Adherencia, carga y morbilidad de enfermedades crónicas en una clínica ambulatoria: A-CaMo I
Date
Subject
Chronic diseases
adherence
burden
morbidity
reliability
Enfermedades crónicas
adherencia
carga
morbilidad
confiabilidad
adherence
burden
morbidity
reliability
Enfermedades crónicas
adherencia
carga
morbilidad
confiabilidad
Language:
Journal Title
Journal ISSN
Volume Title
Publisher
Intituto Tecnológico de Santo Domingo (INTEC)
Introducción:
Las enfermedades crónicas no transmisibles (ENT) representan un desafío significativo para la salud global debido a su duración prolongada y tasas de progresión variadas, lo que conduce a un aumento en la falta de adherencia, especialmente en países en desarrollo. La adherencia farmacológica, definida por la OMS, es crucial para mantener la calidad de vida de los pacientes y reducir la morbilidad, sin embargo, sigue siendo inadecuada, con aproximadamente un 50% de no adherencia en países desarrollados, el 30% de los cuales es involuntario. Comprender la carga de enfermedad es vital, pero la investigación sobre adherencia a medicamentos, carga y morbilidad en la República Dominicana y otros países de América Latina es insuficiente, lo que hace necesarios estudios exhaustivos.
Objetivos:
Determinar el grado de adherencia farmacológica, carga de enfermedad y morbilidad entre individuos con enfermedades crónicas fueron los objetivos principales del estudio.
Metodología:
El proyecto fue un estudio transversal prospectivo que examinó los datos sociodemográficos, historias clínicas y regímenes de medicación de una muestra de 284 pacientes que asistieron a una clínica ambulatoria. Los pacientes fueron seleccionados mediante un muestreo por conveniencia, para luego ser evaluados e entrevistados después de la consulta para cualquiera de las enfermedades presentes en las escalas MAR o los cuestionarios DBMA. La selección buscó únicamente a aquellos individuos que cumplieran con los criterios de inclusión (> 18 años, diagnosticados con una enfermedad presente en alguna de las escalas) y no cumplieran con los criterios de exclusión (no poder completar el cuestionario debido a la barrera del idioma). Los datos recopilados se almacenaron utilizando el programa KoboToolBox y luego se resumieron con la media y la desviación estándar para su procesamiento adicional utilizando STATA BE. Las pruebas estadísticas se programaron con un alfa del 5%, IC del 95% y p < 0,05 para significación estadística.
Resultados:
La muestra, compuesta por 133 individuos, tuvo una edad media de aproximadamente 58,4 años, con una mayoría de participantes femeninas. La mayoría de los participantes estaban casados, eran dominicanos y de etnia hispano-latina, siendo el cristianismo la religión predominante. En cuanto al historial médico previo, aunque una parte sustancial no tenía antecedentes de enfermedades respiratorias o cardiovasculares, la diabetes mellitus fue prevalente, lo que indica posibles implicaciones para el estado de salud actual y la adherencia al tratamiento. La adherencia, medida por puntajes diarios y semanales, osciló entre 1,0 y 3,8, con un puntaje de carga por paciente promedio de 50,1 y por enfermedad de 2,6. El análisis reveló que el 16,9% de los participantes eran monomórbidos, mientras que el 83,1% eran multimórbidos, lo que demuestra la complejidad de las condiciones de salud dentro de la cohorte.
Conclusión:
Los principales resultados del estudio revelan una parte significativa de pacientes sin antecedentes de enfermedades respiratorias o cardiovasculares, lo que sugiere una línea de base relativamente saludable. Sin embargo, una proporción notable tenía diabetes, lo que podría afectar su estado de salud actual y la adherencia al tratamiento. Además, el estudio analiza los factores que influyen en la adherencia, los niveles de carga y las razones de la falta de adherencia. Los hallazgos indican que los pacientes solteros y aquellos con niveles educativos más bajos tienden a exhibir niveles de carga más altos y puntajes de adherencia más bajos. Las condiciones de salud mental como la depresión o la ansiedad, la osteoporosis y la insuficiencia cardíaca están asociadas con niveles de carga elevados. El estudio también evalúa la confiabilidad de las herramientas de medición de la adherencia y la carga, enfatizando la importancia de considerar la variabilidad de la población en la interpretación de los resultados. Las limitaciones incluyen desafíos en la selección de pacientes y la recopilación de datos, especialmente en pacientes con multimorbilidad. En general, el estudio destaca la necesidad de una exploración exhaustiva de la adherencia, la carga y la morbilidad para predecir el control de la enfermedad, la progresión y la calidad de vida del paciente de manera efectiva en futuros proyectos de investigación.
Introduction: Chronic non-communicable diseases (NCDs) are a significant global health challenge due to their prolonged duration and varied progression rates, leading to increased noncompliance, especially in developing nations. Pharmacological adherence, defined by WHO, is crucial for maintaining patients' quality of life and reducing morbidity, yet it remains inadequate, with about 50% non-adherence in developed countries, 30% of which is unintentional. Understanding disease burden is vital, but research on medication adherence, burden, and morbidity in the Dominican Republic and Latin American countries is lacking, necessitating comprehensive studies. Objectives: Ascertaining the degree of pharmaceutical adherence, disease burden, and morbidity amongst individuals with chronic illnesses were the study’s primary endpoints. Methodology: The project was a cross-sectional, prospective study that examined the sociodemographic data, past medical history, and medication regimens of a sample of 284 patients attending an outpatient clinic. Patients were selected using convenience sampling, to be later screened and interviewed after consultation for any of the diseases present on the MAR-Scale or the DBMA questionnaires. The screening sought only those individuals who met inclusion criteria (> 18 years old, diagnosed with a disease present on either scale) and did not meet exclusion criteria (not being able to fill the questionnaire due to language barrier). Data collected was stored using the KoboToolBox program and later summarized with mean and standard deviation for further processing using STATA BE. Statistical tests were programmed with an alpha of 5%, 95% CI, and p < 0.05 for statistical significance. Results: The sample, comprising 133 individuals, had a mean age of approximately 58.4 years, with a majority of female participants. Most participants were married, Dominican, and of Hispanic Latino ethnicity, with Christianity being the predominant religion. Regarding past medical history, while a substantial portion had no prior respiratory or cardiovascular ailments, diabetes mellitus was prevalent, indicating potential implications for current health status and treatment adherence. Adherence, measured by daily and weeklyscores, ranged from 1.0 to 3.8, with the burden score per patient averaging 50.1 and per disease averaging 2.6. The analysis revealed that 16.9% of participants were monomorbid, while 83.1% were multimorbid, showcasing the complexity of health conditions within the cohort. Conclusion: The study's key results reveal a significant portion of patients without a history of respiratory or cardiovascular diseases, suggesting a relatively healthy baseline. However, a notable proportion had diabetes, potentially impacting their current health status and treatment adherence. Furthermore, the study delves into factors influencing adherence, burden levels, and reasons for nonadherence. Findings indicate unmarried patients and those with lower education levels tend to exhibit higher burden levels and lower adherence scores. Mental health conditions like depression or anxiety, osteoporosis, and heart failure are associated with elevated burden levels. The study also assesses the reliability of adherence and burden measurement tools, emphasizing the importance of considering population variability in interpreting results. Limitations include challenges in patient selection and data collection, particularly regarding patients with multimorbidity. Overall, the study highlights the need for comprehensive exploration of adherence, burden, and morbidity to predict disease control, progression, and patient quality of life effectively in future research endeavors.
Introduction: Chronic non-communicable diseases (NCDs) are a significant global health challenge due to their prolonged duration and varied progression rates, leading to increased noncompliance, especially in developing nations. Pharmacological adherence, defined by WHO, is crucial for maintaining patients' quality of life and reducing morbidity, yet it remains inadequate, with about 50% non-adherence in developed countries, 30% of which is unintentional. Understanding disease burden is vital, but research on medication adherence, burden, and morbidity in the Dominican Republic and Latin American countries is lacking, necessitating comprehensive studies. Objectives: Ascertaining the degree of pharmaceutical adherence, disease burden, and morbidity amongst individuals with chronic illnesses were the study’s primary endpoints. Methodology: The project was a cross-sectional, prospective study that examined the sociodemographic data, past medical history, and medication regimens of a sample of 284 patients attending an outpatient clinic. Patients were selected using convenience sampling, to be later screened and interviewed after consultation for any of the diseases present on the MAR-Scale or the DBMA questionnaires. The screening sought only those individuals who met inclusion criteria (> 18 years old, diagnosed with a disease present on either scale) and did not meet exclusion criteria (not being able to fill the questionnaire due to language barrier). Data collected was stored using the KoboToolBox program and later summarized with mean and standard deviation for further processing using STATA BE. Statistical tests were programmed with an alpha of 5%, 95% CI, and p < 0.05 for statistical significance. Results: The sample, comprising 133 individuals, had a mean age of approximately 58.4 years, with a majority of female participants. Most participants were married, Dominican, and of Hispanic Latino ethnicity, with Christianity being the predominant religion. Regarding past medical history, while a substantial portion had no prior respiratory or cardiovascular ailments, diabetes mellitus was prevalent, indicating potential implications for current health status and treatment adherence. Adherence, measured by daily and weeklyscores, ranged from 1.0 to 3.8, with the burden score per patient averaging 50.1 and per disease averaging 2.6. The analysis revealed that 16.9% of participants were monomorbid, while 83.1% were multimorbid, showcasing the complexity of health conditions within the cohort. Conclusion: The study's key results reveal a significant portion of patients without a history of respiratory or cardiovascular diseases, suggesting a relatively healthy baseline. However, a notable proportion had diabetes, potentially impacting their current health status and treatment adherence. Furthermore, the study delves into factors influencing adherence, burden levels, and reasons for nonadherence. Findings indicate unmarried patients and those with lower education levels tend to exhibit higher burden levels and lower adherence scores. Mental health conditions like depression or anxiety, osteoporosis, and heart failure are associated with elevated burden levels. The study also assesses the reliability of adherence and burden measurement tools, emphasizing the importance of considering population variability in interpreting results. Limitations include challenges in patient selection and data collection, particularly regarding patients with multimorbidity. Overall, the study highlights the need for comprehensive exploration of adherence, burden, and morbidity to predict disease control, progression, and patient quality of life effectively in future research endeavors.
Description
Type
info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
info:eu-repo/semantics/publishedVersion
Source
Science and Health; Vol. 8 No. 2 (2024): Science and Health, april-june; 5-34
Ciencia y Salud; Vol. 8 Núm. 2 (2024): Ciencia y Salud, abril-junio; 5-34
2613-8824
2613-8816
10.22206/cysa.2024.v8i2
Ciencia y Salud; Vol. 8 Núm. 2 (2024): Ciencia y Salud, abril-junio; 5-34
2613-8824
2613-8816
10.22206/cysa.2024.v8i2