Patient adherence to ischemic heart disease treatment.

INTRODUCTION:: The effectiveness of the treatment of chronic diseases depends on the participation of the patient, influenced by different sociocultural factors, which are not fully recognized by the treatment routine. OBJECTIVE:: To search for some of these factors that hinder or facilitate adherence to treatment and use of healthcare resources, approaching patients with ischemic heart disease. METHOD:: A cross-sectional study was conducted using face-to-face interviews. We applied semi-structured questionnaires to 347 individuals and recorded 141 interviews for qualitative analysis. Descriptors were selected to identify eight categories of analyses. The quantitative data were submitted to descriptive analysis of frequency. RESULTS:: Only 2% had good medication adherence according to score on Morisky questionnaire. About 23% bought statins; the others obtained statin in the public health institution. Thirty-six speeches were selected and classified according to the following categories: knowledge about disease and medication, difficulty of acquisition, self management of treatment, difficulties of access to health services, side effect of statins, caregiver support, transportation to health services and concerns about the disease progression. However, it was noticed that about 1/3 of the care outside the research institution can be characterized as an attempt to bring rationalization to the health system. CONCLUSION:: The improved adherence to chronic treatment of ischemic heart disease depends on the establishment of effective flows for referral and counter-referral from one care unit to another, relevant information and clarification of the questions for the patients and the attention of health professionals to the many social and cultural factors involved in treatment adherence. New research should be focused on educational groups by integrated multidisciplinary teams in order to share treatment decisions, thereby increasing the patient's commitment to his own health.

Patient adherence to ischemic heart disease treatment / Adesão do paciente ao tratamento da doença isquêmica do coração

Summary Introduction: The effectiveness of the treatment of chronic diseases depends on the participation of the patient, influenced by different sociocultural factors, which are not fully recognized by the treatment routine. Objective: To search for some of these factors that hinder or facilitate adherence to treatment and use of healthcare resources, approaching patients with ischemic heart disease. Method: A cross-sectional study was conducted using face-to-face interviews. We applied semi-structured questionnaires to 347 individuals and recorded 141 interviews for qualitative analysis. Descriptors were selected to identify eight categories of analyses. The quantitative data were submitted to descriptive analysis of frequency. Results: Only 2% had good medication adherence according to score on Morisky questionnaire. About 23% bought statins; the others obtained statin in the public health institution. Thirty-six speeches were selected and classified according to the following categories: knowledge about disease and medication, difficulty of acquisition, self management of treatment, difficulties of access to health services, side effect of statins, caregiver support, transportation to health services and concerns about the disease progression. However, it was noticed that about 1/3 of the care outside the research institution can be characterized as an attempt to bring rationalization to the health system. Conclusion: The improved adherence to chronic treatment of ischemic heart disease depends on the establishment of effective flows for referral and counter-referral from one care unit to another, relevant information and clarification of the questions for the patients and the attention of health professionals to the many social and cultural factors involved in treatment adherence. New research should be focused on educational groups by integrated multidisciplinary teams in order to share treatment decisions, thereby increasing the patient's commitment to his own health.

Resumo Introdução: A efetividade do tratamento das doenças crônicas depende da participação do paciente, influenciada por diferentes motivos socioculturais, pouco reconhecidos pela rotina assistencial. Objetivo: Identificar os fatores de adesão ao tratamento e o uso dos recursos assistenciais de pacientes com doença isquêmica do coração. Método: Estudo transversal com entrevistas presenciais de 347 indivíduos submetidos a questionários semiestruturados, com 141 delas gravadas para análise qualitativa com identificação dos descritores distribuídos por oito categorias. Os dados quantitativos tiveram análise descritiva de frequência. Resultados: Somente 2% tiveram boa adesão medicamentosa; 23% compraram estatina, os demais obtiveram o medicamento em serviços públicos. Foram classificadas 36 falas com as categorias: conhecimento sobre a doença e o tratamento, dificuldade de aquisição do medicamento, gerenciamento pessoal do tratamento, acesso aos serviços de saúde, efeito colateral das estatinas, apoio do cuidador, transporte até o ambulatório, receios quanto à evolução da doença, efeito colateral das estatinas. Foi observado que 1/3 dos atendimentos fora da instituição podem ser caracterizados como tentativa de racionalização da rede. Conclusão: A melhora da adesão ao tratamento da doença isquêmica do coração depende do estabelecimento de fluxos efetivos para referência e contrarreferência entre unidades assistenciais; adequada informação e esclarecimento das dúvidas do paciente; atenção dos profissionais de saúde aos múltiplos fatores sociais e culturais envolvidos com a adesão. São necessários novos estudos sobre o papel da assistência farmacêutica, grupos educativos e integração da equipe multiprofissional no engajamento do paciente para compartilhar as decisões sobre o tratamento, e assim ampliar seu grau de comprometimento com a própria saúde.

[Prevalence of overweight, obesity and life style associated with cardiovascular risk among middle school students]. / Prevalências de sobrepeso, obesidade e hábitos de vida associados ao risco cardiovascular em alunos do ensino fundamental.

BACKGROUND: To study the prevalence of cardiovascular risk associated to the lifestyle of school children from the 5th to 8th grade, in public and private schools. METHODS: Eighty seven randomly selected school rooms were visited adding up to 2,125 students who completed the questionnaire and whose body mass index was calculated. This sample represents around 2% of students from two school districts in the city of Sao Paulo. RESULTS: Of the 2,125 students, 24% were overweight or obese, 53.3% presented inappropriate food habits, 15.4% were sedentary, 62.6% drank alcohol, and 23.1% smoked. Between the 5th and 8th grade, the number of students who drank alcohol doubled and the number of male and female adolescents who tried out smoking increased 3-fold and 5-fold, respectively. Conversely, inappropriate food habits decreased. This situation is found in 40% of students from public schools and in 58% of those in private schools, by the time they reach the 8th grade. Overweight and obesity are more prevalent in private schools and the reduction noted as grades progress did not reach a significance level. Sedentarism is more prevalent in public schools. In private ones, sedentarism is lower among older students, contrary to public schools, where it increases with age. Female adolescents attend fewer physical education classes. Inappropriate food habits were characterized by the habits of adding more salt to pre-prepared food, lower intake of dairy products, fruit and vegetables also a higher intake of soft drinks, butter and snacks. CONCLUSION: Early detection of these cardiovascular risks associated to the lifestyle of these school children endorses the preventive practice of providing health education in schools.

Prevalências de sobrepeso, obesidade e hábitos de vida associados ao risco cardiovascular em alunos do ensino fundamental / Prevalence of overweight, obesity and lyfe style associated with cardiovascular risk among middle school students

OBJETIVO: Estudar a prevalência do risco cardiovascular associado ao estilo de vida de escolares da 5ª à 8ª série do ensino fundamental público e privado. MÉTODOS: Foram visitadas 87 salas, selecionadas aleatoriamente, totalizando 2125 estudantes que responderam ao questionário e tiveram o índice de massa corpórea calculado. A amostra representa cerca de 2 por cento dos alunos de duas regiões de ensino do município de São Paulo. RRESULTADOS: Foram observados 24 por cento com sobrepeso ou obesidade, 53,3 por cento com hábito alimentar inadequado, 15,4 por cento com sedentarismo, 62,6 por cento com consumo de álcool, e 23,1 por cento de cigarro. Entre 5ª e 8ª série dobrou o uso de bebidas alcoólicas, triplicou a proporção de adolescentes do sexo masculino que experimentou o cigarro, e quintuplicou do sexo feminino. Em contraposição, decresceu o hábito alimentar inadequado, embora 40 por cento dos alunos das escolas públicas, e 58 por cento das privadas, apresentem essa condição na 8ª série. O percentual de alunos com sobrepeso e obesidade foi maior nas escolas privadas, com o crescer das séries houve decréscimo dessa proporção, apesar de não atingir nível de significância estatística. O sedentarismo foi maior na escola pública e, com o crescer da idade, se mostrou controverso entre a escola pública e privada, aumentando com a idade na pública. As adolescentes do sexo feminino freqüentam menos as aulas de educação física. Hábito alimentar inadequado foi caracterizado por colocar mais sal na comida já preparada, menor consumo de laticínios, frutas e por outro lado, maior consumo de alimentos representados pelos refrigerantes, manteiga e salgadinhos. CONCLUSÃO: O reconhecimento precoce do risco cardiovascular associado ao estilo de vida fundamenta práticas preventivas de educação em saúde nas escolas.