Variabilidade na adesão aos imunossupressores e demais medicamentos nos receptores de transplante cardíaco em 11 países: estudo descritivo comparativo
Data
2014
Autores
Almeida, Samira Scalso de 
Orientadores
Roza, Bartira de Aguiar
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A não adesão (NA) a terapia medicamentosa é um problema prevalente entre receptores de transplante cardíaco. O objetivo deste estudo é descrever e comparar a prevalência de NA aos imunossupressores e demais medicamentos em 11 países e 4 continentes, utilizando os dados reportados ao estudo BRIGHT. Métodos: Esta foi uma análise preliminar secundária do BRIGHT, estudo internacional, multicêntrico, transversal em 27 centros transplantadores em 11 países (Alemanha, Austrália, Bélgica, Brasil, Canadá, Espanha, EUA, França, Itália, Reino Unido e Suíça). 902 receptores de transplante cardíaco adultos entre o primeiro e o quinto ano pós transplante, foram incluídos na análise. NA aos imunossupressores e demais medicamentos foram avaliados utilizando o BAASIS, um instrumento de auto-relato que avalia diferente dimensões da adesão, como: a NA a ingestão do medicamento, horário de ingestão apenas para os IS, “feriado da droga” (omissão de mais de 2 doses consecutivas), redução da dose inadvertidamente e persistência (interromper o uso inadvertidamente). A NA foi avaliada separadamente por dimensão, para os IS, também a taxa global (qualquer indicação de NA nas últimas 4 semanas) e também pelo relatório complementar realizado por clínicos. A análise dos dados foi realizada por meio de estatística descritiva e inferencial. Resultados: As taxas de NA foram: ingestão do medicamento: 16.1% (variando: 4.9% Itália – 26.2% EUA); NA ao horário: 27.3% (variando: 10% Alemanha – 42.9% Austrália); “feriado da droga” 1.6% (variando: 0% Alemanha, Espanha, França, Itália, Suíça– 6.3% Brasil); redução da dose: 1.4% (variando: 0% Alemanha, Austrália, Bélgica, Brasil, Reino Unido – 4.3% Suíça); não-persistência: 0.6% (variando: 0%-6.3% Brasil); não adesão global: 36.4% (variando: 17.5% Alemanha- 57.1% Austrália). Os demais medicamentos: NA a ingestão do medicamento 20% (variando: 7.5% Alemanha – 32.6% EUA); “feriado da droga” 4.6% (variando: 0% Alemanha – 12.5% Brasil); redução da dose 3.9% (variando: 0% Alemanha e Reino Unido – 12.5% Brasil); não-persistência 2.1% (variando: 0% Alemanha, Brasil, Itália, Suíça e Reino Unido – 5.9% Canadá). Conclusão: A variabilidade observada nas taxas de NA aos imunossupressores e demais medicamentos nos receptores de transplante cardíaco entre os países, sugerem que os fatores relacionados aos sistemas de saúde podem desempenhar um papel importante na explicação da NA dos pacientes (ex. cobertura no custeio dos medicamentos).
Background: Medication non-adherence (NA) is a prevalent problem between heart transplant recipients. The aim of this study was to describe and compare the prevalence of NA to medication (immunosuppressive and others medication) in 11 countries and 4 continents using data from the BRIGHT study. Method: This was a prelimary secondary data analysis of the BRIGHT study, an internationally, multi-center, cross sectional study in 27 HTx (heart transplant) centers and 11 countries (Australia, Belgium, Brazil, Canada, France, Germany, Italy, Spain, Switzerland, the United Kingdom, United States). 902 adult HTx patients between 1 and 5 year post-Tx were included in this analysis. Non-adherence to immunosuppressant’s and other drugs was assessed using the BAASIS, a self-report instrument assessing different dimensions of medication taking, i.e. taking non-adherence, timing non-adherence (for IS), drug holidays, dose reduction and non-persistence. Non-adherence was assessed for all dimension separately, and for IS as well as overall (i.e. any indication on not taking immunosuppressants correctly over the past 4 weeks) and also by collateral report from clinicians. Data were analyzed using descriptive and inferential statistics. Results: The mean HTx patients’ non-adherence levels were following: taking non-adherence: 16.1% (range: 4.9% Italy – 26.2% USA); timing non-adherence: 27.3% (range: 10% Germany – 42.9% Australia); drug holidays 1.6% (range: 0% France, Germany, Italy, Switzerland, Spain – 6.3% Brazil); dose reduction: 1.4% (range: 0% Australia, Brazil, Germany, Belgium, UK – 4.3% Switzerland); non-persistence: 0.6% (range: 0%-6.3% Brazil); overall non-adherence: 36.4% (range: 17.5% Germany- 57.1% Australia). For other drugs were following: taking non-adherence 20% (range: 7.5% Germany – 32.6% USA); drug holidays 4.6% (range: 0% Germany – 12.5% Brazil); dose reduction 3.9% (range: 0% Germany and UK – 12.5% Brazil); non-persistence 2.1% (range: 0% Brazil, Germany, Italy, Switzerland, Uk – 5.9% Canada). Conclusion: The observed variability in HTx patients’ non-adherence to immunosuppressant’s and other drugs across countries suggests that health care system factors play a role in explaining HTx patient’s non-adherence (e.g. drug coverage).
Background: Medication non-adherence (NA) is a prevalent problem between heart transplant recipients. The aim of this study was to describe and compare the prevalence of NA to medication (immunosuppressive and others medication) in 11 countries and 4 continents using data from the BRIGHT study. Method: This was a prelimary secondary data analysis of the BRIGHT study, an internationally, multi-center, cross sectional study in 27 HTx (heart transplant) centers and 11 countries (Australia, Belgium, Brazil, Canada, France, Germany, Italy, Spain, Switzerland, the United Kingdom, United States). 902 adult HTx patients between 1 and 5 year post-Tx were included in this analysis. Non-adherence to immunosuppressant’s and other drugs was assessed using the BAASIS, a self-report instrument assessing different dimensions of medication taking, i.e. taking non-adherence, timing non-adherence (for IS), drug holidays, dose reduction and non-persistence. Non-adherence was assessed for all dimension separately, and for IS as well as overall (i.e. any indication on not taking immunosuppressants correctly over the past 4 weeks) and also by collateral report from clinicians. Data were analyzed using descriptive and inferential statistics. Results: The mean HTx patients’ non-adherence levels were following: taking non-adherence: 16.1% (range: 4.9% Italy – 26.2% USA); timing non-adherence: 27.3% (range: 10% Germany – 42.9% Australia); drug holidays 1.6% (range: 0% France, Germany, Italy, Switzerland, Spain – 6.3% Brazil); dose reduction: 1.4% (range: 0% Australia, Brazil, Germany, Belgium, UK – 4.3% Switzerland); non-persistence: 0.6% (range: 0%-6.3% Brazil); overall non-adherence: 36.4% (range: 17.5% Germany- 57.1% Australia). For other drugs were following: taking non-adherence 20% (range: 7.5% Germany – 32.6% USA); drug holidays 4.6% (range: 0% Germany – 12.5% Brazil); dose reduction 3.9% (range: 0% Germany and UK – 12.5% Brazil); non-persistence 2.1% (range: 0% Brazil, Germany, Italy, Switzerland, Uk – 5.9% Canada). Conclusion: The observed variability in HTx patients’ non-adherence to immunosuppressant’s and other drugs across countries suggests that health care system factors play a role in explaining HTx patient’s non-adherence (e.g. drug coverage).
Descrição
Citação
ALMEIDA, Samira Scalso de. Variabilidade na adesão aos imunossupressores e demais medicamentos nos receptores de transplante cardíaco em 11 países: estudo descritivo comparativo. 2014. 122 f. Dissertação (Mestrado) - Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2014.