Impacto de la carga de trabajo del paciente crónico en la adherencia terapéutica

  1. García Hernández, Alfonso Miguel
  2. Martín Santana, Ylenia de los Ángeles
  3. Suárez Sánchez, Juan José
Revista:
Cultura de los cuidados: Revista de Enfermería y Humanidades

ISSN: 1699-6003

Año de publicación: 2022

Número: 64

Páginas: 253-266

Tipo: Artículo

Otras publicaciones en: Cultura de los cuidados: Revista de Enfermería y Humanidades

Resumen

Objectivo: Relacionar a carga de trabalho do paciente crónico independente com a aderência ao tratamento. Método: Estudo analítico observacional transversal. A amostra consistiu em 390 pacientes da Área de Saúde Básica de Mogán (Gran Canaria), sistematicamente seleccionados de acordo com os critérios de paciente crónico com mais de 50 anos de idade com doença cardiovascular estabelecida, incluindo diagnósticos de Infarto Agudo do Miocárdio, Fibrilação Atrial e Insuficiência Cardíaca (IAM, FA e IC). Doença Pulmonar Obstrutiva Crónica (DPOC) e doença neurológica com o diagnóstico de AVC e doença de Parkinson. O Questionário de Carga de Tratamento (TBQ) foi utilizado para quantificar a carga de trabalho, e a Escala de Adesão ao Tratamento Morisky (MMAS-8) foi utilizada para a aderência. Resultados: 40,5% da amostra teve carga moderada e aderência moderada (38,2%)-baixa (35,4%). A adesão ao tratamento com baixa moderação foi associada a uma pontuação elevada de TBQ (pontuação média de 64,8 pontos). Os grupos de doenças com maior carga são as doenças neurológicas (nota média TBQ de 74,73 pontos), DPOC (nota média TBQ de 69,08 pontos), e finalmente as doenças cardiovasculares (nota média TBQ de 64,47 pontos). Existe uma associação estatisticamente significativa entre carga de trabalho e aderência x2= 68.343 p<0.000. Conclusões: Os doentes crónicos com maior carga de trabalho têm menor aderência terapêutica.

Referencias bibliográficas

  • Abordaje cronicidad canarias SCS. (n.d.).
  • Bayliss, E. A., Steiner, J. F., Fernald, D. H., Crane, L. A., & Main, D. S. (2003). Descriptions of barriers to self-care by persons with comorbid chronic diseases. Annals of Family Medicine, 1(1), 15–21. https://doi.org/10.1370/afm.4
  • Bernabeu-Wittel, M., Ollero-Baturone, M., Moreno-Gaviño, L., Barón-Franco, B., Fuertes, A., Murcia-Zaragoza, J., Ramos-Cantos, C., Alemán, A., & Fernández-Moyano, A. (2011). Development of a new predictive model for polypathological patients. The Profund Index Eur J Intern Med, 22, 311–317.
  • Boehmer, K. R., Kyriacou, M., Behnken, E., Branda, M., & Montori, V. M. (2018). Patient capacity for self-care in the medical record of patients with chronic conditions: A mixed-methods retrospective study 11 Medical and Health Sciences 1117 Public Health and Health Services. BMC Family Practice, 19(1). https://doi.org/10.1186/s12875-018-0852-0
  • Boyd, C. M., Darer, J., Boult, C., Fried, L. P., Boult, L., & Wu, A. W. (2005). Clinical Practice Guidelines and Quality of Care for Older Patients with Multiple Comorbid Diseases. JAMA, 294(6), 716. https://doi.org/10.1001/jama.294.6.716
  • Carl M., V. M. M. F. S. M. (2009). We need minimally disruptive medicine. BMJ, 11, 339.
  • Contel, J. C., Muntané, B., & Camp, L. (2012). La atención al paciente crónico en situación de complejidad: El reto de construir un escenario de atención integrada. Atencion Primaria, 44(2), 107–113. https://doi.org/10.1016/j.aprim.2011.01.013
  • Eton, D., Elraiyah, T. A., Yost, K., Ridgeway, J., Johnson, A., Egginton, J., Mullan, R. J., Murad, M. H., Erwin, P., & Montori, V. (2013). A systematic review of patient-reported measures of burden of treatment in three chronic diseases. Patient Related Outcome Measures, 7. https://doi.org/10.2147/prom.s44694
  • Eton, D., Ramalho de Oliveira, D., Egginton, J., Ridgeway, J., Odell, L., May, C., & Montori, V. (2012). Building a measurement framework of burden of treatment in complex patients with chronic conditions: a qualitative study. Patient Related Outcome Measures, 39. https://doi.org/10.2147/prom.s34681
  • Gallacher, K., Morrison, D., Jani, B., Macdonald, S., May, C. R., Montori, V. M., Erwin, P. J., Batty, G. D., Eton, D. T., Langhorne, P., & Mair, F. S. (2013). Uncovering Treatment Burden as a Key Concept for Stroke Care: A Systematic Review of Qualitative Research. In PLoS Medicine,10(6). https://doi.org/10.1371/journal.pmed.1001473
  • Gu, Q., Koenig, L., Faerberg, J., Steinberg, C. R., Vaz, C., & Wheatley, M. P. (2014). The medicare hospital readmissions reduction program: Potential unintended consequences for hospitals serving vulnerable populations. Health Services Research, 49(3), 818–837. https://doi.org/10.1111/1475-6773.12150
  • Gual, N., Yuste Font, A., Enfedaque Montes, B., Blay Pueyo, C., Martín Álvarez, R., & Inzitari, M. (2017). Profile and evolution of chronic complex patients in a subacute unit. Atencion Primaria, 49(9), 510–517. https://doi.org/10.1016/j.aprim.2016.11.010
  • Jowsey, T., Mcrae, I., Gillespie, J., Banfield, M., & Yen, L. (2013). Time to care? Health of informal older carers and time spent on health related activities: an Australian survey. http://www.biomedcentral.com/1471-2458/13/374
  • Leppin, A. L., Gionfriddo, M. R., Kessler, M., Brito, J. P., Mair, F. S., Gallacher, K., Wang, Z., Erwin, P. J., Sylvester, T., Boehmer, K., Ting, H. H., Murad, M. H., Shippee, N. D., & Montori, V. M. (2014). Preventing 30-day hospital readmissions: A systematic review and meta-analysis of randomized trials. In JAMA Internal Medicine, American Medical Association. 174(7),1095–1107. https://doi.org/10.1001/jamainternmed.2014.1608
  • Leppin, A. L., Montori, V. M., & Gionfriddo, M. R. (2015). Minimally disruptive medicine: A pragmatically comprehensive model for delivering care to patients with multiple chronic conditions. In Healthcare (Switzerland), 3 (1), 50–63. https://doi.org/10.3390/healthcare3010050
  • May, C. R., Eton, D. T., Boehmer, K., Gallacher, K., Hunt, K., MacDonald, S., Mair, F. S., May, C. M., Montori, V. M., Richardson, A., Rogers, A. E., & Shippee, N. (2014). Rethinking the patient: Using Burden of Treatment Theory to understand the changing dynamics of illness. BMC Health Services Research, 14(1). https://doi.org/10.1186/1472-6963-14-281
  • Monsen, K. A., Holland, D. E., Fung-Houger, P. W., & Vanderboom, C. E. (2014). Seeing the Whole Person: Feasibility of Using the Omaha System to Describe Strengths of Older Adults with Chronic Illness. Research and Theory for Nursing Practice, 28(4), 299–315. https://doi.org/DOI: 10.1891/1541-6577.28.4.299
  • Morisky, D. E., Ang, A., Krousel-Wood, M., & Ward, H. J. (2008). Predictive Validity of a Medication Adherence Measure in an Outpatient Setting. In the Journal of Clinical Hypertension,10(5).
  • Parekh, A., Kronick, R., & Tavenner, M. (2014). Optimizing health for persons with multiple chronic conditions. Journal of the American Medical Association, 312(12), 1199–1200. https://doi.org/https://doi.org/10.1001/jama.2014.10181
  • Porter, M. E. (2010). What is Value in Health Care? New England Journal of Medicine, 363(26), 2477–2481.
  • Ridgeway, J. L., Egginton, J. S., Tiedje, K., Linzer, M., Boehm, D., Poplau, S., de Oliveira, D. R., Odell, L., Montori, V. M., & Eton, D. T. (2014). Factors that lessen the burden of treatment in complex patients with chronic conditions: A qualitative study. Patient Preference and Adherence, 8, 339–351. https://doi.org/10.2147/PPA.S58014
  • Rubiera López, G., & Riera Velasco, J. R. (2004). Programa para mejorar la atención de las enfermedades crónicas. Aplicación del Modelo de Cuidados para Enfermedades Crónicas PROGRAMA DE SALUD. Aten Primaria, 34(4).
  • Sav, A., Kendall, E., McMillan, S. S., Kelly, F., Whitty, J. A., King, M. A., & Wheeler, A. J. (2013). ‘You say treatment, I say hard work’: treatment burden among people with chronic illness and their carers in Australia. Health Soc Care Community, 21(6), 665–674.
  • Sav, A., King, M. A., Whitty, J. A., Kendall, E., Mcmillan, S. S., Kelly, F., Hunter, B., & Wheeler, A. J. (2015). Burden of treatment for chronic illness: A concept analysis and review of the literature. Health Expectations, 18(3), 312–324. https://doi.org/10.1111/hex.12046
  • Sav, A., Salehi, A., Mair, F. S., & McMillan, S. S. (2017). Measuring the burden of treatment for chronic disease: Implications of a scoping review of the literature. In BMC Medical Research Methodology. BioMed Central Ltd, 17(1). https://doi.org/10.1186/s12874-017-0411-8
  • Shippee, N. D., Shah, N. D., May, C. R., Mair, F. S., & Montori, V. M. (2012). Cumulative complexity: A functional, patient-centered model of patient complexity can improve research and practice. Journal of Clinical Epidemiology, 65(10), 1041–1051. https://doi.org/10.1016/j.jclinepi.2012.05.005
  • Sidorkiewicz, S., Tran, V. T., Cousyn, C., Perrodeau, E., & Ravaud, P. (2016). Discordance between drug adherence as reported by patients and drug importance as assessed by physicians. Annals of Family Medicine, 14(5), 415–421. https://doi.org/10.1370/afm.1965
  • Spencer-Bonilla, G., Quiñones, A. R., & Montori, V. M. (2017). Assessing the Burden of Treatment. Journal of General Internal Medicine, 32(10), 1141–1145. https://doi.org/10.1007/s11606-017-4117-8
  • Tinetti, M. E., Fried, T. R., & Boyd, C. M. (2012). Designing health care for the most common chronic condition - Multimorbidity. In JAMA - Journal of the American Medical Association,307(23), 2493–2494. https://doi.org/10.1001/jama.2012.5265
  • Tran, V. T., Harrington, M., Montori, V. M., Barnes, C., Wicks, P., & Ravaud, P. (2014). Adaptation and validation of the Treatment Burden Questionnaire (TBQ) in English using an internet platform. BMC Medicine, 12(1). https://doi.org/10.1186/1741-7015-12-109
  • Vázquez Díaz, J. R. (2022). Need for new leadership in Primary Care and Family Medicine in Spain. In Atención Primaria, Elsevier Doyma, 54(2). https://doi.org/10.1016/j.aprim.2022.102282
  • Wolff, J. L., & Boyd, C. M. (2015). A Look at Person-Centered and Family-Centered Care Among Older Adults: Results from a National Survey. Journal of General Internal Medicine, 30(10), 1497–1504. https://doi.org/10.1007/s11606-015-3359-6
  • Ysrraelit, M. C., Fiol, M. P., Peña, F. V., Vanotti, S., Terrasa, S. A., Tran, V. T., Montori, V. M., & Correale, J. (2019). Adaptation and validation of a Spanish version of the treatment burden questionnaire in patients with multiple sclerosis. BMC Neurology, 19(1). https://doi.org/10.1186/s12883-019-1441-0