Adesão ao uso de corticóide inalatório na asma: taxas relatadas pelos responsáveis e mensuradas pela farmácia

Lasmar, Laura Maria de Lima Belizário Facury; Camargos, Paulo Augusto Moreira; Costa, Leila F.; Fonseca, Maria Teresa Mohallem; Fontes, Maria Jussara Fernandes; Ibiapina, Cássio da Cunha; Alvim, Cristina Gonçalves; Moura, José Augusto Rubim de; Goulart, Eugênio Marcos Andrade; Sakurai, Emília

doi:10.1590/s0021-75572007000600013

Cited by 7 publications

(7 citation statements)

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“…Compliance rates reported by parents and/or guardians were always higher ( P < 0.001) and exhibited a weak correlation with pharmacy records during the period studied: 4th (r = 0.37) and 12th (r = 0.31) month follow-ups [9]. …”

Section: Achieved Resultsmentioning

confidence: 99%

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Wheezy Child Program

Lasmar¹,

Fontes²,

Mohallen³

et al. 2009

World Allergy Organization Journal

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BackgroundUntil 1994, assistance provided by the Municipal Public Health System to children with asthma in Belo Horizonte, Brazil, was ineffective because it focused only on treating exacerbations. This scenario motivated the implementation of the Wheezy Child Program.ObjectivesThe main objectives were to reduce emergency room visits and hospitalizations.MethodsThe strategies adopted were as follows: continued medical education for pediatricians, reorganization of public assistance into different levels of complexity regarding asthma care, and free dispensation of inhaled beclomethasone, albuterol, and valved spacers. A partnership between the Pediatric Pulmonology staff of the Federal University of Minas Gerais and the Belo Horizonte Municipal Health Authority made these strategies come to fruition, especially through the training of health workers and the devising of protocol after GINA guidelines.ResultsOf 2149 patients with a history of hospitalization after program admission, only 453 were re-admitted in the 6 to 12 months after, a reduction of 79%. There was a 300% increase in the use of aerosol and a reduction to 50% in the use of oxygen-driven nebulizers (P < 0.001) in the management of exacerbations. For patients enrolled in the program with moderate and severe persistent asthma, the median adherence rate was 50%.ConclusionsThe Wheezy Child Program has significantly reduced hospitalizations and emergency room visits, has improved quality of life, and has shown that programs of this kind are feasible in low- to middle-income countries. More than 30,000 children have been assisted by the program, and now it seeks to optimize asthma control and increase adherence rates.

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Section: Achieved Resultsmentioning

confidence: 99%

“…Examination of pharmacy records was valuable, inexpensive, and easy to perform and has been progressively implemented in the asthma program framework [9]. …”

Section: Achieved Resultsmentioning

confidence: 99%

Wheezy Child Program

Lasmar¹,

Fontes²,

Mohallen³

et al. 2009

World Allergy Organization Journal

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“…Of those, nine studies were conducted in the United States, (32,33,(36)(37)(38)(39)(40)(41) one in Norway, (35) and one in Brazil. (42) Patient reports were compared to data obtained by means of electronic medication monitors in three studies. Mean adherence rates obtained from patient reports were 95.4, 75 and 80%, respectively, whereas those obtained from electronic medication monitors were 13.7, 27 and 50%, respectively.…”

Section: Final Commentsmentioning

confidence: 99%

“…Mean reported adherence rates obtained from patient reports were 64.5 and 93.2%, respectively, whereas those obtained from medication dispensing records were 49.1 and 61%, respectively. (38,42) In one study, medication dispensing records were compared to the use of electronic medication monitors. Mean adherence rates were 75 and 27%, respectively.…”

Section: Final Commentsmentioning

confidence: 99%

“…This method not only facilitates the active search for missing patients but also improves the quality of treatment of asthma patients. (42) Adherence determined by pharmacy records on medication dispensing can be carried out at most health care facilities, since this method can be easily executed, improving treatment. It should be included in the routine practice as an instrument to improve the quality of the management of patients with asthma.…”

Section: Final Commentsmentioning

confidence: 99%

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Métodos empregados na verificação da adesão à corticoterapia inalatória em crianças e adolescentes: taxas encontradas e suas implicações para a prática clínica

Jentzsch

Camargos

2008

J. bras. pneumol.

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Nonadherence to inhaled corticosteroid therapy is common and has a negative effect on clinical control, as well as increasing morbidity rates, mortality rates and health care costs. This review was conducted using direct searches, together with the following sources: Medline; HighWire; and the Latin American and Caribbean Health Sciences Literature database. Searches included articles published between 1992 and 2008. The following methods of assessing adherence, listed in ascending order by degree of objectivity, were identified: patient or family reports; clinical judgment; weighing/dispensing of medication, electronic medication monitoring; and (rarely) biochemical analysis. Adherence rates ranged from 30 to 70%. It is recognized that the degree of adherence determined by patient/family reports or by clinical judgment is exaggerated in comparison with that obtained using electronic medication monitors. Physicians should bear in mind that true adherence rates are lower than those reported by patients, and this should be considered in cases of poor clinical control. Weighing the spray quantifies the medication and infers adherence. However, there can be deliberate emptying of inhalers and medication sharing. In some countries, pharmacies provide the dates on which the medication was dispensed and refilled. This strategy is valid and should be used in Brazil. The use of electronic medication monitors, which provide the date and time of each triggering of the medication device, although costly, is the most accurate method of assessing adherence. The results obtained with such monitors demonstrate that adherence was lower than expected. Physicians should improve their knowledge on patient adherence and use accurate methods of assessing such adherence.Keywords: Patient compliance; Asthma/therapy; Asthma/prevention & control. ResumoAdesão inadequada à corticoterapia inalatória é comum e contribui para um controle clínico insatisfatório, aumento da morbidade, mortalidade e dos custos do setor. Este artigo de revisão foi conduzido utilizando-se bancos de dados Medline, HighWire, Literatura Latino-Americana e do Caribe em Ciências da Saúde e pesquisa direta, entre 1992 e 2008. Os métodos para avaliar a adesão, citados em ordem crescente de sua objetividade, são: relato do paciente ou seus familiares, julgamento clínico, pesagem da medicação, dispensação de medicação, dosadores eletrônicos e análise bioquímica (pouco utilizada). As taxas de adesão variaram de 30 a 70%. A adesão determinada pelo relato do paciente/ familiares e julgamento clínico é reconhecidamente exagerada quando comparada à obtida através do dosador eletrônico. O clínico deve sempre lembrar que as taxas reais de adesão são menores do que as relatadas pelo paciente e isso deve ser considerado, se não houver bom controle da doença. A pesagem do spray quantifica a medicação e infere adesão, porém pode ocorrer esvaziamento deliberado e compartilhamento da medicação. A farmácia fornece datas de dispensação e recarga da medicação. Esta estratégia é v...

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