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INTRODUCTION: Digital health or "e-health" is a set of applications based on information and communication technologies (ICTs) that can be used to promote self-care and medication adherence in patients with chronic diseases. The aim of this study was to carry out a review of systematic reviews (meta-review) on efficacy studies of e-health interventions to promote adherence to antiretroviral therapy (ART) in people living with HIV/AIDS. METHODOLOGY: A review of systematic reviews ("meta-review") was performed using the Medline-PubMed database on efficacy studies of e-health components to promote adherence to ART, in patients with HIV/AIDS, proposing a structured search strategy (PICO question). A selection process for systematic reviews was conducted based on inclusion and exclusion criteria. Subsequently, the corresponding data were extracted, and the analysis was accomplished in descriptive tables. RESULTS: A total of 29 systematic reviews were identified, from which 11 were selected. These reviews comprised 55 RCTs with different e-health interventions and enrolled a total of 15,311â¯HIV/AIDS patients. Studies included a total of 66 comparisons (experimental group vs. control group) in indirect adherence measurements based on different measurement techniques (36 statistically significant); 21 comparisons of viral load (VL) measurements (10 statistically significant); and 8 comparisons of CD4+ cell count measurements (3 statistically significant). m-Health was the most studied component followed by the telephone call and e-learning. CONCLUSION: Evidence was found that supports that some e-health interventions are effective in promoting adherence to ART and improving health outcomes in patients with HIV/AIDS, although it is identified that more studies are needed for more robust evidence.
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Introducción: la falta de adherencia farmacológica, siendo un problema de salud pública es una de las principales causas de incremento de la morbimortalidad, discapacidad y costos sanitarios en los pacientes con enfermedades crónicas no transmisibles. Objetivo: describir la prevalencia de la no adherencia al tratamiento farmacológico de los pacientes adultos con patología crónica que asistieron a un centro médico de la ciudad de Tunja, desde septiembre a noviembre del año 2022. Materiales y métodos: estudio observacional de corte transversal que incluyó adultos mayores de 18 años con enfermedad crónica no transmisible en el servicio de consulta externa de un centro de salud de baja complejidad, se recolectó los datos de las historias clínicas, se utilizó estadística descriptiva y Odds Ratio para análisis de asociación. Resultados: se analizaron 216 pacientes. La prevalencia de no adherencia al tratamiento farmacológico fue del 75%, el promedio de edad de pacientes con patología crónica fue 65,5 años, el sexo femenino representó el 56,9%, la mayoría de los casos tuvieron hipertensión arterial sistémica (94,4%), más de la mitad presentaron comorbilidades (73,1%) y el 45,3% estaban polimedicados. Los factores relacionados con la no adherencia farmacológica según el test de Morisky-Green fueron edad menor a 60 años (p=0,033), sexo masculino (p=0,045), consumo de alcohol (p=0,003) y tabaco (p=0,003), ausencia de comorbilidades (p=0,008) y no polifarmacia (p=0,004). Conclusión: la no adherencia farmacológica presentó una prevalencia, por encima a la reportada en la literatura y el principal factor asociado fue el consumo de tabaco. Los resultados obtenidos proporcionan conocimientos para nuevas investigaciones (AU)
Introduction: lack of pharmacological adherence, being a public health problem, is one of the main causes of increased morbidity and mortality, disability and health costs in patients with chronic non-communicable diseases. Objective: to describe the prevalence of non-adherence to pharmacological treatment in adult patients with chronic pathology who attended a medical center in the city of Tunja, from September to November 2022. M aterials and methods: cross-sectional observational study that included adults over 18 years of age with chronic non-communicable disease in the outpatient service of a low-complexity health center, data was collected from medical records, descriptive statistics were used and Odds Ratio for association analysis. Results: 216 patients were analyzed. The prevalence of non-adherence to pharmacological treatment was 75%, the average age of patients with chronic pathology was 65.5 years, the female sex represented 56.9%, the majority of cases had systemic arterial hypertension (94,4%), more than half had comorbidities (73.1%) and 45.3% were polypharmacy. The factors related to pharmacological non-adherence according to the Morisky-Green test were age under 60 years (p=0.033), male sex (p=0.045), alcohol consumption (p=0.003) and tobacco (p=0.003), absence of comorbidities (p=0.008) and no polypharmacy (p=0.004). Conclusion: pharmacological non-adherence had a high prevalence above that reported in the literature and the main associated factor was tobacco consumption. The results obtained provide knowledge for new research (AU)
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Adesão à Medicação/estatística & dados numéricos , Comorbidade , Inquéritos e Questionários , Instalações de SaúdeRESUMO
INTRODUCTION: Digital health or "e-Health" is a set of applications based on Information and Communication Technologies that can be used to promote self-care and medication adherence in patients with chronic diseases. The aim of this study was to carry out a review of systematic reviews (meta-review) on efficacy studies of e-Health interventions to promote adherence to antiretroviral therapy in people living with HIV/AIDS. METHOD: A review of systematic reviews ("meta-review") was performed using the Medline-PubMed database on efficacy studies of e-Health components to promote adherence to antirretroviral therapy, in patients with HIV/AIDS, proposing a structured search strategy (PICO question). A selection process for systematic reviews was conducted based on inclusion and exclusion criteria. Subsequently, the corresponding data were extracted, and the analysis was accomplished in descriptive tables. RESULTS: A total of 29 systematic reviews were identified, from which 11 were selected. These reviews comprised 55 randomized controlled therapies with different e-Health interventions and enrolled a total of 15,311 HIV/AIDS patients. Studies included a total of 66 comparisons (experimental group vs. control group) in indirect adherence measurements based on different measurement techniques (36 statistically significant); 21 comparisons of viral load measurements (10 statistically significant); and 8 comparisons of CD4+ cell count measurements (3 statistically significant). m-Health was the most studied component followed by the telephone call and e-Learning. CONCLUSIONS: Evidence was found that supports that some e-Health interventions are effective in promoting adherence to antirretroviral therapy and improving health outcomes in patients with HIV/AIDS, although it is identified that more studies are needed for more robust evidence.
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Fundamento: El incumplimiento del tratamiento por las personas diabéticas, no solo empeora el pronóstico, sino su calidad de vida. Objetivo: Caracterizar la adherencia terapéutica en pacientes diabéticos tipo 2 pertenecientes a cuatro áreas de salud, de dos municipios de Cuba. Métodos: Se realizó un estudio descriptivo y transversal en dos áreas de salud de los municipios de Cárdenas y Santiago de Cuba, en el periodo enero - agosto de 2019. El universo estuvo representado por 1091 personas diabéticas que se recuperaron de un estudio previo efectuado entre el 2015 y 2016 en las mismas áreas de salud. A estas se les realizó mediciones antropométricas, de la presión arterial, hemoglobina glicada y se aplicó un cuestionario. Se estudiaron variables: sociodemográficas (edad, sexo, color de la piel, ocupación, nivel de escolaridad, convivencia), factores de riesgo y comorbilidades, tratamiento farmacológico y no farmacológico y su relación con la adherencia. Las variables categóricas fueron presentadas como frecuencias y porcentajes. Resultados: La adherencia fue de 70,7 %, relacionada estadísticamente con color de piel blanca, nivel de escolaridad alto, control de la hemoglobina glicada según edad y valor inferior a 7 %, así como, el no padecimiento de comorbilidades como enfermedades cardiovasculares, respiratorias crónicas, dislipidemia, no consumo de bebidas alcohólicas, ni azucaradas. Conclusiones: La no disponibilidad de medicamentos en farmacia, el olvido en tomarlos y en los horarios establecidos resultaron las principales barreras referidas por los pacientes, esto debe tenerse en cuenta para incidir de forma favorable en el control de la diabetes mellitus.
Foundation: Non-compliance with treatment by diabetic people not only worsens the prognosis, but also their quality of life. Objective: To characterize therapeutic adherence in type 2 diabetic patients belonging to four health areas, from two municipalities in Cuba. Methods: A descriptive and cross-sectional study was carried out in two health areas of the municipalities of Cárdenas and Santiago de Cuba, in the period January - August 2019. The universe was represented by 1091 diabetic people who recovered from a previous study carried out between 2015 and 2016 in the same health areas. They underwent anthropometric measurements, blood pressure, glycated hemoglobin and a questionnaire was applied. Variables were studied: sociodemographic (age, sex, skin color, occupation, level of education, cohabitation), risk factors and comorbidities, pharmacological and non-pharmacological treatment and their relationship with adherence. Categorical variables were presented as frequencies and percentages. Results: Adherence was 70.7 %, statistically related to white skin color, high level of education, control of glycated hemoglobin according to age and value less than 7 %, as well as not suffering from comorbidities such as cardiovascular diseases, chronic respiratory diseases, dyslipidemia, no consumption of alcoholic or sugary beverages. Conclusions: The non-availability of medications in the pharmacy, forgetting to take them and at the established times were the main barriers reported by patients, this must be taken into account to have a favorable impact on the control of diabetes mellitus.
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OBJECTIVE: The aim of this study was to analyze the recommended prevention measures in our health area for patients discharged after a myocardial infarction. METHODS: This was a retrospective descriptive study that selected patients with acute coronary syndrome in our health area in the previous calendar year. Control of the risk factors observed at the time of the coronary event and at 1 year and medication prescribed 1 year after the episode were studied. Variables including age, sex, control of dyslipidemia, hypertension or diabetes mellitus, adherence to treatment and lifestyle habits were analyzed. RESULTS: Risk factor control was insufficient and sometimes even unassessed at the time of infarction. Although a slight improvement was perceived, control remained insufficient 1 year later. Moreover, patients, particularly women, were undertreated: one fifth (20%) more men were receiving appropriate treatment than women year after the myocardial event. CONCLUSIONS: An additional effort must be made compared to what is currently being done, both by specialists in Hospital Care and Primary Care, to carry out good control of risk factors, meaning the control of certain diseases such as diabetes, high blood pressure or dyslipidemia, as well as habits or lifestyles that increase the probability of suffering a cardiovascular event. Furthermore, it is important to avoid these cardiovascular diseases and their relapse to reinforce adherence to the prescribed treatments.
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Estilo de Vida , Adesão à Medicação , Infarto do Miocárdio , Humanos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Adesão à Medicação/estatística & dados numéricos , Infarto do Miocárdio/prevenção & controle , Estudos de Coortes , Isquemia Miocárdica/prevenção & controle , Fatores de Risco , Síndrome Coronariana Aguda/terapia , Hipertensão/tratamento farmacológico , Dislipidemias/tratamento farmacológico , Fatores Sexuais , Diabetes MellitusRESUMO
OBJECTIVE: To evaluate the association between therapeutic adherence and the phases of grief in patients with type 2 diabetes mellitus. DESIGN: Cross-sectional observational study. SITE: Family Medicine Unit No. 53 of the Mexican Institute of Social Security in the State of Guanajuato. PARTICIPANTS: A total of 354 patients with type 2 diabetes mellitus were recruited, of whom 236 corresponded to the group without therapeutic adherence and 118 to the group with therapeutic adherence. INTERVENTIONS: Two structured surveys were administered to both groups. MAIN MEASUREMENTS: The Morisky 8 scale was used to measure therapeutic adherence and the phases of grief scale (EFD-66) to measure grief due to loss of health. RESULTS: The median denial phase and depression phase scores were higher in the nonadherence group than in the adherence group (p=.000). The median negotiation phase and acceptance phase score was higher in the adherence group than in the nonadherence group (p=.000). Multivariate analysis identifies that denial is the main factor associated with non-adherence (OR=1.25; 95% CI: 1.14-1.37); while negotiation (OR=0.88; 95% CI: 0.82-0.94) and acceptance are associated with adherence (OR=0.79; 95% CI: 0.75-0.83). CONCLUSIONS: There is an association between therapeutic adherence and phases of grief.
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Depressão , Diabetes Mellitus Tipo 2 , Pesar , Humanos , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/terapia , Estudos Transversais , Masculino , Feminino , Pessoa de Meia-Idade , México , Inquéritos e Questionários , Idoso , Cooperação do Paciente , Adulto , Negação em PsicologiaRESUMO
Introduction and objectives Prior studies have not determined whether the effect of dual antiplatelet therapy (DAPT) cessation on the subsequent risk of major adverse cardiac events (MACE) varies by the choice of P2Y12-inhibitor after acute coronary syndrome (ACS). Methods We performed a prespecified subanalysis of a multicenter, prospective registry of ACS patients discharged on ticagrelor or clopidogrel between 2015 and2019. Nonadherence to DAPT was categorized as physician-guided discontinuation and disruption due to adverse effects, nonadherence, or bleeding. The association between DAPT cessation and 1-year MACE was analyzed using multivariate time-updated Cox models with inverse probability of censoring weighted estimators. Results Out of 2180 patients, 174 (8.3%) prematurely discontinued DAPT (physician-guided, n=126; disruption, n=48). Nonadherent patients were older and had more comorbidities than those on DAPT. Compared with physician-guided discontinuation, disruption occurred earlier after discharge and was more frequent with ticagrelor than with clopidogrel. In time-varying analysis, DAPT cessation was associated with an increased risk of MACE (adjusted HR, 1.32, 95%CI, 1.10-1.76), largely driven by disruption (adjusted HR, 1.47, 95%CI, 1.22-1.73). There was an exponential increase in MACE risk after DAPT cessation within 90 days after ACS, especially after disruption of ticagrelor compared with clopidogrel (Pinteraction<.001). After adjustment for DAPT duration, this interaction was not statistically significant on the additive scale (relative excess risk due to interaction 0.12, 95%CI,−0.99-1.24). Conclusions In this all-comers registry, 1 in 12 patients prematurely discontinued DAPT within 1 year after ACS. Compared with physician-recommended discontinuation, disruption resulted in a significantly higher risk of MACE. After adjustment for DAPT duration, this association was not moderated by the choice of P2Y12-inhibitor (AU)
Introducción y objetivos Una baja adherencia al tratamiento antiagregante plaquetario doble (TAPD) condiciona peor pronóstico tras un síndrome coronario agudo (SCA). Se analizó si el riesgo de eventos adversos cardiovasculares mayores (MACE) tras la interrupción prematura del TAPD varía según el inhibidor del P2Y12. Métodos Análisis preespecificado de pacientes con SCA tratados con ticagrelor o clopidogrel entre 2015 y 2019 dentro de un registro prospectivo multicéntrico. Se categorizó la suspensión prematura como indicada por el médico o como interrupción por hemorragia, efectos secundarios o incumplimiento del paciente. La asociación entre la suspensión del TAPD y los MACE se analizó mediante modelos multivariantes de Cox dependientes del tiempo, con estimadores robustos ponderados por probabilidad inversa de censura. Resultados De 2.180 pacientes, 174 (8,3%) suspendieron el TAPD precozmente (126 por indicación médica y 48 por disrupción). Los pacientes incumplidores tenían más edad y más comorbilidad que los adherentes. Frente a la suspensión indicada por el médico, la disrupción del TAPD fue más precoz y frecuente con el ticagrelor que con el clopidogrel. La suspensión del TAPD condicionó mayor riesgo de MACE (HRajustada=1,32; IC95%, 1,10-1,76), principalmente en caso de la disrupción (HRajustada=1,47; IC95%, 1,22-1,73). Este riesgo aumentó exponencialmente en los 90 días posteriores al SCA y fue más evidente con ticagrelor (pinteracción<0,001). Tras considerar la duración del TAPD, esta interacción no resultó significativa en la escala aditiva (exceso de riesgo debido a interacción=0,12; IC95%, 0,99 a 1,24)(AU)
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Inibidores da Agregação Plaquetária/uso terapêutico , Síndrome Coronariana Aguda/tratamento farmacológico , Adesão à Medicação , Clopidogrel/uso terapêutico , Ticagrelor/uso terapêutico , Resultado do TratamentoRESUMO
Los Sistemas Personalizados de Dosificación (SPD) son una herramienta eficaz, segura y homologada para el reacondicionamiento de fármacos en farmacia comunitaria. Estos implican la revisión del uso del medicamento (RUM) y la colaboración con el médico de atención primaria (MAP). En el presente artículo se describe el caso de una paciente de 57 años intervenida de lumbociatalgia en 2021 y 2022, con dolor crónico mal controlado y aturdimiento derivado del olvido y/o duplicidad de las tomas. Durante la dispensación habitual se detectan estos problemas relacionados con el medicamento (PRM) y se deriva a la paciente al servicio SPD. Tras la implantación del mismo, la paciente mejora a nivel cognitivo, eliminando el aturdimiento y controlando el dolor, lo que supuso un aumento en su calidad de vida. En conclusión, se destaca la importancia de los diferentes servicios disponibles en la farmacia para mejorar la calidad de vida del paciente, la adherencia al tratamiento y la detección de PRM. (AU)
Monitored Dosage Systems (MDS) are an efficient, reliable and approved device for drug reconditioning in pharmacy. These systems imply a review on proper drug use and the collaboration between primary health care and pharmacists. The case study describes a female patient with a surgical intervention due to lumbosciatica in 2021 and 2022. Patient describes uncontrolled chronic pain and confusion related to improper drug use. During regular dispensing of her medication, these medicine-related problems (MRP) were detected and the patient was referred to the MDS service. After its implementation, the patients confusion was eliminated and pain management was achieved, increasing her quality of life. As a conclusion, the different health services provided by the pharmacy can improve a patients quality of life, treatment adherence and MRP detection. (AU)
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Humanos , Feminino , Pessoa de Meia-Idade , Cooperação e Adesão ao Tratamento , Polimedicação , Formas de Dosagem , Qualidade de Vida , Cálculos da Dosagem de MedicamentoRESUMO
INTRODUCTION AND OBJECTIVES: Prior studies have not determined whether the effect of dual antiplatelet therapy (DAPT) cessation on the subsequent risk of major adverse cardiac events (MACE) varies by the choice of P2Y12-inhibitor after acute coronary syndrome (ACS). METHODS: We performed a prespecified subanalysis of a multicenter, prospective registry of ACS patients discharged on ticagrelor or clopidogrel between 2015 and2019. Nonadherence to DAPT was categorized as physician-guided discontinuation and disruption due to adverse effects, nonadherence, or bleeding. The association between DAPT cessation and 1-year MACE was analyzed using multivariate time-updated Cox models with inverse probability of censoring weighted estimators. RESULTS: Out of 2180 patients, 174 (8.3%) prematurely discontinued DAPT (physician-guided, n=126; disruption, n=48). Nonadherent patients were older and had more comorbidities than those on DAPT. Compared with physician-guided discontinuation, disruption occurred earlier after discharge and was more frequent with ticagrelor than with clopidogrel. In time-varying analysis, DAPT cessation was associated with an increased risk of MACE (adjusted HR, 1.32, 95%CI, 1.10-1.76), largely driven by disruption (adjusted HR, 1.47, 95%CI, 1.22-1.73). There was an exponential increase in MACE risk after DAPT cessation within 90 days after ACS, especially after disruption of ticagrelor compared with clopidogrel (Pinteraction<.001). After adjustment for DAPT duration, this interaction was not statistically significant on the additive scale (relative excess risk due to interaction 0.12, 95%CI,-0.99-1.24). CONCLUSIONS: In this all-comers registry, 1 in 12 patients prematurely discontinued DAPT within 1 year after ACS. Compared with physician-recommended discontinuation, disruption resulted in a significantly higher risk of MACE. After adjustment for DAPT duration, this association was not moderated by the choice of P2Y12-inhibitor. Clinical trial registered at ClinicalTrials.gov (Identifier: NCT02500290).
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Síndrome Coronariana Aguda , Intervenção Coronária Percutânea , Humanos , Clopidogrel/uso terapêutico , Ticagrelor/uso terapêutico , Inibidores da Agregação Plaquetária/efeitos adversos , Síndrome Coronariana Aguda/terapia , Resultado do Tratamento , Sistema de Registros , Intervenção Coronária Percutânea/efeitos adversosRESUMO
La adherencia terapéutica, es un hecho variante y complejo ya que son diversos los factores que influyen en él. En los países desarrollados la adherencia terapéutica de los pacientes que padecen enfermedades crónicas es del 50%, requiriendo acciones de prevención y promoción de la salud, que se ven intensificadas cuando la falta de adherencia terapéutica está unida al abuso de sustancias y la dependencia de alcohol. El señor D.R. es un paciente varón de 69 años con paresia crural izquierda, trastorno de la marcha, dependencia para las ABVD y AIVD, HTA, ateromatosis carotidea, mala adherencia terapéutica, abuso de alcohol, sobrepeso e hipercolesterolemia, que ingresa en el hospital en el servicio de Neurología tras sufrir un ictus isquémico. Durante este ingreso, se distingue el progreso en el nivel de implicación y compromiso del paciente con su propia salud. A través de la taxonomía NANDA-I, NOC y NIC, se llevó a cabo un plan de cuidados, aplicando un lenguaje estandarizado y con intervenciones basadas en la evidencia científica. (AU)
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Humanos , Masculino , Idoso , Cooperação e Adesão ao Tratamento , Alcoolismo , Paresia/terapiaRESUMO
Introducción: La hipertensión arterial es una enfermedad crónica con gran prevalencia, que repercute en la calidad de vida, donde influyen múltiples factores psicosociales que ayudan a garantizar un control adecuado. Objetivo: Determinar el impacto de la influencia de factores psicosociales en el control de la tensión arterial de los pacientes hipertensos en régimen penitenciario. Materiales y métodos: Se realizó un estudio observacional, descriptivo y longitudinal sobre el valor de factores psicosociales en el control de la hipertensión arterial, tratados en un establecimiento penitenciario perteneciente a los Servicios Médicos del Ministerio del Interior, en la provincia de Camagüey, durante los años 2020-2022. La muestra quedó conformada por 82 pacientes hipertensos de difícil control atendidos en consulta, en los cuales se estudiaron diversos factores psicosociales que pudieran intervenir en el control de la tensión arterial. Resultados: La muestra quedó conformada por 82 pacientes hipertensos de difícil control, atendidos en consulta. Predominaron los blancos, con edad entre 41 y 60 años, nivel secundario, con incumplimiento del tratamiento médico, poco apoyo social, con familia con trastornos de violencia, y aislamiento social con condenas anteriores. Conclusiones: En el recluso hipertenso los factores psicosociales cobran un papel muy importante, partiendo de los trastornos afectivos que tienen estos enfermos por falta de apoyo social, convivir en un medio muy agresivo que produce trastornos de sus funciones cognitivas, que afecta el control de la tensión arterial, los cuales están organizados desde un paradigma biomédico, clínico y farmacológico. De esta forma, la somatización de los factores psicosociales juega un importante -aunque no determinante- papel en el descontrol de las cifras tensionales y la no adherencia al tratamiento.
Introduction: Arterial hypertension is chronic illness with great prevalence that rebounds on the quality of life, where many psychosocial factors influence that help ensure the appropriate control. Objective: To determine the impact of the influence of psychosocial factors in the control of the arterial tension of the hypertensive patient in the penitentiary system. Materials and methods: An observational, descriptive and longitudinal study was carried out on the value of psychosocial factors in the control of arterial hypertension in a prison facility belonging to the Medical Services of the Ministry of the Interior, in the province of Camaguey, during the years 2020-2022. The sample was made up of 82 hypertensive patients of difficult control attended in consultation, in which diverse psychosocial factors were studied that could intervene in the control of the arterial tension. Results: The sample was composed of 82 hypertensive patients of difficult control, attended in consultation. White people predominated, aged between 41 and 60 years, secondary level of schooling, with non-compliance with medical treatment and little social support; from a family with violence disorders; socially isolated and with previous convictions. Conclusions: In the hypertensive inmate, psychosocial factors play a very important role, based on the affective disorders that these patients have due to lack of social support, living together in a very aggressive environment that produces disorders of their cognitive functions, which affects the control of arterial tension; these are organized from a biomedical, clinical and pharmacological paradigm. In this way, the somatization of psychosocial factors plays an important-although not determining-role in the lack of blood pressure control and non-adherence to the treatment.
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Introducción: La adherencia al tratamiento farmacológico favorece la supresión viral y reduce la resistencia a la terapia antirretroviral de gran actividad a largo plazo. Objetivo: Determinar la relación entre los aspectos farmacológicos y la adherencia al tratamiento antirretroviral de una IPS colombiana. Metodología: Estudio analítico transversal en pacientes con diagnóstico de VIH en tratamiento antirretroviral entre los años 2012 a 2020. Se utilizó un modelo de regresión logística binaria múltiple con fines explicativos. Resultados: Se analizaron 9835 pacientes donde la proporción de adherencia fue de 90 % y en el modelo ajustado se evaluó su relación con los antecedentes de no adherencia (ORa:0,52 IC95 °/o:0,40-0,66), grupo farmacológico (2 ITIAN + 1 IP u otro) (ORa:1,22 IC95 %:0,99-1,76), dos tomas al día (ORa:1,02 IC95 %:0,74-1,40), unidades al día (≥ 3) (ORa:0,69 IC95 %:0,47-1,02), reacciones adversas a medicamentos (ORa:0,56 IC95 °%:0,40-0,78), polimedicación (ORa:1,36 IC95 %:1,00-1,85), tiempo TAR (1 a 2 años) (ORa:1,63 IC95 %:1,27-2,09),tiempo TAR (6 a 12 meses) (ORa:1,66 IC95 %:1,27-2,18), tiempo TAR (<6 meses) (ORa:1,36 IC95 %:1,03-1,78), tasa de reclamación de los medicamentos (ORa:0,42 IC95 %:0,32-0,55) y antecedentes PRUM (ORa:0,11 IC95 %:0,09-0,14). Discusión: La proporción de adherencia obtenida es superior a lo descrito para otros países (entre 60-77 %); sin embargo se encuentra que los hallazgos correspondientes al efecto de las variables farmacológicas analizadas son acordes a lo descrito en estudios previos en el tema Conclusión: Los antecedentes de no adherencia, reacciones adversas, tasa de reclamación de los medicamentos y antecedentes de problemas relacionados con el uso de medicamentos son aspectos que reducen la probabilidad de adherencia; mientras que el mayor tiempo de uso del tratamiento aumenta la misma.
Introduction: Adherence to drug treatment promotes viral suppression and reduces long-term resistance to highly active antiretroviral therapy (HAART). Objective: To determine the relationship between the pharmacological aspects and adherence to antiretroviral treatment in a Colombian IPS. Methodology: Cross-sectional analytical study in patients with HIV on antiretroviral treatment between 2012 and 2020. A multiple binary logistic regression model was used for explanatory purposes. Results: A total of 9,835 patients were analyzed where the proportion of adherence was 90 % and in the adjusted model its relationship with history of non-adherence was assessed (ORa: 0,52 95 % CI: 0,40-0,66), pharmacological group (2 NRTI + 1 PI or other) (ORa: 1,22 95 % CI: 0,99-1,76), two doses per day (ORa: 1,02 95 % CI: 0,74-1,40), units per day (≥ 3 ) (ORa: 0,69 95 % CI: 0,47-1,02), adverse drug reactions (ORa: 0,56 95 % CI: 0,40-0,78), polypharmacy (ORa: 1,36 95 % CI : 1,00-1,85), ART time (1 to 2 years) (ORa: 1,63 95 % CI: 1,27-2,09), ART time (6 to 12 months) (ORa: 1,66 95 % CI: 1,27-2,18), ART time (<6 months) (ORa: 1,36 95 % CI: 1,03-1,78), inconsistency in the claim (ORa: 0,42 95 % CI: 0,32-0,55) and PRUM history (ORa: 0,11 95 % CI: 0,09-0,14). Discussion: The proportion of adherence obtained is higher than that described for other countries (between 60-77 %); however, the findings corresponding to the effect of the pharmacological variables analysed are in line with those described in previous studies on the subject. Conclusion: The history of non-adherence, adverse reactions, inconsistencies in the claim fill history and problems related to the use of medications are aspects that reduce the probability of adherence. While the longer time of use of the treatment increases adherence.
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Background: Urinary incontinence (UI) is a medical and social problem that has a great impact on the quality of life of women. Pelvic floor muscle strengthening exercises have been shown to be a form of conservative treatment. However, there is still high failure in this treatment. Objective: To analyze the factors associated with low home therapeutic adherence to pelvic floor exercises in patients with UI. Material and methods: An analytical cross-sectional prolective study was carried out in women aged 20-85 years, with UI and under conservative treatment with pelvic floor muscle exercises. They were questioned about their demographic data; the Morisky Green therapeutic adherence questionnaire and the Likert-type satisfaction scale were applied on the results of the questionnaire. Results: 235 women with UI and with a prescription for pelvic floor muscle exercises, with a median of 55 (46-64) years, were analyzed. The lack of adherence to pelvic floor exercises was observed in 130 (55.32%), whose causes were their work (37.69%), forgetfulness (23.08%) and lack of interest (12.08%). The risk factors for non-adherence were having 3 or less children (OR 1.81 [95% CI 1.10-3.23], p = 0.02), and not feeling satisfied with the exercises (OR 6.70 [95% CI 3.75-11.97], p < 0.001. Conclusion: The factors associated with low home therapeutic adherence to pelvic floor exercises in patients with urinary incontinence were having 3 or less children and not being satisfied with the results.
Introducción: la incontinencia urinaria (IU) es un problema médico y social que causa gran impacto en la calidad de vida de las mujeres. Se ha evidenciado que los ejercicios de fortalecimiento muscular del suelo pélvico (SP) son una forma de tratamiento conservador; sin embargo, aun hay elevado fracaso en este tratamiento. Objetivo: analizar los factores asociados a la baja adherencia terapéutica domiciliaria de los ejercicios del suelo pélvico en pacientes con IU. Material y métodos: estudio transversal analítico prolectivo en mujeres de 20-85 años de edad, con IU y en tratamiento conservador con ejercicios musculares de SP. Se les interrogó sobre sus datos demograficos; se aplicó el Cuestionario de adherencia terapéutica de Morisky-Green y la escala de satisfacción tipo Likert sobre los resultados del cuestionario. Resultados: se analizaron 235 mujeres con IU y prescripción de ejercicios musculares de SP, con una mediana de 55 años (46-64). Hubo falta de adherencia a los ejercicios del SP en 130 (55.32%), cuyas causas fueron actividades laborales (37.69%), olvido (23.08%) y falta de interés (12.08%). Los factores de riesgo para no adherencia fueron: tener tres hijos o menos (RM 1.81 [IC 95% 1.10-3.23], p = 0.02) y no sentirse satisfecha con los resultados de los ejercicios respecto a los síntomas de IU (RM 6.70 [IC 95% 3.75-11.97], p < 0.001). Conclusión: los factores asociados a la baja adherencia terapéutica domiciliaria de los ejercicios del SP en pacientes con IU fueron tener 3 hijos o menos y no sentirse satisfecha con los resultados sobre la mejoría en los síntomas de IU.
Assuntos
Diafragma da Pelve , Incontinência Urinária , Criança , Humanos , Feminino , Diafragma da Pelve/fisiologia , Estudos Transversais , Qualidade de Vida , Incontinência Urinária/terapia , Terapia por Exercício/métodos , Resultado do TratamentoRESUMO
Objetivo Describir las percepciones y las experiencias cotidianas de los médicos de atención primaria (AP) en el abordaje de la falta de adherencia terapéutica en pacientes con riesgo cardiovascular, así como sus expectativas y las posibles áreas de mejora. Material y métodos Estudio cualitativo (en el marco del proyecto REAAP: Red de Expertos en Adherencia de Atención Primaria) realizado en varias comunidades autónomas de España a partir de un cuestionario de respuesta abierta completado por médicos de AP. Los escritos se analizaron mediante el método marco o Framework Analysis para orientar la codificación de los temas. Resultados Participaron 18 médicos, de cuyas respuestas se identificaron tres temas principales: abordaje de la adherencia durante la práctica clínica, barreras que dificultan una correcta adherencia e intervenciones para mejorar la adherencia. Las estrategias más señaladas para facilitar la adherencia terapéutica de los pacientes fueron: mejorar la comunicación médico-paciente y la continuidad asistencial, involucrar a las farmacias comunitarias y simplificar el tratamiento prescribiendo fármacos a combinaciones fijas. Conclusiones Los médicos asistenciales de AP apuntan a que no existe una estrategia ideal que por sí sola facilite la adherencia terapéutica, siendo necesario combinar varias intervenciones para optimizarla. Conocer la problemática y las herramientas disponibles y ausentes en la práctica habitual permitirá un mejor abordaje de la adherencia de los pacientes. En esta línea, iniciativas como el proyecto REAAP son un medio importante para que el personal sanitario, y el resto de actores implicados reconozcan la importancia que merece esta cuestión (AU)
Objective To describe the perceptions and daily experiences of primary care (PC) physicians in dealing with the lack of therapeutic adherence in patients with cardiovascular risk, as well as their expectations and possible areas for improvement. Material and methods A qualitative study (within the framework of the REAAP project: Network of Experts in Adherence in Primary Care) carried out in several autonomous communities in Spain using an open-ended questionnaire completed by PC physicians and analyzed using the framework analysis method to guide the coding of the topics. Results Eighteen physicians participated, and three main themes were identified from their responses: an approach to adherence during clinical practice, barriers that hinder the appropriate adherence, and interventions to improve it. The strategies most frequently mentioned to facilitate patients therapeutic adherence were improving physician-patient communication and continuity of care, involving community pharmacies, and simplifying treatment by prescribing drugs in fixed combinations. Conclusions There is no single ideal strategy to facilitate therapeutic adherence, and it is necessary to combine several interventions to optimize it. The first step is to understand the problems and the tools available. Initiatives such as the REAAP project are an important means to improve patient adherence, and for healthcare personnel to recognize the importance that this issue deserves (AU)
Assuntos
Humanos , Atenção Primária à Saúde , Doenças Cardiovasculares/prevenção & controle , Cooperação e Adesão ao Tratamento , Pesquisa Qualitativa , Inquéritos e Questionários , Fatores de RiscoRESUMO
OBJECTIVE: To describe the perceptions and daily experiences of primary care (PC) physicians in dealing with the lack of therapeutic adherence in patients with cardiovascular risk, as well as their expectations and possible areas for improvement. MATERIAL AND METHODS: A qualitative study (within the framework of the REAAP project: Network of Experts in Adherence in Primary Care) carried out in several autonomous communities in Spain using an open-ended questionnaire completed by PC physicians and analyzed using the framework analysis method to guide the coding of the topics. RESULTS: Eighteen physicians participated, and three main themes were identified from their responses: an approach to adherence during clinical practice, barriers that hinder the appropriate adherence, and interventions to improve it. The strategies most frequently mentioned to facilitate patients' therapeutic adherence were improving physician-patient communication and continuity of care, involving community pharmacies, and simplifying treatment by prescribing drugs in fixed combinations. CONCLUSIONS: There is no single ideal strategy to facilitate therapeutic adherence, and it is necessary to combine several interventions to optimize it. The first step is to understand the problems and the tools available. Initiatives such as the REAAP project are an important means to improve patient adherence, and for healthcare personnel to recognize the importance that this issue deserves.
Assuntos
Doenças Cardiovasculares , Humanos , Doenças Cardiovasculares/prevenção & controle , Fatores de Risco , Cooperação do Paciente , Fatores de Risco de Doenças Cardíacas , Atenção Primária à Saúde/métodos , Adesão à MedicaçãoRESUMO
Introducción: Los embarazos no deseados en adolescentes tienen graves consecuencias tanto para las propias adolescentes y sus bebés como para el uso de los recursos del sistema sanitario. Una de las razones es el escaso uso de píldoras anticonceptivas orales (ACO) entre esta población, debido principalmente a la falta de información o a la no adherencia a los medicamentos. El objetivo de este estudio fue describir la información que reciben las adolescentes sobre los ACO y su uso, así como su percepción del papel del farmacéutico comunitario en este campo. Método: Se realizó un estudio observacional transversal mediante encuesta, aplicada a mujeres entre 12-19 años residentes en España, independientemente de si habían utilizado o no ACO, durante abril de 2021. Para la difusión de esta encuesta se utilizaron diferentes redes sociales. Asimismo, se contactó con diferentes asociaciones españolas dedicadas a la orientación de la planificación familiar y la salud sexual en adolescentes. Resultados: El 81,7% (n=76) de los encuestados no había tomado ACO, aunque el 35,5% (n=33) sí había mantenido relaciones sexuales. El 6% (n=1) que tomaba o había tomado ACO informó que eran adherentes. El 88% (n=82) pensaba que el farmacéutico tiene conocimientos sobre medicamentos; sin embargo, sólo el 19,4% (n=18) les consultaría para resolver dudas sobre ACO. Conclusiones: Para resolver los problemas de falta de información sobre ACO y de adherencia en mujeres adolescentes, el farmacéutico comunitario es un profesional accesible que puede contribuir a ello adoptando una actitud activa y utilizando diferentes formas de material educativo. (AU)
Introduction: Unintended pregnancies in adolescents have serious consequences both for the adolescents themselves and their babies and for the use of health system resources. One of the reasons is the low use of oral contraceptive pills (OCPs) among this population, mainly due to lack of information or non-adherence to the medication. The aim of this study was to describe the information adolescents receive about OCPs and their use, as well as their perception of the role of the community pharmacist in this field. Method: A cross-sectional observational study was carried out by means of a survey applied to women aged 12-19 years living in Spain, regardless of whether or not they had used OCPs, during April 2021. Different social networks were used to disseminate the survey. Different Spanish associations dedicated to family planning and adolescent sexual health counselling were also contacted. Results: 81.7% (n=76) of respondents had not taken OCPs, although 35.5% (n=33) had had sex. The 6% (n=1) who were taking or had taken OCPs reported adherence. 88% (n=82) thought that the pharmacist is knowledgeable about medicines; however, only 19.4% (n=18) would consult them for OCP questions. Conclusions: To solve the problems of lack of information about OCPs and adherence in adolescent women, the community pharmacist is an accessible professional who can contribute to this by taking an active role and using different forms of educational materials. (AU)
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Humanos , Feminino , Adolescente , Anticoncepcionais Orais/uso terapêutico , Farmacêuticos , Percepção , Serviços Comunitários de Farmácia , Espanha , Inquéritos e Questionários , Estudos Transversais , Cooperação e Adesão ao TratamentoRESUMO
Introducción: Debido a la baja calidad de vida y ad-herencia al tratamiento de los pacientes con psoria-sis se plantea desarrollar un protocolo de empode-ramiento que conduzca a un mayor conocimiento del autocuidado en pacientes con esta patología, acorde a sus necesidades, siendo importante el papel del farmacéutico para la mejora de ambos. Método: Se administró el test Morisky Green-4 items y el cuestionario Dermatology Life Quality Index a 40 pacientes con psoriasis que acudían a una farmacia comunitaria. Con estos datos, la información de las guías clínicas y la colaboración con un dermatólogo, se diseñó un protocolo de autocuidado.Resultados: Se observó falta de adherencia en el 100% de los pacientes y una calidad de vida leve/moderada (5,3±4,2), en las preguntas relacionadas con: los síntomas cutáneos afectan mucho/muy al 50% de los pacientes y la sensación de vergüenza y dificultad con su tratamiento entre poco y mucho en el 60%. Con estos resultados se diseñaron dos dípticos. A los 3 meses la calidad de vida mejoró a 3,98±2,05, p=0,048, y se observó falta de adheren-cia en el 70% de los pacientes.Conclusiones: Los protocolos de autocuidado son necesarios para mejorar la calidad de vida de los pacientes crónicos. El papel del farmacéutico es importante a través de un protocolo de autocuida-do en pacientes con psoriasis, ayudando a mejorar la adherencia al tratamiento y la calidad de vida. (AU)
Introduction: Due to the low quality of life and adherence to treatment of patients with psoriasis, it is proposed to develop an empowerment protocol that leads to greater knowledge of self-care in pa-tients with this pathology, according to their needs, with the role of the pharmacist being important for the improvement of both.Method: The Morisky Green-4 items test and the Dermatology Life Quality Index questionnaire were administered to 40 patients with psoriasis who attended a community pharmacy. With these data, information from clinical guidelines and collabora-tion with a dermatologist, a self-care protocol was designed.Results: Lack of adherence was observed in 100% of the patients and a mild/moderate quality of life (5.3±4.2), in questions related to: skin symptoms af-fect a lot/very much 50% of the patients and feeling of embarrassment and difficulty with their treat-ment between a little and a lot in 60%. With these results, two diptychs were designed. Three months later, the quality of life improved to 3.98±2.05, p=0.048, and non-adherence was observed in 70% of the patients.Conclusions: Self-care protocols are necessary to improve quality of life of chronic patients. The role of the pharmacist is important through a self-care protocol in patients with psoriasis, helping to im-prove adherence to treatment and quality of life. (AU)
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Humanos , Autocuidado , Psoríase , Farmácias , Qualidade de Vida , Cooperação e Adesão ao TratamentoRESUMO
Objetivos: evaluar la adherencia y la calidad de vida de los pacientes con leucemia linfocítica crónica tratados con antineoplásicos orales. Comparar la adherencia y la calidad de vida según el fármaco recibido y según la línea de tratamiento.Métodoestudio descriptivo prospectivo realizado de junio a noviembre de 2021 en un hospital terciario. Se incluyeron pacientes con leucemia linfocítica crónica, atendidos en la consulta de Farmacia Oncológica y tratados con antineoplásicos orales desde al menos 6 meses antes de la inclusión en el estudio. Se estimó la adherencia mediante el cuestionario Moriskys 8 item Medication Adherence Scale y el recuento de medicación sobrante, considerándose adherentes si su tasa de adherencia era ≥ 90%. Para evaluar la calidad de vida, se utilizó el cuestionario EQ-5D-3L del grupo EuroQol, la escala Functional Assessment of Chronic Illness Therapy Fatigue y el QLQ-C30 de la European Organization for Research and Treatment of Cancer. Se programaron 2 entrevistas: en el momento de la inclusión y a los 3 meses. Se revisó la historia clínica, recogiéndose variables demográficas y clínicas. El análisis estadístico se realizó con el programa SPSS® 25.0.Resultadosse incluyeron 23 pacientes, todos fueron adherentes según el recuento de medicación, 20 presentaron adherencia alta, y 3 media, según Moriskys 8 item Medication Adherence Scale. Los resultados del cuestionario EQ-5D-3L mostraron que los pacientes eran autónomos para su cuidado personal y sus actividades cotidianas, el 69,6% no tenían problemas de movilidad, el 78,3% no tenía ansiedad/depresión y el 56,5% presentaba algún tipo de dolor. (AU)
Objective: To evaluate adherence and quality of life to oral antineoplastic treatment in patients with chronic lymphocytic leukemia. To compare adherence and QoL according to treatment subgroups and treatment-line subgroups.MethodsWe conducted a descriptive prospective study from June to November 2021 in a tertiary care hospital. Patients treated at the Oncology Pharmacy with a diagnosis of chronic lymphocytic leukemia and treatment with oral antineoplastics for at least 6 months before inclusion in the study were included. Adherence was assessed using Moriskys 8 item Medication Adherence Scale and leftover pills counts, considering adherents if their adherence rate was ≥ 90%. Quality of life was assessed with Euro-Qol EQ-5D-3L questionnaire, Functional Assessment of Chronic Illness Therapy Fatigue scale and QLQ-C30 questionnaire from European Organization for Research and Treatment of Cancer. Two interviews were scheduled: at the time of inclusion and at 3 months. Variable collected: demographic data, clinical data (disease and treatment); and response (scores obtained from questionnaires and adherence rate). The data statistical analysis was carried out with SPSS® 25.0 software.ResultsTwenty three patients were included, all of them showed an adherence rate higher than 90%; 20 patients were considered high adherent, and 3 patients medium adherent to treatment according to Moriskys 8 item Medication Adherence Scale. (AU)
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Humanos , Antineoplásicos/efeitos adversos , Leucemia Linfocítica Crônica de Células B/terapia , Qualidade de Vida , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
Introducción: se han realizado algunos estudios preliminares que muestran la aparición de factores de riesgo no investigados previamente relativos al sistema sanitario que pueden reducir la adherencia y/o persistencia de los tratamientos farmacológicos. De su conocimiento se pueden explorar posibles soluciones. Objetivo: estimar la incidencia de los factores de riesgo relativos al sistema sanitario que pueden reducir la adherencia/persistencia a los tratamientos asociados a problemas de acceso a los mismos en farmacia comunitaria. Método: estudio prospectivo aleatorizado transversal en farmacias comunitarias del Principado de Asturias y Aragón. La variable principal es la incidencia de nuevos factores de riesgo que hacen que la prescripción sea inadecuada para su dispensación. Se analizan diferentes subgrupos en función de tipo de factor de riesgo, tipo de población y tipo de prescripción.Resultados: el paciente tipo es una persona vulnerable en función de su edad (65,4 años), pluripatología y polifarmacia (6,8 medicamentos). Tras la evaluación de 138.697 dispensaciones en 98 farmacias comunitarias se detectaron 2.009 pacientes con 2.221 dispensaciones con factores de riesgo frente a la adherencia y/o persistencia (1,6 % de del total de dispensaciones). El tipo de incidencia más frecuentemente observado fue caducidad de la receta (54,7 %; IC95 %=52,6-56,8), seguido de ausencia de receta (18,7 %; IC95 %: 17,1-20,3). Por su parte los problemas de suministro alcanzaron el 10,2 % (IC95 %= 10,6 %-10,9 %). Los grupos terapéuticos más comprometidos fueron los grupos N-Sistema Nervioso (27,6 %), C-Aparato Cardiovascular (20,3 %) y A-Aparato Digestivo (15,3 %) (AU)
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Humanos , Acessibilidade aos Serviços de Saúde , Cooperação e Adesão ao Tratamento , Estudos Transversais , Estudos Prospectivos , Fatores de Risco , Projetos PilotoRESUMO
Mujer de 56 años que arrastra problemas de salud neurológicos desde 2017 tras sufrir un accidente de tráfico. Le diagnostican un parkinsonismo. En noviembre de 2021 acude a consultar información sobre los cribados de deterioro cognitivo desde la farmacia comunitaria al presentar queja de olvidos frecuentes. Finalmente, en junio de 2022 se lleva a cabo una evaluación farmacoterapéutica del tratamiento siguiendo la metodología Dáder y se estudia la carga anticolinérgica (CA) que presenta la medicación. Según la escala CALS, la paciente presentó una CA de 3,25 que se puede relacionar con aparición de efectos adversos como alteraciones de la cognición. Al no tener controlado el dolor, se le sugiere volver a consultar con su médico para intentar lograr un tratamiento efectivo. Con la nueva visita se diagnostica un trastorno neurológico funcional y trastorno depresivo mayor. Con el cambio de tratamiento, la CA disminuyó hasta 1. El tratamiento del dolor neuropático es complejo y el diagnóstico certero es importante para instaurar el tratamiento efectivo. Aunque muchas veces la sintomatología conlleva a confundir el diagnóstico y tratar con fármacos no eficaces para solucionar el problema que causan reacciones adversas como es el caso. En estas situaciones es necesario una reevaluación periódica del tratamiento y del estado cognitivo del paciente (AU)