Adesão ao tratamento farmacológico e comportamento de autocuidado de pacientes com insuficiência cardíaca
Data
2022-01
Autores
Lima, Jannaina Gomes de [UNIFESP]
Orientadores
Lopes, Juliana de Lima [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivos: Avaliar a adesão ao tratamento farmacológico e o comportamento de autocuidado de pacientes com insuficiência cardíaca (IC) e identificar a relação das variáveis sociodemográficas e clínicas com o nível de adesão ao tratamento farmacológico e o comportamento de autocuidado. Método: Estudo transversal e analítico realizado em um ambulatório de miocardiopatia da cidade de São Paulo. A amostra foi constituída por pacientes com IC que não apresentavam déficit visual, auditivo e ou cognitivo. A adesão ao tratamento farmacológico foi avaliada pela escala de Medida de Adesão ao Tratamento (MAT) e o comportamento de autocuidado pela European Heart Failure Self-care Behavior Scale (EHFScBS). As variáveis sociodemográficas e clínicas foram selecionadas por meio de uma revisão de literatura. O estudo foi aprovado pelo comitê de ética em pesquisa (nº 2.555.873). A descrição das variáveis quantitativas foi realizada por meio de média, desvio padrão e quartis e as variáveis qualitativas por frequências percentuais e absolutas. Foram utilizados para análise dos dados o coeficiente de correlação de Spearman, teste de Mann Whitney, teste Exato de Fisher e teste de Kruskal Wallis. Fatores que apresentaram valores de p≤0,10 e as variáveis de interesse clínico foram incluídos na análise múltipla. Foram considerados significativos valores de p≤0,05. Resultados: Foram analisados 340 pacientes, destes 90,6% foram aderentes ao tratamento medicamentoso e o escore médio de autocuidado foi de 24,7 pontos. Na análise univariada, observou-se que pacientes que tomam mais medicamentos tem uma tendência a um melhor autocuidado (p≤0,001) e pacientes sem companheiro (p=0,022), sedentários (p<0,001) e com vínculo empregatício ativo (p<0,001) tendem a ter um pior comportamento de autocuidado. Pacientes com três a cinco salários mínimos (p=0,03) e os que fazem uso de antagonistas dos receptores de mineralcorticoides (p=0,017) têm menor propensão a ser não aderente e pacientes com depressão (p=0,001) são menos aderentes ao tratamento farmacológico. Na análise múltipla, observou-se que pacientes não aderentes tem escore de autocuidado 1,2 vezes maior do que os aderentes; o aumento de uma unidade no número de tomadas de medicamentos leva a um decréscimo no escore de autocuidado cerca de 0,9%; pacientes sem companheiro têm, em média, escore de autocuidado 8% maior do que os com companheiro; pacientes com vínculo ativo têm escore de autocuidado 12% maior do que os com vínculo inativo; pacientes sedentários têm, em média, escore de autocuidado 24% maior do que pacientes não sedentários. Pacientes com renda familiar superior a três salários mínimos tem menor prevalência de não adesão ao tratamento medicamentoso; pacientes com depressão e que ingerem bebidas alcoólicas têm prevalência de não aderência 3,7 e 3,5 vezes maior, respectivamente, do que aqueles que não tem tais antecedentes. Conclusão: A maioria dos participantes eram aderentes ao tratamento medicamentoso e tinham autocuidado adequado. Os fatores relacionados ao comportamento de autocuidado foram adesão ao tratamento farmacológico, número de tomadas de medicamentos, estado civil, vínculo empregatício e sedentarismo. A adesão ao tratamento farmacológico se relacionou com o comportamento de autocuidado, renda familiar, depressão e ingestão de bebida alcóolica. A equipe interdisciplinar deve realizar intervenções para os pacientes com estas características, visando maior adesão ao tratamento farmacológico e melhora do comportamento de autocuidado.
Objectives: To assess medication adherence and self-care behavior among patients with heart failure (HF) and identify the relationship between sociodemographic and clinical variables with medication adherence and self-care behavior. Method: This cross-sectional and correlational study was conducted in an outpatient heart failure clinic located in São Paulo, SP, Brazil. The sample comprised patients with HF with no visual or auditory impairment or cognitive deficits. Medication adherence was assessed by the Measure Treatment Adherence (MTA) scale, and self-care behavior was evaluated using the European Heart Failure Self-care Behavior Scale (EHFScBS). The sociodemographic and clinical variables were selected through a literature review. The study was approved by the Institutional Review Board (No. 2.555.873). The quantitative variables were described according to mean, standard deviation, and quartiles, while the qualitative variables were described according to relative and absolute frequencies. Spearman’s correlation coeficiente, the Mann-Whitney test, Fisher´s Exact Test, and Krukal Wallis test were used to analyze data. The factors presenting p≤0.10 and variables of clinical interest were included in the multiple analysis; significance was set at p≤0.05. Results: Most participants were adherent to drug treatment and had self-care.340 patients were analyzed: 90.6% presented treatment adherence; the mean score obtained in self-care was 24.7. The univariate analysis showed that patients who take more medications tend to take better care of themselves (p≤0.001), whereas patients without a partner (p=0.022), sedentary (p<0.001), or working (p<0.001) tend to present worse self-care. Patients receiving from three to five times the minimum wage (p=0.03) and those taking mineralocorticoid receptor antagonists (p=0.001) are less likely to not adhere to the medication treatment, whereas patients with depression (p=0.001) are less adherent to the medication treatment. The multiple analysis showed that non-adherent patients scored 1.2 times higher than adherent patients; one unit increase in the number of medications decreases self-care score by approximately 0.9%. On average, patients without a partner obtained scores 8% higher than those with a partner, and working patients obtained scores 12% higher than unemployed patients or on leave. On average, sedentary patients obtained self-care scores 24% higher than non-sedentary patients. Medication non-adherence is less prevalent among patients with family income higher than three times the minimum wage, whereas non-adherence was 3.7 and 3.5 times higher among patients with depression and who consume alcohol, respectively than among their counterparts. Conclusion: The factors related to self-care include medication adherence, number of medications, marital status, having a job, and sedentariness. Medication adherence was associated with self-care, family income, depression, and alcohol consumption. Interdisciplinary teams should implement interventions among patients with these characteristics to promote medication adherence and improve self-care.
Objectives: To assess medication adherence and self-care behavior among patients with heart failure (HF) and identify the relationship between sociodemographic and clinical variables with medication adherence and self-care behavior. Method: This cross-sectional and correlational study was conducted in an outpatient heart failure clinic located in São Paulo, SP, Brazil. The sample comprised patients with HF with no visual or auditory impairment or cognitive deficits. Medication adherence was assessed by the Measure Treatment Adherence (MTA) scale, and self-care behavior was evaluated using the European Heart Failure Self-care Behavior Scale (EHFScBS). The sociodemographic and clinical variables were selected through a literature review. The study was approved by the Institutional Review Board (No. 2.555.873). The quantitative variables were described according to mean, standard deviation, and quartiles, while the qualitative variables were described according to relative and absolute frequencies. Spearman’s correlation coeficiente, the Mann-Whitney test, Fisher´s Exact Test, and Krukal Wallis test were used to analyze data. The factors presenting p≤0.10 and variables of clinical interest were included in the multiple analysis; significance was set at p≤0.05. Results: Most participants were adherent to drug treatment and had self-care.340 patients were analyzed: 90.6% presented treatment adherence; the mean score obtained in self-care was 24.7. The univariate analysis showed that patients who take more medications tend to take better care of themselves (p≤0.001), whereas patients without a partner (p=0.022), sedentary (p<0.001), or working (p<0.001) tend to present worse self-care. Patients receiving from three to five times the minimum wage (p=0.03) and those taking mineralocorticoid receptor antagonists (p=0.001) are less likely to not adhere to the medication treatment, whereas patients with depression (p=0.001) are less adherent to the medication treatment. The multiple analysis showed that non-adherent patients scored 1.2 times higher than adherent patients; one unit increase in the number of medications decreases self-care score by approximately 0.9%. On average, patients without a partner obtained scores 8% higher than those with a partner, and working patients obtained scores 12% higher than unemployed patients or on leave. On average, sedentary patients obtained self-care scores 24% higher than non-sedentary patients. Medication non-adherence is less prevalent among patients with family income higher than three times the minimum wage, whereas non-adherence was 3.7 and 3.5 times higher among patients with depression and who consume alcohol, respectively than among their counterparts. Conclusion: The factors related to self-care include medication adherence, number of medications, marital status, having a job, and sedentariness. Medication adherence was associated with self-care, family income, depression, and alcohol consumption. Interdisciplinary teams should implement interventions among patients with these characteristics to promote medication adherence and improve self-care.
Descrição
Citação
LIMA, J.G. Adesão ao tratamento farmacológico e comportamento de autocuidado de pacientes com insuficiência cardíaca. São Paulo, 2022. 84 f. Dissertação (Mestrado em Enfermagem) - Escola Paulista de Enfermagem (EPE), Universidade Federal de São Paulo (UNIFESP). São Paulo. 2022.