Navegando por Palavras-chave "Adesão À Medicação"

Agora exibindo 1 - 2 de 2
  • Nenhuma Miniatura disponível
    Item
    Somente Metadadados
    Mensuração Da Adesão Aos Medicamentos Imunossupressores Em Pacientes Pediátricos No Pós-Transplante Renal
    (Universidade Federal de São Paulo (UNIFESP), 2017-02-24) Silva, Ana Carolina Maximo [UNIFESP]; Roza, Bartira De Aguiar [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: The adherence to the therapeutic treatment after a transplant is a multidimensional phenomenon determined by the conjunction of five agents as follows: the health-care staff, social and economic factors, the treatment itself, the patient and the disease. Although there is not one method that is considered to be efficient, there are various methods described in the literature to detect non-adherence in post-transplanted patients. Objective: Measure the adherence to the immunosuppressive medication in renal post-transplant by using the Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS). Method: The sample comprised 156 post-transplanted renal pediatric patients who had been at home for at least four weeks after being discharged from hospital. They were evaluated by BAASIS as to the ingestion of prescribed drugs, number of days using the correct dose of the prescribed drugs, taking the prescribed drugs within 25% of the prescribed schedule for doing so, pause on the medication intake, time of exceeding ingestion of 24 hours, dose alterations by the patient’s own decision, complexity of the prescribed doses, patient’s treatment perception, creatinine levels and the registry of admission to the hospital by acute cellular rejection as confirmed through biopsy. Results: The results showed 66,7% of adherence to immunosuppressant medication and 33,3% of non-adherence. In the presence of a caregiver the adherence was of 68,2% and without the caregiver it dropped to 25%. A prevalence of boys was observed at 60,9% (p=0,0081), difference in average of creatinine by gender (p=0,044), type of treatment: Hemodialysis (p=0,010) and Conservative (p=0,035), surgical procedure (p=0,004), type of transplant (p<0,001) and hospitalization due to acute cellular rejection (p=0,005). Conclusions: The present study enabled the identification of some specificities of the pediatric population in renal post-transplant regarding non-adherence to medication. It showed that the higher the non-adherence rates to medication, the worse are the parents/guardians and patients’ adherence perception. Through such findings it is understood how necessary it is to review medication adherence, the existence of barriers to such adherence and the presence of a caregiver. Thus, it is necessary to monitor the adherence and its barriers in order to design follow-up strategies focusing in educational actions that promote self-care and support to adherence. Such strategies are essential to the effectiveness of medication adherence in post-transplanted renal pediatric patients which in turn will alter results and improve patient survival.
  • Nenhuma Miniatura disponível
    Item
    Somente Metadadados
    Não adesão ao tratamento no transplante de fígado
    (Universidade Federal de São Paulo (UNIFESP), 2019-04-25) Oliveira, Priscilla Caroliny De [UNIFESP]; Roza, Bartira De Aguiar [UNIFESP]; Schirmer, Janine [UNIFESP]; http://lattes.cnpq.br/3721636964139813; http://lattes.cnpq.br/9255434835123749; http://lattes.cnpq.br/3558901850783019; Universidade Federal de São Paulo (UNIFESP)
    Objectives: To evaluate the interventions of the multiprofessional team that provide improved adherence to treatment after liver transplantation; to assess levels of non-adherence to immunosuppressive therapy in a sample of liver transplant recipients using the Basel Assessment of Adherence with immunosuppressive medication Scalee to correlate sociodemographic characteristics and clinical factors to non-adherence to medication; to develop a model of evaluation of nonadherence to the treatment in the context of liver transplantation capable of covering several dimensions of the phenomenon, correlating the levels of non adherence to the different methods of measurement applied in liver transplant patients; to reflect on the theoretical and practical aspects related to non-adherence to treatment in the context of liver transplantation and to correlate with the concepts of normality established by Michael Foucault and The Power as Knowing Participation in Change Theory. Methods: This study adopted a mixed method design, in which elements of qualitative and quantitative research were combined. The work was divided into four subprojects: 1- adherence to treatment in liver transplantation: an integrative review; 2- evaluation of adherence to treatment in patients submitted to liver transplantation; 3 - New perspectives of analysis in nonadherence research in liver transplantation by means of data association: pilot study. 4 - subjectivity, adherence in transplantation and biopolitics - possible reflections of power as normative practice in health. The study was and approved by the Ethics and Research Committee under the opinion 623.082 and Certificate of Presentation for Ethical Appreciation nº1643201470005505. Results: The integrative review, which aimed to evaluate the interventions of the multiprofessional team that provides the improvement of adherence to treatment after liver transplantation, initially selected 84 publications. After applying the exclusion criteria, 10 studies were selected. Four significant categories were found: educational interventions; adoption of an individual therapeutic plan; change in immunosuppressive regimen; emotional support, psychological support and strengthening of the support network. The level of nonadherence in liver transplantation was 49% and was directly related to the use of mycophenolic acid (p = 0.007) and administration of multiple doses of immunosuppressants daily (p = 0.004). No statistically significant correlations were found between non-adherence to immunosuppressive therapy and sociodemographic characteristics and other clinical variables analyzed. It was proposed a data triangulation model that evaluated the non adherence to liver transplantation under different aspects: a) direct evaluation of non adherence - through the application of a self-report instrument, associated to the perspective of the patient himself and the specialist responsible for follow-up; b) clinical evaluation, considering the serum immunosuppressive level in use, alterations of the aminotransferases, histological analysis of the graft and previous treatment for rejection; c) behavioral evaluation, which analyzed the existence of reports of therapeutic failure and absences on outpatient return. These indicators were analyzed individually and together. The theoretical essay aimed to develop a systematic reflection on adherence to treatment in the context of transplantation, based on the historicity of its concept of adherence through the construction of parallels between the concepts of adherence and health. The problem of non-adherence questions the team about its role, which requires listening to the demands that come in to everyday praxis. In this perspective, the theory of power as knowledge and participation for change of Elizabeth Barrett is emphasized, for emphasizing the subjective aspect present in health care, emphasizing the role of a dialogue and supported action in the establishment of solidarity and socio- and fostering the social role of users of transplantation actions and services. Conclusion: In view of the gaps highlighted and the results pointed out through the integrative review, it is understood that it is necessary to intensify efforts for the development of research with designs that produce strong evidences regarding the interventions adopted by the multiprofessional team capable of improving the adherence. This study showed that nearly half of the patients stopped adhering to immunosuppressive therapy after liver transplantation. Since unfavorable outcomes in transplantation are closely related to adherence failures, it is important that nurses assess this behavior during outpatient follow-up of liver transplant recipients. The application of triangulation methods to qualitatively assess noncompliance in an adult liver transplant program included 10 indicators in the analysis and identified a non-adherence level of 14.3%. At the end of the reflective study, it was possible to conclude that the phenomenon of adherence is more complex than we have traditionally described, because it depends on the subjective process that involves many questions that are not yet addressed by nurses in general. The threshold between adhesion and nonadherence is unique, even if it is influenced by plans that transcend the strictly individual, such as social, economic, political, historical and cultural.