Effect of Hospital - community Integration Follow - up on Medication Compliance in Patients with Mental Disorder / 现代医院

Objective To explore the effect of hospital-community integration follow-up pattern on medication compliance in patients with mental disorder. Methods From January 2016 to January 2017, 96 patients were treated effectively with systemic therapy in psychosomatic department and TCM WM department, and 96 discharged mental disorder patients were treated with brief psychiatric rating scale (BPRS) ≤ 28. The patients were randomly divided into 48 cases in the intervention group and the control group; both groups were standardized medication; control group received an outpatient referral, intervention group combined with medical doctors in our hospital and community doctors for one year follow-up intervention. Observed the condition of illness and medication compliance after six months and one year intervention between two groups, compared the patient recurrence rate of one year after discharge. Results BPRS score of intervention group was significantly lower than control group (P＜0. 01), the difference was statistically significant, while intervention group had higher compliance than control group (P＜0. 01), and the difference was statistically significant. Recurrence rate (20. 83％) of intervention group was significantly lower than control group (38. 78％) ( 2 = 4. 03, P＜0. 05), the difference was statistically significant. Conclusion Hospital-community integration follow-up has positive effect on stabilizing patients with mental disorder and improving compliance and decreasing relapse rate.

Validez y confiabilidad del cuestionario para medir la adherencia al tratamiento de pacientes con enfermedad cardiovascular / Validity and Reliability of a Questionnaire to Measure Adherence to Treatment by Patients with Cardiovascular Disease / Validade e confiabilidade do questionário para medir a adesão ao tratamento de pacientes com doença cardiovascular

RESUMEN Objetivo: elaborar y validar un instrumento para medir la adherencia al tratamiento farmacológico y no farmacológico de pacientes con diagnóstico de enfermedad cardiovascular, a partir de un referente teórico sustentado en las conductas de adherencia al tratamiento y la autoeficacia. Materiales y métodos: se detalla el proceso de validez facial, de contenido y de constructo realizado al instrumento, así como las pruebas de confiabilidad. El instrumento fue sometido a evaluación por parte de 6 expertos, 380 adultos de diferentes características sociodemográficas y posteriormente aplicado a 145 pacientes con diagnóstico de enfermedad cardiovascular isquémica. Resultados: se obtuvo un cuestionario con 29 ítems, 6 dimensiones, un alfa de Cronbach de 0,837 y un puntaje entre 29-174, lo que indica que a mayor puntaje mejor adherencia. Conclusiones: se considera un instrumento útil para determinar conductas terapéuticas de adherencia al tratamiento en pacientes con enfermedad cardiovascular isquémica, pues está sustentado en un constructo teórico que se fundamenta, por una parte, en las conductas de adherencia y, por otra, en la autoeficacia como predictor de esta, lo que amplía el abordaje de medición del fenómeno incluida la determinación de las capacidades que perciben los pacientes para poder llevar a cabo un tratamiento.

ABSTRACT Objective: Develop and validate an instrument to measure adherence to pharmacological and non-pharmacological treatment on the part of patients diagnosed with cardiovascular disease, based on a theoretical reference supported by treatment adherence behavior and self-efficacy. Materials and methods: The process of facial, content and construct validity performed on the instrument is outlined in detail, as are the reliability tests. The instrument was subject to evaluation by six experts and 380 adults with different sociodemographic characteristics, before being applied to 145 patients who had been diagnosed with ischemic cardiovascular disease. Results: A questionnaire with 29 items, 6 dimensions, a Cronbach's alpha of 0.837 and a score of 29-174 was obtained, indicating that the higher the score, the better the adherence. Conclusions: It is considered a useful instrument to determine therapeutic behavior in terms of adherence to treatment among patients with ischemic cardiovascular disease, since it is based on a theoretical construct that is founded on adherence behavior, on the one hand, and self-efficacy, on the other. The latter is a predictor of adherence behavior. This broadens the approach to measuring the phenomenon, including determining the abilities or capacity perceived by patients in order to complete a treatment.

RESUMO Objetivo: elaborar e validar um instrumento para medir a adesão ao tratamento farmacológico e não farmacológico de pacientes com diagnóstico de doença cardiovascular, a partir de um referencial teórico apoiado nos comportamentos de adesão ao tratamento e na autoeficácia. Materiais e métodos: detalha-se o processo de validade facial, de conteúdo e de construto realizado ao instrumento, bem como os testes de confiabilidade. O instrumento foi submetido à avaliação por parte de 6 especialistas, 380 adultos de diferentes características sociodemográficas e, em seguida, aplicado a 145 pacientes com diagnóstico de doença cardiovascular isquêmica. Resultados: obteve-se um questionário com 29 itens, 6 dimensões, um alfa de Cronbach de 0.837 e uma pontuação entre 29-174, o que indica que quanto maior a pontuação, melhor a adesão. Conclusões: considera-se um instrumento útil para determinar comportamentos terapêuticos de adesão ao tratamento em pacientes com doença cardiovascular isquêmica, pois está sustentado num construto teórico que se fundamenta, por um lado, nos comportamentos de adesão e, por outro, na autoeficácia como preditor desta, o que amplia a abordagem de medição do fenômeno incluída a determinação das capacidades que percebem os pacientes para poder realizar um tratamento.

Effect of"hormone calendar"on oral hormone compliance with discharged neurological patients / 现代临床护理

Objective To improve the effect on oral hormone compliance with discharged neurological patients. Methods The convenience sampling method was used by selecting 230 hospital patients as control group between January to December, 2015 and another 152 patients in the hospital between January and December 2016 as experimental group. After discharge, the experimental group was treated with auxiliary hormone drugs,"hormone calendar"method, and the control group with the conventional education. The two groups were compared in terms of compliance in hormone taking, error in medication error and disease recurrence. Results About 2 months and 4 months after discharge, compliance with medication of the control group was higher than that of the experimental group. The error rate of medication and the recurrence rate were significantly higher than those of the control group (all P<0.05). Conclusion"hormone calendar"can enhance the medication compliance of hormonal medication, reduce the error rate of medication and recurrence rate, thus worth promoting.

Effect of"hormone calendar"on oral hormone compliance with discharged neurological patients / 现代临床护理

Objective To improve the effect on oral hormone compliance with discharged neurological patients. Methods The convenience sampling method was used by selecting 230 hospital patients as control group between January to December, 2015 and another 152 patients in the hospital between January and December 2016 as experimental group. After discharge, the experimental group was treated with auxiliary hormone drugs,"hormone calendar"method, and the control group with the conventional education. The two groups were compared in terms of compliance in hormone taking, error in medication error and disease recurrence. Results About 2 months and 4 months after discharge, compliance with medication of the control group was higher than that of the experimental group. The error rate of medication and the recurrence rate were significantly higher than those of the control group (all P<0.05). Conclusion"hormone calendar"can enhance the medication compliance of hormonal medication, reduce the error rate of medication and recurrence rate, thus worth promoting.

Fatores associados à adesão ao tratamento anti-hipertensivo por idosos na atenção primária / Factors affecting adherence of the elderly to antihypertensive drug treatment in primary health care

Compliance with antihypertensive drug treatmentis essential for the management of patients with highblood pressure, which contributes to the reduction ofmorbidity and mortality from this disease. Thus, theaim of this study was to determine antihypertensivedrug treatment compliance and associated factorsin elderly patients with high blood pressure enrolledat a district Family Health Clinic, Londrina, Paraná,Brazil. This was a cross-sectional study of elderlypatients (60 or older), selected from the PrimaryCare Information System. The variables of interest(socioeconomic and demographic, lifestyle, accessto health services and medication adherence) werecollected by applying a semi-structured questionnairein a household survey. Compliance was assessed by theMorisky-Green test and blood pressure control. Of the117 elderly surveyed, 54.7% were identified as adheringto the antihypertensive drug treatment and 61.4%had controlled blood pressure. The average number ofantihypertensive drugs used was 1.97, the commonestbeing hydrochlorothiazide (30.8%), enalapril (24.8%)and captopril (14.5%). Adherence to pharmacologicaltreatment was shown to be associated with femalesex (61.8%; p<0.05) and age between 60 and 79 years(67.9%; p<0.01). Better control of blood pressurewas associated with less education (75.6%; p<0.05)and a lack of paid work (69.4%; p<0.02). Resultsindicated moderate adherence to antihypertensive drugtreatment and blood pressure control. Furthermore,it was found that the socioeconomic and demographiccharacteristics were more strongly associated withadherence to treatment and blood pressure control.

A adesão ao tratamento anti-hipertensivo é fundamental para o manejo dos pacientes portadores de hipertensão arterial, o que contribui para a redução da morbi-mortalidade por esta enfermidade. Desta forma, este estudo teve como objetivo determinar a adesão ao tratamento anti-hipertensivo e fatores associados em idosos hipertensos cadastrados em uma Unidade de Saúde da Família, Londrina-PR. Desenvolveu-se um estudo transversal com idosos (60 anos ou mais), selecionados a partir do Sistema de Informação da Atenção Básica. As variáveis de interesse (socioeconômicas e demográficas, hábitos de vida, acesso aos serviços de saúde e adesão ao tratamento medicamentoso) foram obtidas pela aplicação de um formulário semiestruturado através de um inquérito domiciliar. A adesão foi avaliada por meio do Teste de Morisky-Green e o controle pressórico. Dos 117 idosos investigados, 54,7% foram identificados como aderentes ao tratamento anti-hipertensivo e 61,4% apresentaram pressão arterial controlada. A média de medicamentos anti-hipertensivos utilizados foi de 1,97, destacando-se hidroclorotiazida (30,8%), enalapril (24,8%) e captopril (14,5%). A adesão ao tratamento farmacológico apresentou-se associada ao sexo feminino (61,8%; p<0,05) e a idade entre 60 e 79 anos (67,9%; p<0,01). O controle pressórico mostrou-se associado à menor escolaridade (75,6%; p<0,05) e não possuir trabalho remunerado (69,4%; p<0,02). Os resultados observados indicam moderada adesão ao tratamento anti-hipertensivo e ao controle pressórico. Além disso, detectou-se que as variáveis socioeconômicas e demográficas mostraram-se mais fortemente associadas à adesão e controle pressórico.

Impacto inicial de uma clínica de insuficiência cardíaca em hospital cardiológico privado / Initial impact of a disease management program on heart failure in a private cardiology hospital

Fundamentos: A insuficiência cardíaca ainda leva a hospitalizações frequentes apesar dos notáveis avanços terapêuticos. Programas que monitoram e otimizam cuidados têm potencial para melhorar o controle desses pacientes apesar de evidências ainda controversas quanto ao seu real benefício. Objetivos: Caracterizar a população incluída em clínica de insuficiência cardíaca e avaliar a hipótese de benefícios a curto prazo (seis meses). Métodos: Estudo prospectivo que avaliou pacientes hospitalizados com insuficiência cardíaca em hospital privado cardiológico de janeiro a dezembro 2012. Os pacientes foram estratificados em: Grupo 1 – pacientes pré-Programa de cuidados (feito apenas registro de dados); Grupo 2 – pacientes pós-Programa (registro dos mesmos dados junto com intervenções educativas feitas pelo programa de cuidados da Clínica de Insuficiência Cardíaca). Analisadas características da população, indicadores de qualidade e desfechos clínicos. Resultados: Avaliados 762 pacientes, média de idade 70,4±11,0 anos, 56,0 % do sexo masculino. Fração de ejeção reduzida observada em 65,0 %, perfil hemodinâmico B em 66,0 %, etiologia isquêmica em 52,0 % e infecção como fator de descompensação em 29,0 % dos casos. Desfechos analisados nos Grupos 1 e 2, respectivamente: re-hospitalização em 30 dias (13,0 % vs. 9,0 %; p=0,10); tempo médio de hospitalização (9,0 dias vs. 8,4 dias; p=0,4); descompensação por má aderência (17,0 % vs. 10,0 %; p=0,004); mortalidade hospitalar (9,0 % vs. 8,0 %; p=0,7).

Background: Heart failure still leads to frequent hospitalizations despite notable therapeutic advances. Programs that monitor and optimize care have the potential to enhance control of these patients, although evidence of their real benefits is still controversial. Objectives: To describe the population with heart failure included in a Clinical Care Program, assessing the hypothesis of short-term benefits (6 months). Methods: Prospective study assessing heart failure patients in a private cardiology hospital from January to December 2012, divided into two groups: Group 1 – pre-Care Program patients with only data recorded; Group 2 – post-Care Program patients with the same data recorded, together with educational interventions through the Care Program run by the Heart Failure Clinic. The demographic characteristics of the population were analyzed, together with quality indicators and clinical outcomes. Results: Among the 762 patients assessed, the mean age was 70.4±11.0 years, with 56.0% male. Reduced ejection fraction was noted in 65.0%, hemodynamic profile B in 66.0%, ischemic etiology in 52.0% and infection as a decompensation factor in 29.0% of cases. The outcomes analyzed in Groups 1 and 2 were, respectively: hospital readmissions within 30 days (13.0% vs. 9.0%; p=0.1); average length of stay (9.0 days vs. 8.4 days, p=0.4); decompensation due to poor compliance (17.0% vs. 10.0%; p=0.004); and in-hospital mortality (9.0% vs. 8.0%; p=0.7).

Adesão ao tratamento da dor crônica: aspectos demográficos, terapêuticos e psicossocioculturais / Compliance with the chronic pain treatment: demographic, therapeutic and psycho-social-cultural

Os objetivos deste estudo foram identificar a prevalência de adesão plena, parcial e não adesão ao tratamento em doentes com dor crônica ao longo de seis meses; caracterizar os motivos da adesão e buscar relações entre adesão e variáveis demográficas, psicossocioculturais, de características de dor e do tratamento. Trinta docentes do Ambulatório de Dor do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo foram avaliados em cinco entrevistas ao longo de seis meses. Os instrumentos utilizados foram: identificação e caracterização da dor, descrição do tratamento medicamentoso, Escala de Locus de Controle da Saúde, Inventário de Depressão de Beck e Inventário de Atitudes frente à Dor-versão breve. Os doentes foram classificados quanto à adesão em plenamente aderentes (cumprimento total da prescrição medicamentosa), parcialmente aderentes (cumprimento parcial da prescrição medicamentosa) e não aderentes (não cumprimento da prescrição). Foram feitos testes estatísticos para verificar a presença de relações entre as variáveis e, em todos os testes, foi utilizado o nível de significância de 5%. O índice de não adesão e adesão parcial foi alto, entre 40,0% e 56,7%, e não houve variação significativa ao longo de seis meses. O Índice de Acerto de Ingestão Medicamentosa foi entre 57,2% e 69%, e também não houve variação. A principal razão para adesão plena foi "o remédio melhora a dor" (54,0% a 63,9%), para a adesão parcial foi "sente-se mal, tem efeitos colaterais" (55,6% a 66,6%), e para a não adesão foram "indisponibilidade na farmácia do hospital" (23,1% a 28,9%), "sente-se mal, tem efeitos colaterais" (25%) e "dinheiro insuficiente para a compra" (15,4% a 23,7%). A depressão e o locus de controle da saúde não variaram em seis meses. As atitudes frente à dor, com exceção do domínio cura médica, também não variaram ao longo de seis meses. Não se observaram relações estatisticamente ) significativas entre adesão e idade, estado civil, escolaridade, renda, características de dor, número de comprimidos, número de tomadas, uso de automedicação, presença de depressão, dimensões externalidade outros poderosos e acaso do locus de controle da saúde, e domínios controle, emoção, medicação e cura médica do Inventário de Atitudes frente à Dor. Observaram-se relações estatisticamente significativas entre adesão e presença de efeitos colaterais, dimensão internalidade e índice de Internalidade Total do locus de controle da saúde e domínios incapacidade, dano físico e solicitude do Inventário de Atitudes frente à Dor.

The aims of this study were identifying the prevalence of total compliance, partial compliance and non-compliance with the treatment of patients with chronic pain in the lenght of six months; characterising their reason for compliance and looking for relationship between compliance and demographic, psycho-social-cultural, characteristics of pain and treatment variables. Thirty out-patient in the Pain Clinic of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo were evaluated in five interviews in a period of six months. The instruments used were: identification and characterisation of pain, description of medical treatment, Multidimensional Health Locus of Control Scale, Beck Depression Inventory and Survey of Pain Attitudes-brief version. Patients were classified according to compliance as totally compliant (closely following the medical prescription), partially compliant (partially following the medical prescripton) and non-compliant (not following the medical prescription). Statistical tests were carried out to verify the presence of relationship among variables and, in every test, the significance level of 5% was used. The incidence of non-compliance and partial compliance was high, varying between 40,0% and 56,7%, and there was no significant variation during the six months. The Indexes of Right Ingestion of Medication was between 57,2% and 69% and, here too, there was not variation. The main reason for total compliance was "the medication eases the pain" (54,0% to 63,9%), for partial compliance was "felling bad, presence of side effects" (55,6% to 66,6%), and for non-compliance were "medicine unavailable in the hospital pharmacy" (23,1% to 28,9%)," feeling bad, having side effects" (25%) and "can not afford to buy the medicine prescribed" (15,4% to 23,7%). The depression and the health locus of control did not change in six months. Attitudes towards pain, with exception of cure dimension, did not change during six months. No significant statistic relationships were observed between compliance and age, marital status, education background, income group, characteristics of pain, number of pills taken, frequency of ingestion of medicine, use of self-medication, occurence of depression, powerful others and chance externality dimensions of health locus of control and control, emotion, medication and cure domains of the Survey of Pain Attitudes. Significant statistical relationships were observed between compliance and presence of side effects, internality dimension and total internal indexes of health locus of control besides disability, harm and solicitude domains in Survey of Pain Attitudes.

Investigation of the Patient's Compliance with Medication in Tibetan Living in Tibet Plateau / 中国药房

OBJECTIVE:To realize the current situation of patient's compliance with medication in Tibetan and to evaluate the methods of increasing patient's compliance METHODS:Questionnaire inquisition was adopted in 188 Tibetan patients to investigate the type of diseases,situation of medication and condition of compliance RESULTS:The compliance with medication was related with the type of diseases,patient's educational background and knowledge about diseases It was a good way to raise the patient's compliance that the patient's recognition of diseases and pharmacotherapy should be improved and communication between doctor and patient and guidance on drug use should be enhanced CONCLUSION:Aiming at patients in different ages,the subject matter of medication consultation service should not be the same