Adesão terapêutica: contributos para a compreensão e intervenção / Therapeutic adherence: contributions to understanding and intervention / Adherencia terapéutica: contribuciones a la comprensión e intervención

Resumo Enquadramento: A adesão terapêutica (AT) visa a melhor saúde dos indivíduos e populações, reveste-se de grande complexidade e é influenciada por múltiplos fatores. As taxas de não-adesão continuam demasiado elevadas, sendo importante melhor conhecer para intervir. Objetivos: Analisar conceitos de AT; refletir sobre fatores associados à AT; sistematizar estratégias de intervenção; compreender métodos de avaliação. Principais tópicos em análise: A AT, enquanto comportamento do utente, é esperada como resposta às recomendações/prescrições dos profissionais de saúde, após cooperação mútua. A motivação do utente para ultrapassar barreiras à mudança de comportamento mostra-se fundamental. O utente é tomado como corresponsável pelo tratamento. Os profissionais de saúde adotam estratégias de promoção da AT em prol dos utentes, mobilizando-os. Serviços e políticas de saúde apoiam a minimização dos obstáculos e incentivam a avaliação da AT para melhorar práticas. Conclusão: A AT é multifatorial, o que dificulta o processo. Para o êxito da AT é necessária coordenação exemplar de todos os atores envolvidos, utentes, profissionais de saúde e instâncias sociais e políticas, antecipando medidas adequadas.

Abstract Background: Therapeutic adherence (TA) aims to improve the health of individuals and populations. It is highly complex and influenced by multiple factors. Non-adherence rates are still excessively high, and it is important to know more about them to intervene. Objectives: To analyze concepts of TA, reflect on factors associated with TA, systematize intervention strategies, and understand assessment methods. Main topics under analysis: As part of patient behavior, TA is the expected outcome of health professionals' recommendations/prescriptions, following mutual cooperation. Patient motivation is essential to overcome barriers to behavioral change, and patients are considered co-responsible for their treatment. Health professionals adopt TA promotion strategies to benefit and mobilize users. Health services and policies support the minimization of obstacles and encourage the evaluation of TA to improve practices. Conclusion: TA is multifactorial, which makes the process more difficult. Successful TA requires coordinating all involved stakeholders - users, health professionals, and social and political bodies, by anticipating the appropriate measures.

Resumen Marco contextual: La adherencia terapéutica (AT) tiene como objetivo mejorar la salud de los individuos y las poblaciones, es muy compleja y está influida por múltiples factores. Las tasas de no adherencia siguen siendo demasiado elevadas, y es importante comprenderlas mejor para poder intervenir. Objetivos: Analizar los conceptos de AT; reflexionar sobre los factores asociados a la AT; sistematizar las estrategias de intervención; comprender los métodos de evaluación. Principales temas en análisis: La AT, como comportamiento del usuario, se espera como respuesta a las recomendaciones/prescripciones de los profesionales de la salud, tras una cooperación mutua. La motivación del usuario para superar las barreras al cambio de comportamiento es esencial. El usuario se considera corresponsable del tratamiento. Los profesionales sanitarios adoptan estrategias de promoción de la AT en favor de los usuarios y los movilizan. Los servicios y las políticas sanitarias apoyan la minimización de los obstáculos y fomentan la evaluación de la AT para mejorar las prácticas. Conclusión: La AT es multifactorial, lo que complica el proceso. El éxito de la AT requiere una coordinación ejemplar de todas las partes interesadas, los usuarios, los profesionales sanitarios y los organismos sociales y políticos, y anticipar así las medidas adecuadas.

Grado de incumplimiento terapéutico en función del nivel de alfabetización en salud en pacientes en hemodiálisis / Degree of non-compliance with treatment as a function of health literacy level in haemodialysis patients

Introducción: El paciente en hemodiálisis está sometido a un régimen terapéutico cuya adherencia contribuye a disminuir la aparición de complicaciones asociadas. El incumplimiento terapéutico es un problema prevalente en la práctica clínica. Bajos niveles de alfabetización en salud se relacionan con falta de autocuidados, errores en la toma de medicaciones y dificultad para entender instrucciones, lo que trae consigo una mayor tasa de incumplimiento terapéutico.Objetivo:Conocer el grado de incumplimiento terapéutico en función del grado de alfabetización en salud de los pacientes sometidos a HD y valorar otros posibles factores implicados.Material y Método:Estudio prospectivo en 35 pacientes en programa de hemodiálisis. La alfabetización en salud se valoró con el cuestionario Health Literacy Survey European Union y el grado de incumplimiento terapéutico mediante la ganancia de peso interdialítica e indicadores analíticos, según recomendaciones de guías clínicas.Resultados:Los pacientes con nivel de alfabetización adecuada (≥34 puntos) presentaron menor incumplimiento terapéutico que pacientes con alfabetización inadecuada en relación con la ganancia de peso interdialítica (78% vs 70%), potasio (67% vs 56%), albúmina (83% vs 72%) pero mayor IT con el fósforo (83,33% vs 51,44%) -p<0,05 en todos los casos-.Conclusiones:Los pacientes con mayor nivel de alfabetización en salud tienen un menor grado de incumplimiento terapéutico, a excepción del fósforo, que es el parámetro con peor tasa de adherencia. (AU)

Introduction: Haemodialysis patients are subject to a therapeutic regimen whose adherence helps to reduce the occurrence of associated complications. Non-compliance is a prevalent problem in clinical practice. Low levels of health literacy are associated with lack of self-care, errors in taking medications and difficulty in understanding instructions, leading to a higher rate of non-compliance.Objective:To determine the level of non-compliance with treatment according to the level of health literacy of haemodialysis patients and to assess other possible factors involved.Material and Method:Prospective study of 35 haemodialysis patients. Health literacy was assessed using the Health Literacy Survey European Union questionnaire and the degree of therapeutic non-compliance was assessed using interdialytic weight gain and analytical indicators, according to the recommendations of clinical guidelines.Results:Patients with adequate literacy (≥34 points) had lower non-compliance than patients with inadequate literacy in relation to interdialytic weight gain (78% vs 70%), potassium (67% vs 56%), albumin (83% vs 72%); but higher non-compliance with phosphorus (83.33% vs 51.44%) - p<0.05 in all cases.Conclusions:Patients with a higher level of health literacy have a lower degree of non-compliance, except for phosphorus, which is the parameter with the worst adherence rate. (AU)

Cumplimiento del Protocolo de Lavado de Manos por profesionales de enfermería en un servicio de salud de la ciudad de Encarnación, marzo-julio del 2019 / Compliance with the handwashing protocol by nursing professionals in a health service of the city of Encarnacion, March-July 2019

El cumplimiento del protocolo de lavado de manos evita las infecciones nosocomiales, mientras que el incumplimiento ocasiona consecuencias como el aumento de la morbimortalidad, la estancia hospitalaria, así como gastos adicionales al sistema sanitario y al usuario. Esto se puede prevenir con el lavado de manos que surgió como teoría desde la antigüedad. El trabajo de investigación fue de tipo observacional descriptivo con enfoque cuantitativo y fue realizado en 24 enfermeros de un servicio de salud de la ciudad de Encarnación con el objetivo de evaluar el cumplimiento del protocolo del lavado de manos establecido en el Manual de Prevención y Control de Infecciones asociado a la Atención de la Salud del año 2017 del Ministerio de Salud Pública y Bienestar Social. Los resultados evidenciaron un 54% de incumplimiento en la técnica de lavado de manos, un 44% de incumplimiento parcial y solamente un 2% de cumplimiento. En cuanto a los cinco momentos del lavado de manos, el 85% no cumplió con todos los momentos y un 70% no ha recibido capacitación referente al lavado de manos en los últimos 2 años. Se evidenció un alto porcentaje de incumplimiento del protocolo de lavado de manos, lo que representa un riesgo para la salud que podría subsanarse con la realización de cursos de capacitaciones o retroalimentación a los profesionales de enfermería

Compliance of handwashing protocol avoid nosocomial infections, while non-compliance causes consequences such as increased morbidity and mortality, hospital stay, additional cost to the health system and the patient. This can be prevented with handwashing which emerged as a theory in ancient times. This study was descriptive observational with quantitative approach and was carried out in 24 nurses at a health service in the city of Encarnacion in order to evaluate the compliance of handwashing protocol, established in the Infection Prevention and Control Manual associated to Health Care of 2017 of the Ministry of Health Care and Social Welfare. The results showed 54% of non-compliance in the handwashing technique, 44% of partial non-compliance and just 2% of compliance. In relation to the five moments of handwashing technique, 85% did not follow all the steps and 70% did not receive training regarding to the hand washing technique in the last 2 years. A high percentage of non-compliance with the hand washing technique protocol was evidenced, which represents a health risk, which can be corrected with training or feedback workshops for nursing professionals

Incumplimiento terapéutico en úlceras vasculares: caso clínico / Therapeutic breach in vascular ulcers: clinical case

Se presenta un caso clínico donde la paciente manifiesta una sintomatología derivada del incumplimiento del régimen terapéutico prescrito para las úlceras vasculares que presenta en ambos miembros inferiores. Tras la valoración, se determina que los factores asociados al incumplimiento son el desencadenante de los síntomas referidos, revisándose y modificándose el plan de cuidados establecido. Con esta actuación se contribuyo a la evolución favorable de las lesiones y a un mayor control del tratamiento por parte de la paciente. Se debe reconocer todos los factores que influyen en la atención a la población y del manejo del lenguaje enfermero. El cuidado holístico debe primar en la atención enfermera, de manera que permita detectar este tipo de situaciones y planificar las actuaciones concretas para cada problemática de cada persona.

A clinical case is presented where the patient manifests a symptomatology derived from non-compliance with the prescribed therapeutic regimen for vascular ulcers presented in both lower limbs. After the assessment, it is determined that the factors associated with non-compliance are the trigger of the referred symptoms, reviewing and modifying the established care plan. This action contributed to the favorable evolution of the lesions and to a greater control of the treatment by the patient. All factors that influence population care and nursing language management must be recognized. Holistic care should take priority in nursing care, so that it can detect these types of situations and plan specific actions for each problem of each person.

Self-Regulation Assessment Based on Compliance and Noncompliance in Children / Valoración de la Autorregulación con base en el Cumplimiento y el Incumplimiento en los Niños / Avaliação da Autorregulação com base no Cumprimento e no Incumprimento em Crianças

Abstract In this paper, I reflect on the information that compliance and noncompliance behaviors provide about self-regulation development in children. I argue that these behaviors show differences in self-regulation, depending on the level of independence of the children, their motivation, and the emotional activation they express when disobeying. I further suggest methodologies to assess each of these factors. Specifically, I propose to differentiate several types of compliance and noncompliance behaviors, record children's behavior and type of parental control simultaneously, and analyze children's behavior in response to legitimate and illegitimate demands. These distinctions are important for a more thorough and accurate approach to studying self-regulation in children.

Resumen En este trabajo llevo a cabo una reflexión acerca de la información que los comportamientos de cumplimiento e incumplimiento nos brindan acerca del desarrollo de la autorregulación en los niños. Sostengo que las diferencias que estos comportamientos revelan en cuanto a la autorregulación dependen del nivel de autonomía de los niños, su motivación y la activación emocional que demuestran cuando desobedecen. Sugiero también algunas metodologías para valorar cada uno de estos factores. Específicamente, propongo diferenciar entre los distintos tipos de cumplimiento e incumplimiento, registrar de manera simultánea el comportamiento de los niños y el tipo de control ejercido por los padres y analizar el comportamiento con el que responden los niños a exigencias legítimas e ilegítimas. Estas distinciones son importantes para un abordaje más completo y preciso del estudio de la autorregulación en los niños.

Resumo Neste trabalho, realizo uma reflexão sobre a informação que os comportamentos de cumprimento e incumprimento nos oferecem acerca do desenvolvimento da autorregulação em crianças. Sustento que as diferenças que esses comportamentos revelam quanto à autorregulação dependem do nível de autonomia das crianças, sua motivação e a ativação emocional que demonstram quando desobedecem. Sugiro também algumas metodologias para avaliar cada um desses fatores. Em específico, proponho diferenciar entre os tipos de cumprimento e incumprimento, registrar de maneira simultânea o comportamento das crianças e o tipo de controle exercido pelos pais, além de analisar o comportamento com o qual respondem as crianças a exigências legítimas e ilegítimas. Essas diferenciações são importantes para uma abordagem mais completa e precisa do estudo da autorregulação em crianças.

Illegal fishing and territorial user rights in Chile.

Illegal fishing poses a major threat to conservation of marine resources worldwide. However, there is still limited empirical research that quantifies illegal catch levels. We used the randomized response technique to estimate the proportion of divers and the quantities of loco (Concholepas concholepas) they extracted illegally. Loco have been managed for the past 17 years through a territorial user rights for fisheries system (TURFs) in Chile. Illegal fishing of loco was widespread within the TURFs system. Official reported landings (i.e., legal landings) accounted for 14-30% of the total loco extraction. Our estimates suggest that ignoring the magnitude of illegal fishing and considering only official landing statistics may lead to false conclusions about the status and trends of a TURFs managed fishery. We found evidence of fisher associations authorizing their members to poach inside TURFs, highlighting the need to design TURFs systems so that government agencies and fishers' incentives and objectives align through continuous adaptation. Government support for enforcement is a key element for the TURFs system to secure the rights that are in place.

Risk Factors associated with defaulting from visceral leishmaniasis treatment: analysis under routine programme conditions in Bihar, India.

OBJECTIVE: To assess the rate of default from treatment in the visceral leishmaniasis (VL) elimination programme and to identify risk factors and its underlying causes. METHODS: Case-control study conducted between December 2009 and June 2012 in three primary health centres (PHCs) of Muzaffarpur district, India. Patients who defaulted from treatment from the PHCs were considered as 'cases' and those who completed their treatment as 'controls'. Two controls were included in the study for each case. Respondents' opinion and satisfaction with the services provided at the PHCs were also elicited. Logistic regression was performed to assess the contribution of sociodemographic variables on patient status, and a discriminant analysis was used (after decomposing the original data) to identify factors that can predict the patient status as defaulter or not, based on factor scores of the components as predictor variables. RESULTS: During the study period, 16.3% (89/544) of patients defaulted; 87 cases and 188 controls were interviewed through a semistructured questionnaire. Women tended to be more at risk for default (OR, 1.6, 95% CI (0.9 -2.9). Treatment received was miltefosine in 55.6% and sodium stibogluconate (SSG) in 44.4%. Most (86%) defaulters completed their treatment at other healthcare facilities; 70% of them preferred non-governmental institutions. Most cited reasons for default were seeking a second opinion for VL treatment and preferring to be treated in specialised VL centres. Discriminant analysis showed only one significant predictor: dissatisfaction with the medical care received in PHCs. CONCLUSION: Efforts are needed to enhance the quality of VL care at PHC level, which will be beneficial in increasing treatment completion rates.

[Non-compliance with the systemic antibiotic treatment prescribed in Primary Health Care emergency departments (Study INCUMAT')]. / Incumplimiento del tratamiento antibiótico sistémico prescrito en servicios de urgencias de Atención Primaria (Estudio INCUMAT).

INTRODUCTION: Non-compliance with antibiotics treatment has severe consequences. Although antibiotics are commonly prescribed drugs, there are few studies that evaluate therapeutic compliance in acute diseases. The main objective of this study is to determine the percentage of non-compliance with the systemic antibiotics treatment prescribed in emergency departments. MATERIAL AND METHODS: A prospective observational study was performed in the Emergency Department of 2 health centres of the Cantabria Health Service between the months of June and September 2014. The study included patients of any age, and those could be monitored, who were prescribed a systemic antibiotic for any infectious disease. Sociodemographic variables, diseases, and compliance were the variables studied. The Morinsky-Green test was used, plus 3 questions added by the authors. RESULTS: Of the 303 patients included, non-compliance, evaluated using the Morinsky-Green test, was 32.7% (95% CI 27.6-38.1), with this rising to the 44.9% (95% CI 39.4-50.5) when the 3 mentioned questions were added to the test. A downward trend is observed in non-compliance as the age increases. The risk of non-compliance is twice in men than in women: OR=2.02 (95% CI 1.27-3.24). CONCLUSIONS: Almost half (45%) of the patients who are prescribed antibiotics do not comply with the indications. Most of them attribute this fact to forgetfulness in compliance with the prescribed treatment. The elderly and women follow the treatment better, which should be taken into account when designing strategies to improve therapeutic compliance.

Factores que intervienen en el incumplimiento del control de crecimiento y desarrollo del niño y la niña menor de dos años Centro Materno Infantil Tablada de Lurín. Lima - 2014 / Factors involved in the non-compliance with the control of growth and development of the children under than two years Center Maternal-Child Tablada of Lurin. Lima - 2014

Determinar los factores que intervienen en el incumplimiento del control CRED del niño y la niña menor de dos años C.M.I. Tablada de Lurín, Material y Método: El estudio fue de nivel aplicativo, tipo cuantitativo, método descriptivo simple de corte transversal. La población estuvo conformada por 25 madres. La técnica fue la entrevista, y el instrumento un cuestionario aplicado previo consentimiento informado. Resultados. En relación a los factores que intervinieron en el incumplimiento del control CRED del niño y la niña menor de dos años en el CMI Tablada de Lurín, se encuentra que del 100 por ciento (25 por ciento) de madres entrevistadas refirieron, 100 por ciento (25) número de profesionales de enfermería insuficiente, 88 por ciento (22) horario de atención, 64 por ciento (16) tiempo de espera, 48 por ciento (12), quehaceres del hogar, 48 por ciento (12) cuidado de hijos menores de edad, 24 por ciento (7) trabajo, 24 por ciento (7) horario de trabajo, 8 por ciento (2) información brindada por la enfermera no es útil, 8 por ciento (2) información brindada por la enfermera no es clara, 4 por ciento (1) desconocimiento importancia del control CRED, y 4 por ciento (1) tiempo para el control CRED inadecuado. Conclusiones. Los factores que influyeron en el incumplimiento del control CRED del niño y la niña menor de dos años en el C.M.I. Tablada de Lurín, según refirieron las madres entrevistadas, en su totalidad manifestó número de profesionales de enfermería insuficiente, en mayor porcentaje horario de atención, un buen porcentaje tiempo de espera demasiado, un porcentaje considerable por los quehaceres del hogar, así como por cuidado de hijos menores de edad, y en menor porcentaje por trabajo y horario del mismo un mínimo porcentaje pero significativo consideraron que la información brindada por la enfermera no es clara ni útil, seguido por desconocimiento importancia del control CRED, y tiempo para el control inadecuado...

Treatment compliance in chronic illness: Current situation and future perspectives. / Adherencia terapéutica en la enfermedad crónica: estado de la situación y perspectiva de futuro.

Long-term chronic diseases have a high mortality rate around the world, affecting both genders equally. Despite improvements in the diagnosis and treatment of various health problems, lack of treatment compliance remains an obstacle to improving health and patient quality of life, and it carries a high associated socio-healthcare cost. The objectives of this study were to develop the concept of «therapeutic adherence¼, which includes both pharmacological compliance as well as non-pharmacological (level of agreement and patient involvement, lifestyle changes, etc.) treatments. The study also aimed to establish the clinical and socio-health impact of non-compliance, the reasons for non-compliance, and methods and strategies to improve compliance. The results of this study support therapeutic adherence as an essential goal of the healthcare system that encompasses all stakeholders involved in patient health.

Determinación de resultados negativos asociados a la medicación en pacientes con diagnóstico de trastornos del humor, hospitalizados en el Servicio de Psiquiatría del Hospital Regional de Iquique Dr. Ernesto Torres Galdames, durante el año 2009 / Determination of negative results associated with medication in patients with mood disorders, hospitalized in the Psychiatry Service Units of the Regional Hospital of Iquique Dr. Ernesto Torre Galdames, during the year 2009

Resultados Negativos Asociados a la Medicación (RNM) son eventos cada vez más frecuentes, vinculados a la terapia farmacológica que obstaculiza los objetivos terapeúticos planteados en los pacientes que requieren tratamiento. Esta investigación se realizó en las dependencias del Servicio de Psiquiatría del Hospital Regional de Iquique, cuyo principal objetivo fue la detección de RNM en las fichas clínicas de pacientes con diagnóstico de trastornos del humor hospitalizados durante el año 2009. Los casos fueron estudiados apoyados con la metodología Dáder y la clasificación de los RNM identificados, se realizó de acuerdo al tercer consenso de Granada. El total de casos incluidos fue de 164, de ellos el 38,4 por ciento presentó un RNM principalmente del tipo "seguridad". La distribución de los RNM a través de las variables independientes se concentró en: sexo femenino, edades entre 18 y 44 años, pacientes con polifarmacia y en hospitalizaciones que se prolongaron hasta por 30 días. Para evaluar si están asociadas estas variables con la aparición de un RNM se aplicó la prueba estadística chi-cuadrado, revelándose diferencias estadísticas significativas en polifarmacia y días cama. Se concluye que los factores asociados a la aparición de un RNM en los pacientes con trastornos del humor del servicio de psiquiatría son la polifarmacia y los días que dura su hospitalización.

Negative Results Associated with Medication (NRM) are increasingly frequent events, linked to pharmacological therapies that hinder the therapeutic goals in the patients who require treatment. This investigation was conducted in the psychiatry service units of the regional hospital of Iquique, whose main objective was de detection of RNM in the clinical records of patients diagnosed with mood disorders, hospitalized in 2009. The cases were studied with the Dáder methodology; the classification of identified RNM was performed according to the third Granada consensus. The total number of cases was 164, 38,4 percent of them presented an RNM through the independent variables focused on: female, aged between 18 and 44 years, patients with poly pharmacy and hospitalization which lasted up to 30 days. To asses whether these variables were associated with the appearance of an RNM, chi-square statistic test used, revealed statistically significant differences in polypharmacy and bed days. In conclusion, the factors associated with the appearance of a RNM in patients with mood disorder are: polypharmacy and days of hospitalization.