adherence to pharmacotherapy in Brazil was 20.2%, ranging from 17.0 to 27.8% between regions. Furthermore, this study revealed absolute and relative socioeconomic inequalities in non-adherence to pharmacotherapy of chronic diseases in Brazil (SII = -7.4; RII = 0.69) and the Northeast (SII = -14.0; RII = 0.59) and Center West (SII = -20.8; RII = 0.38) regions. The probability of non-adherence to pharmacotherapy in Brazil was higher among individuals with worse socioeconomic status. CONCLUSION The findings of the present study indicate the need for the restructuring and strengthening of public policies aimed at reducing socioeconomic inequalities, in order to promote equity in adherence to the pharmacotherapy associated with chronic diseases.
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Ferreira J. Doenças crônicas não transmissíveis e os dilemas do cuidado: a teoria da ordem negociada revisitada. SAUDE E SOCIEDADE 2020. [DOI: 10.1590/s0104-12902020190149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo As doenças crônicas não transmissíveis são responsáveis por um alto índice de mortalidade no Brasil. Do ponto de vista socioantropológico, elas são exemplares na ilustração da experiência do mundo do doente em todas as dimensões da sua vida, tanto nos aspectos simbólicos como socioeconômicos e na sua interação com os profissionais da saúde. A teoria da ordem negociada, de Isabelle Baszanger, inspirada na perspectiva interacionista, trata da relação médico-paciente diante da doença crônica em que se estabelece uma condição de negociação permanente entre os dois polos. Contrariando a ideia do doente como um agente meramente passivo, a teoria mostra o seu protagonismo onde o médico precisará participar dessa negociação. Essa construção se desenvolve em todas as esferas da vida social: trabalho, família, serviços e profissionais de saúde, nos quais o doente procura a manutenção de sua inserção social. Assim, para o doente, trata-se, antes de tudo, da gestão de sua identidade, em que ele se apropriará de técnicas de controle de sintomas e do tratamento, a fim de manter ou restabelecer uma vida “normal”. Esse ensaio busca revisitar essa teoria dialogando com outros autores e através de reflexões advindas pesquisas etnográficas anteriores.
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Borba LDO, Capistrano FC, Ferreira ACZ, Kalinke LP, Mantovani MDF, Maftum MA. Adaptation and validation of the Measuring of Treatment Adherence for mental health. Rev Bras Enferm 2019; 71:2243-2250. [PMID: 30365790 DOI: 10.1590/0034-7167-2017-0796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 05/06/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to adapt culturally and validate the Measuring Instrument of Treatment Adherence for mental health. METHOD methodological study, carried out with 300 individuals with mental disorders, in two Psychosocial Care Centers in Curitiba, state of Paraná, Brazil, from April to June 2014. The cross-cultural adaptation was developed according to international recommendations, the construct validation was made by exploratory factor analysis, and internal consistency was verified by Cronbach's alpha. RESULTS through the evaluation of a committee of experts and completion of the pre-testing, face and content validation was achieved. From the factor analysis, we identified two factors of the instrument's construct: involuntary action and voluntary action, with a total explanation variance of 55.7%. The value of Bartlett's test of sphericity was p<0.001. Cronbach's alpha was 0.74. CONCLUSION the adapted and validated instrument proved to be trustworthy to be applied to the verification of adherence to drug therapy for individuals with mental disorders.
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Albuquerque NLSD, Oliveira ASSD, Silva JMD, Araújo TLD. Association between follow-up in health services and antihypertensive medication adherence. Rev Bras Enferm 2018; 71:3006-3012. [PMID: 30517405 DOI: 10.1590/0034-7167-2018-0087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/01/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the association between the characteristics of follow-up in health services and adherence to antihypertensive medication in patients with cardiovascular disease. METHOD Analytical study carried out with 270 patients suffering from hypertension and hospitalized due to cardiovascular complications. Data collection occurred between November 2015 and April 2016, involving sociodemographic variables, presence of self-reported diabetes, accessibility and use of health services, blood pressure levels and medication adherence (analyzed through the Morisky-Green Test). RESULTS The rate of adherence to antihypertensive therapy was 63.0%. Enrollment in the Hiperdia program had no statistical significance to medication adherence. People who attended at least between 4 and 6 nursing consultations throughout the data collection period (p = 0.02) had better adherence. CONCLUSION The study's findings provide support for the reorientation of health services and their public policies towards improving adherence to antihypertensive therapeutics.
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Garcia ALDF, Kaya ANM, Ferreira EA, Gris EF, Galato D. Self-medication and adherence to drug treatment: assessment of participants of the Universidade do Envelhecer (the University of Aging) program. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2018. [DOI: 10.1590/1981-22562018021.180106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objectives : to evaluate the use of medication (for continuous use and self-medication) and adherence to treatment among elderly and non-elderly participants of the Universidade do Envelhecer (UniSer). Method : an observational, quantitative and cross-sectional study, using the interview technique, was carried out at UniSer with 215 subjects. A structured instrument was used for the collection of sociodemographic variables and self-medication data. The 1986 Morisky-Green-Levine Scale (MGL) and the Brief Medication Questionnaire (BMQ) regimen screening tool were used to assess adherence. Descriptive analyzes of the data were performed, and the chi-squared Test and Fisher’s Exact Test were applied to evaluate the association between variables of interest. Results : of the participants, 127 (59.1%) were elderly (< 60 years old), of whom 81.9% were women. Regarding self-medication, 22.9% of elderly and 21.7% of non-elderly persons practiced it in the previous seven days (p=0.848), even if they considered it dangerous (p=0.472). A total of 45.8% of the elderly and 55.6% of the non-elderly irrationally self-medicated within the analyzed period, while 76.4% of the elderly and 64.8% of the non-elderly used medications of continuous use (p=0.063). A total of 78.8% of the elderly and 76.1% of the non-elderly were not adherent to treatment (p=0.719) according to the MGL scale, while the BMQ Regimen Screen found that 36.7% of the elderly and 41.1% of the non-elderly were not adherent (p=0.595). Conclusion : these findings demonstrate that there were no significant differences between the groups studied and health education actions should be carried out with an emphasis on guidelines on adherence and the rational use of medicines.
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Borba LDO, Maftum MA, Vayego SA, Mantovani MDF, Felix JVC, Kalinke LP. Adherence of mental therapy for mental disorder patients to drug health treatment [corrected]. Rev Esc Enferm USP 2018; 52:e03341. [PMID: 29947709 DOI: 10.1590/s1980-220x2017006603341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 01/31/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the adherence of mental disorder patients to drug therapy for mental health treatment and the association between demographic, socioeconomic, clinical and pharmacotherapeutic variables to treatment adherence. METHOD A cross-sectional study conducted with mental disorder patients in two Psychosocial Care Centers in Curitiba/Paraná in 2014. Data from structured interviews and medical records were submitted to descriptive and bivariate analysis. RESULTS 300 patients with mental disorders participated in the study. 51% of participants adhered to the drug therapy, the highest adherence was among males with no family history of mental disorder, diagnosed with schizophrenia, with disease duration of less than 1 year, who did not forget to take the medicine not even once in the previous month and who relied on family participation. Adherence was lower among the interviewees with individual income lower than one minimum wage, perception of regular and poor health, diagnosis of depression associated with another disorder, treatment time in the service over 2 years and with a history of attempted suicide. CONCLUSION Low adherence to the drug therapy was observed. The variables associated with adherence were gender, individual income, family history of mental disorder, perception about their health, diagnosis of mental disorder, duration of illness and treatment, suicide attempt, failing to take the medication at least once in the previous month and family participation.
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Affiliation(s)
| | - Mariluci Alves Maftum
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brasil
| | - Stela Adami Vayego
- Universidade Federal do Paraná, Departamento de Estatística, Curitiba, PR, Brasil
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Fritzen JS, Motter FR, Paniz VMV. Regular access and adherence to medications of the specialized component of pharmaceutical services. Rev Saude Publica 2017; 51:109. [PMID: 29166445 PMCID: PMC5697919 DOI: 10.11606/s1518-8787.2017051006932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 12/13/2016] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of the adherence to the medications of the Specialized Component of Pharmaceutical Services and its association with regular access in users of these medications in the municipality of São Leopoldo, State of Rio Grande do Sul, Brazil. METHODS This is a cross-sectional study with adults aged 20 years and over, who are users of medications of the Specialized Component of Pharmaceutical Services. Sampling was carried out consecutively for users who accessed the service of the Specialized Component of Pharmaceutical Services during the period from December 2014 to March 2015. Adherence was measured by the Brief Medication Questionnaire, and adherents were defined as those who did not present barriers to adherence in the three domains. Regular access was defined as getting all medications in the last three months, regardless of how it was obtained (paying or for free). Data analysis was performed using Poisson regression with robust variance. RESULTS We interviewed 414 subjects, being them mostly women (60.9%), with mean age of 55 years (SD = 13), and using a single medication of the Specialized Component of Pharmaceutical Services (68.1%). The prevalence of adherence to the medications used in the last seven days was 28.3% and the prevalence of free regular access was 46.1%, and 25.7% did not have access to all treatment. After adjusting for the number of medications in the Specialized Component of Pharmaceutical Services and the number of medications of continuous use, users who had free regular access in the last three months were 60% more likely to show adherence. For individuals with paid regular access, no association was found between access and adherence. CONCLUSIONS The regularity in the free access to the medications of the Specialized Component of Pharmaceutical Services has an impact on the behavior of users, contributing to their commitment to treatment and self-care. The Specialized Component of Pharmaceutical Services needs programming in order to avoid irregular access, which suggests a significant limitation of the drug policies in Brazil.
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Affiliation(s)
- Janaína Soder Fritzen
- Universidade do Vale do Rio dos Sinos. Programa de Pós-Graduação em Saúde Coletiva. São Leopoldo, RS, Brasil
| | - Fabiane Raquel Motter
- Universidade do Vale do Rio dos Sinos. Programa de Pós-Graduação em Saúde Coletiva. São Leopoldo, RS, Brasil
| | - Vera Maria Vieira Paniz
- Universidade do Vale do Rio dos Sinos. Programa de Pós-Graduação em Saúde Coletiva. São Leopoldo, RS, Brasil
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Jesus NSD, Nogueira ADR, Pachu CO, Luiz RR, Oliveira GMMD. Blood Pressure Treatment Adherence and Control after Participation in the ReHOT. Arq Bras Cardiol 2017; 107:437-445. [PMID: 27982269 PMCID: PMC5137388 DOI: 10.5935/abc.20160165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 06/02/2016] [Indexed: 01/13/2023] Open
Abstract
Background Lack of adherence to pharmacological treatment is one of the main causes of
low control rates in hypertension. Objective To verify treatment adherence and associated factors, as well as blood
pressure (BP) control in participants of the Resistant Hypertension Optimal
Treatment (ReHOT) clinical trial. Method Cross-sectional study including all 109 patients who had completed the ReHOT
for at least 6 months. We excluded those participants who failed to respond
to the new recruitment after three phone contact attempts. We evaluated the
BP control by ambulatory BP monitoring (ABPM; controlled levels: 24-hour
systolic and diastolic BP < 130 x 80 mmHg) and analyzed the patients'
treatment adherence using the Morisky Medication Adherence Scale (MMAS)
questionnaire validated by Bloch, Melo, and Nogueira (2008). The statistical
analysis was performed with the software IBM SPSS statistics 21.0. We tested
the normality of the data distribution with kurtosis and skewness. The
variables tested in the study are presented with descriptive statistics.
Comparisons between treatment adherence and other variables were performed
with Student's t test for independent variables and Pearson's chi-square or
Fisher's exact test. To conduct analyses among patients considering
adherence to treatment and BP control, we created four groups: G0, G1, G2,
and G3. We considered a 5% significance level in all tests. Results During the ReHOT, 80% of the patients had good BP control and treatment
adherence. Of 96 patients reevaluated in the present study, only 52.1% had
controlled hypertension when assessed by ABPM, while 31.3% were considered
adherent by the MMAS. Regarding other ABPM measures, we observed an absence
of a nocturnal dip in 64.6% of the patients and a white-coat effect and
false BP control in 23% and 12.5%, respectively. Patients' education level
showed a trend towards being a determinant factor associated with lack of
adherence (p = 0.05). Resistant hypertension and number of medications were
significantly associated with BP control assessed by ABPM (p = 0.009 and p =
0.001, respectively). Resistant hypertension was also significantly
associated with group G0 (patients with no control or adherence, p =
0.012). Conclusion There was a decrease in BP control and adherence measured by the MMAS after
participation of at least 6 months in the ReHOT clinical trial.
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Affiliation(s)
- Nathália Silva de Jesus
- Programa de Pós-Graduação em Cardiologia, Universidade Federal do Rio de Janeiro, RJ - Brazil
| | | | - Cacilda Oliveira Pachu
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, RJ - Brazil
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Pantuzza LL, Ceccato MDGB, Silveira MR, Junqueira LMR, Reis AMM. Association between medication regimen complexity and pharmacotherapy adherence: a systematic review. Eur J Clin Pharmacol 2017; 73:1475-1489. [PMID: 28779460 DOI: 10.1007/s00228-017-2315-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/26/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE The purpose of this study was to systematically review evidence regarding the association between regimen complexity and adherence. METHODS Articles were searched in MEDLINE, LILACS, Cochrane, CINAHL, PsycINFO and references of included studies. Search terms included medication regimen complexity, medication adherence and their synonyms. Randomized clinical trials, cross-sectional, cohort or case-control studies published until March 2016 in English, Portuguese or Spanish were eligible if quantitatively examined the association between complexity and adherence in patients of any age and sex, under any type of medication therapy. Complexity was defined according to the strategy used to assess it in the individual studies. All types of instruments used to assess complexity and adherence were considered. Data extraction was performed using an electronic spreadsheet. Quality assessment was conducted independently using standard scales. The data were qualitatively synthesized. RESULTS Fifty-four studies were included: 37 cross-sectional and 17 cohorts. Most were conducted in outpatient setting. Most frequently, studies were carried out with HIV-infected individuals or patients with chronic conditions. The most frequent methods used to assess complexity and adherence were complexity index (19) and self-report (27), respectively. Complexity was associated with adherence in 35 studies. Most of them (28) identified that participants with more complex regimens were less likely to adhere to pharmacotherapy; seven studies found a direct correlation. The others found inconclusive results or no association between complexity and adherence. The studies had low to moderate-methodological quality. CONCLUSION Although there was variability regarding the association between complexity and adherence, most studies showed that an increased regimen complexity reduces medication adherence.
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Affiliation(s)
- Laís Lessa Pantuzza
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Maria das Graças Braga Ceccato
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Micheline Rosa Silveira
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Luane Mendes Ribeiro Junqueira
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Adriano Max Moreira Reis
- Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
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Tavares NUL, Bertoldi AD, Mengue SS, Arrais PSD, Luiza VL, Oliveira MA, Ramos LR, Farias MR, Pizzol TDSD. Factors associated with low adherence to medicine treatment for chronic diseases in Brazil. Rev Saude Publica 2016; 50:10s. [PMID: 27982378 PMCID: PMC5157921 DOI: 10.1590/s1518-8787.2016050006150] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/25/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To analyze factors associated with low adherence to drug treatment for chronic diseases in Brazil. METHODS Analysis of data from Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - Brazilian Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based cross-sectional household survey, based on a probabilistic sample of the Brazilian population. We analyzed the association between low adherence to drug treatment measured by the Brief Medication Questionnaire and demographic, socioeconomic, health, care and prescription factors. We used Poisson regression model to estimate crude and adjusted prevalence ratios, their respective 95% confidence interval (95%CI) and p-value (Wald test). RESULTS The prevalence of low adherence to drug treatment for chronic diseases was 30.8% (95%CI 28.8-33.0). The highest prevalence of low adherence was associated with individuals: young adults; no education; resident in the Northeast and Midwest Regions of Brazil; paying part of the treatment; poor self-perceived health; three or more diseases; reported limitations caused by a chronic disease; using five drugs or more. CONCLUSIONS Low adherence to drug treatment for chronic diseases in Brazil is relevant, and regional and demographic differences and those related to patients' health care and therapy regime require coordinated action between health professionals, researchers, managers and policy makers. OBJETIVO Analisar fatores associados à baixa adesão ao tratamento farmacológico de doenças crônicas no Brasil. MÉTODOS Análise de dados oriundos da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM), inquérito domiciliar de base populacional, de delineamento transversal, baseado em amostra probabilística da população brasileira. Analisou-se a associação entre baixa adesão ao tratamento medicamentoso mensurado pelo Brief Medication Questionnaire e fatores demográficos, socioeconômicos, de saúde, assistência e prescrição. Foi utilizado modelo de regressão de Poisson para estimar as razões de prevalência brutas e ajustadas, os respectivos intervalos de 95% de confiança (IC95%) e p-valor (teste de Wald). RESULTADOS A prevalência de baixa adesão ao tratamento farmacológico de doenças crônicas foi de 30,8% (IC95% 28,8-33,0). As maiores prevalências de baixa adesão estiveram associadas a indivíduos: adultos jovens; que nunca estudaram; residentes na região Nordeste e Centro-Oeste do País; que tiveram que pagar parte do tratamento; com pior autopercepção da saúde; com três ou mais doenças; que referiam limitação causada por uma das doenças crônicas; e que faziam uso de cinco medicamentos ou mais. CONCLUSÕES A baixa adesão ao tratamento medicamentoso para doenças crônicas no Brasil é relevante e as diferenças regionais, demográficas e aquelas relacionadas à atenção à saúde do paciente e ao regime terapêutico requerem ações coordenadas entre profissionais de saúde, pesquisadores, gestores e formuladores de políticas para o seu enfrentamento.
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Affiliation(s)
- Noemia Urruth Leão Tavares
- Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil
| | - Andréa Dâmaso Bertoldi
- Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | - Sotero Serrate Mengue
- Programa de Pós-Graduação em Epidemiologia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Paulo Sergio Dourado Arrais
- Departamento de Farmácia. Faculdade de Farmácia, Odontologia e Enfermagem. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - Vera Lucia Luiza
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Maria Auxiliadora Oliveira
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Luiz Roberto Ramos
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. São Paulo, SP, Brasil
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Tatiane da Silva Dal Pizzol
- Departamento de Produção e Controle de Medicamentos. Faculdade de Farmácia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
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Molino CGRC, Carnevale RC, Rodrigues AT, Moriel P, Mazzola PG. HIV pharmaceutical care in primary healthcare: Improvement in CD4 count and reduction in drug-related problems. Saudi Pharm J 2016; 25:724-733. [PMID: 28725145 PMCID: PMC5506733 DOI: 10.1016/j.jsps.2016.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 11/05/2016] [Indexed: 12/11/2022] Open
Abstract
Background: Highly active antiretroviral therapy (HAART) is complex and many factors contribute to a patient's response to initial therapy including adherence, drug effectiveness, and tolerance. Close HAART follow-up is needed, particularly when there are concurrent therapies such as prophylactic antibiotics and medications for the treatment of comorbidities. Objective: To assess the effectiveness of pharmacist intervention in reducing drug related problems in HIV/AIDS outpatients (intervention group) and in improving clinical parameters in the intervention group compared to the control group. Methods: We conducted a prospective controlled intervention study with patients paired by gender and initial T CD4+ lymphocyte (CD4) count. HIV-infected patients of a public outpatient service were enrolled for the study by consecutive and convenience sampling. Patients selected for the study were divided into a control group and an intervention group. Both groups were followed for one year; however, only the intervention group received pharmaceutical care. The primary outcome was the drug related problem (DRP) analysis for the intervention group. Secondary outcomes were CD4 count and viral load evaluation for both groups. Results: There was a total of 143 patients enrolled in this study, with 53 (37.06%) patients in the control group and 90 (62.94%) patients in the intervention group. A total of 202 pharmacist interventions with 193 pharmacist-patient and 9 pharmacist-physician interventions were proposed. After one year of pharmaceutical care, a reduction of 38.43% between the initial and final DRP was found (p = 0.0001). The most common DRPs found were related to medication safety. The intervention group showed a mean increase of 84% for the CD4 count in comparison with that observed in the control group. The viral load was not significantly different between the final and initial mean values for both groups. Conclusion: Pharmacist appointments enabled identification, prevention, and solving of drug related problems, especially those related to drug safety. Also, pharmacist interventions improved adherence and increased HAART effectiveness as suggested by the higher elevation in the CD4 count seen in the intervention group in comparison with the control group.
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Affiliation(s)
- C G R C Molino
- Department of Clinical Pathology, School of Medical Sciences (FCM), University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126, Campinas, São Paulo 13083-970, Brazil
| | - Renata Cavalcanti Carnevale
- Department of Clinical Pathology, School of Medical Sciences (FCM), University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126, Campinas, São Paulo 13083-970, Brazil
| | - Aline Teotonio Rodrigues
- Department of Clinical Pathology, School of Medical Sciences (FCM), University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126, Campinas, São Paulo 13083-970, Brazil
| | - Patricia Moriel
- Faculty of Pharmaceutical Sciences (FCF), University of Campinas (UNICAMP), Department of Clinical Pathology, School of Medical Sciences (FCM), University of Campinas (UNICAMP), Rua Sérgio Buarque de Holanda, 250, CB-II - sala E06 - 2° Piso, Campinas, São Paulo 13083-859, Brazil
| | - Priscila Gava Mazzola
- Faculty of Pharmaceutical Sciences (FCF), University of Campinas (UNICAMP), Department of Clinical Pathology, School of Medical Sciences (FCM), University of Campinas (UNICAMP), Rua Sérgio Buarque de Holanda, 250, CB-II - sala E06 - 2° Piso, Campinas, São Paulo 13083-859, Brazil
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Lima DBDS, Moreira TMM, Borges JWP, Rodrigues MTP. ASSOCIATION BETWEEN TREATMENT COMPLIANCE AND DIFFERENT TYPES OF CARDIOVASCULAR COMPLICATIONS IN ARTERIAL HYPERTENSION PATIENTS. TEXTO & CONTEXTO ENFERMAGEM 2016. [DOI: 10.1590/0104-07072016000560015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
ABSTRACT: This cross-sectional analytical study was carried out at 23 Family Health Centers in Fortaleza-CE, Brazil. The objective was to verify the link between anti-hypertension treatment compliance and the types of cardiovascular complications present in hypertensive patients. The sample was composed of 182 hypertensive patients registered in the Sistema de Gestão Clínica de Hipertensão Arterial e Diabetes Mellitus da Atenção Básica who accepted to answer and fill in a structured form and an instrument to assess compliance. Among the arterial hypertension patients questioned, 62.0% were women, 66.9% were elderly people, 52.2% were patients with a family income between 1.5 and four monthly minimum wages, 61.2% had between one and eight years of education and 60.4% lived in households with two to four people. The most frequent complications found were cerebrovascular accident (37.9%) followed by acute myocardial infarction (20.3%). Treatment compliance was present in 52.0% of patients and was associated to cerebrovascular accident (p<0.001; OR=3.048; 95%CI=1.633-5.681). The results obtained suggest the need for a behavioral change in hypertensive patients, adopting health promotion measures in order to prevent further cardiovascular complications.
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