Patient adherence to ischemic heart disease treatment

Nobre, Moacyr Roberto Cuce; Domingues, Rachel Zanetta de Lima

doi:10.1590/1806-9282.63.03.252

Summary

Introduction:

The effectiveness of the treatment of chronic diseases depends on the participation of the patient, influenced by different sociocultural factors, which are not fully recognized by the treatment routine.

Objective:

To search for some of these factors that hinder or facilitate adherence to treatment and use of healthcare resources, approaching patients with ischemic heart disease.

Method:

A cross-sectional study was conducted using face-to-face interviews. We applied semi-structured questionnaires to 347 individuals and recorded 141 interviews for qualitative analysis. Descriptors were selected to identify eight categories of analyses. The quantitative data were submitted to descriptive analysis of frequency.

Results:

Only 2% had good medication adherence according to score on Morisky questionnaire. About 23% bought statins; the others obtained statin in the public health institution. Thirty-six speeches were selected and classified according to the following categories: knowledge about disease and medication, difficulty of acquisition, self management of treatment, difficulties of access to health services, side effect of statins, caregiver support, transportation to health services and concerns about the disease progression. However, it was noticed that about 1/3 of the care outside the research institution can be characterized as an attempt to bring rationalization to the health system.

Conclusion:

The improved adherence to chronic treatment of ischemic heart disease depends on the establishment of effective flows for referral and counter-referral from one care unit to another, relevant information and clarification of the questions for the patients and the attention of health professionals to the many social and cultural factors involved in treatment adherence. New research should be focused on educational groups by integrated multidisciplinary teams in order to share treatment decisions, thereby increasing the patient's commitment to his own health.

Keywords:
medication adherence; patient compliance; qualitative research; myocardial ischemia; health service

[1] *Correspondence: Address: Av. Dr. Enéas de Carvalho Aguiar, 44, bl. II, 1º subsolo, sala 15, São Paulo, SP - Brazil, Postal code: 05403-900. mrcnobre@usp.br

I	Knowledge about the medication	"The first gave me a lot of pain in my leg, I couldn't even stand up. I said to my son that the pain was killing me, and then, later, the doctor explained it all."
II	Difficulty to acquire the medication	"The bad thing is that the pharmacy doesn't have all the medicines and I can't always buy them, then I end up without my medication until they receive more. I keep calling and asking please, but they do not always send all medications. The ones I know that are always missing, I take half to try to make it last longer."
III	Global management of the treatment	"Look at the prescription, I don't know if I take it, it's a lot of medicine and sometimes the pharmacy gives another one."
IV	Access to health services	"I've never had a problem getting the pills. Before I had to come here, now it's better, they send it to my house, which is near here. I don't like to make an appointment because it's always full, we sometimes go back to the doctor's office without the exams. Then the doctor gets angry and says that we did not insist, but this is not true. There is always medication, I mean statins, but sometimes other drugs are missing."
V	Side effects of the drug	"I'm not going to lie, I have to say the truth. Sometimes, I stop taking it because I get too tired, it's because there is not enough fat in my body. Then I stop it for about ten days, and feel better again."
VI	Caregiver support	"When my daughter comes, it is easy, because she makes the doctor answer the doubts, everything is explained. But if she can't come, it all becomes a mess, because I do not know if I am getting better or worse, I get confused."
VII	Transport to health services	"I live a long way from here and it's very hard to come, so I got a health insurance to follow me closely."
VIII	Be afraid of disease progression	"I was always afraid to die until the first heart attack. Then I've lost my fear. It's ugly, like a rag entering your throat, you want to do something, but you can't, so I do everything the doctor says."

Brasil