Avaliação da adesão à terapia imunossupressora por autorrelato de pacientes submetidos ao transplante renal

Abstract

Este artigo está licenciado sob forma de uma licença Creative Commons Atribuição 4.0 Internacional, que permite uso irrestrito, distribuição e reprodução em qualquer meio, desde que a publicação original seja corretamente citada. ABSTRACT AIMS: To evaluate the characteristics and risk factors related to the adherence to immunosuppressive treatment of renal transplant patients using the self-report method by means of the Basel Assessment of Adherence Scale for Immunosuppressives (BAASIS). METHODS: A prospective cohort study with a quantitative approach was performed at the Nephrology and Transplantation Service of São Lucas Hospital of the Pontifical Catholic University of Rio Grande do Sul, with patients older than 18 years, transplanted from kidneys from deceased or living donors, with a minimum transplant time of three months and a maximum of 12 months. The BAASIS instrument was applied to evaluate adhesion. For statistical analysis, Fisher exact test (Monte Carlo simulation) was used to verify the association between the categorical variables, Student t test for independent sample means and Mann Whitney test in the variables without normality. A p<0.05 was adopted for the results to be considered significant. RESULTS: The sample consisted of 59 patients, 57.6% of whom were male, 79.7% were white, the mean age was 45.8 years, 57.6% had elementary school and 72.9% were catholic. Hemodialysis was the most used method, in 86.4% of patients before transplantation, and the mean time in the waiting list was 19.5 months. After transplantation, the mean time of hospitalization was 17.2 days. The assessment of adherence by BAASIS characterized 83% of patients as non-adherent. The main fact considered as non-adherence was to take the immunosuppressive drugs with more than two hours difference from the prescribed time, at least once a week, in the last four weeks. There was no significant difference when the statistical analysis was performed to compare the adhesion rate among the various categories of the demographic and clinical variables of the patients. CONCLUSIONS: A high rate of patients not adherent to the immunosuppressive treatment was identified, and the change in the schedule of immunosuppressants was the main fact that characterized this behavior. A shorter waiting time in the transplant queue was associated with non-adherence. The other variables, demographic and clinical, were not associated to the classification of adherent or non-adherent.

Identification of Factors Associated with Medication Adherence in Renal Transplant Patients: An Integrative Literature Review

“…45 In light of this, the value given to the transplant is higher and therefore serves as a factor that encourages careful behavior with the medications. In addition, studies 18,33 point out that the fact that patients stay for a long time on the transplant waiting list, hoping for the improvement of their clinical condition, influences the higher adherence at the beginning of transplantation.…”

Identificação dos fatores associados com a adesão à medicação em pacientes transplantados renais: Uma revisão da literatura integrativa

“…45 Em função disso, o valor dado ao transplante é maior e, portanto, serve como fator que estimula um comportamento cuidadoso com os medicamentos. Além disso, estudos 18,33 apontam que o fato de os pacientes ficarem por muito tempo na lista de espera pelo transplante, na esperança da melhoria do quadro clínico, influencia a maior adesão no início do transplante.…”

Fatores Associados À Adesão a Terapia Imunossupressora Em Indivíduos Transplantados Renais

“…Os indivíduos com tempo de transplante superior a 6 anos, apresentaram maior taxa de não adesão, semelhante ao estudo realizado com 1505 receptores de órgãos sólidos que também evidenciou uma redução da adesão com o passar dos anos. (15) Pesquisa realizada na Alemanha, também constatou que o tempo pós-transplante teve relação inversamente proporcional à adesão, que pode ser justificado pela maior independência e autonomia conquistada pelos indivíduos com o decorrer dos anos e a retomada das atividades habituais, em detrimento à manutenção dos cuidados com a terapia imunossupressora. (16) Outros fatores também estão relacionados com a redução da adesão, como as dificuldades encontradas no pós--transplante para readequação de um novo estilo de vida, obrigatoriedade da tomada de medicamentos, reeducação alimentar e a necessidade de acompanhamento multiprofissional rotineiramente.…”