P a u lo R o b e rto C h izzo la , A lfre d o Jo se M a n su r, P ro ta sio L e m o s d a L u z, G io va n n i B e llo tti
C om pliance w ith pharm acological treatm ent
in
outpatients
from a B razilian cardiology referral center
Instituto do Corafao, Hospital das Clinicas, University of Sao Paulo - Sao Paulo, BrazilT o e v a lu a te th e d e g re e o f c o m p lia n c e w ith p h a rm a c o lo g ic a l th e ra p y , a n d to id e n tify p re d ic to rs o f n o n -c o m p lia n c e in o u tp a tie n ts fro m a c a rd io lo g y re fe rra l c e n te r in S a o P a u lo , B ra z il, w e s tu d ie d 4 8 5 o u tp a tie n ts , 2 3 0 (4 7 .4 p e rc e n t) m a le s a n d 2 5 5 (5 2 .6 p e rc e n t) fe m a le s , th ro u g h a n in te rv ie w g u id e d b y a q u e s tio n n a ire d u rin g m e d ic a l c o n s u lta tio n . T h e a g e s ra n g e d b e tw e e n 1 7 a n d 8 6 (m e a n 5 4 , s ta n d a rd d e v ia tio n 1 5 ) y e a rs . H e a rt d is e a s e a n d s o c io e c o n o m ic fa c to rs (re s id e n c e , m e a n s o f tra n s p o rt, e d u c a tio n a l le v e l a n d p ro fe s s io n a l s ta tu s ) w e re s tu d ie d . In a d d itio n , w e e x a m in e d th e d ru g s p re s c rib e d in c lu d in g : d iffic u ltie s in ta k in g th e m ; th e s o u rc e o f s u p p ly ; a n d th e p a tie n t's k n o w le d g e o f th e d ru g s . A s s e s s m e n t o f c o m p lia n c e w a s b a s e d o n th e p a tie n ts ' re s p o n s e . T h e p a tie n ts ' a n s w e rs w e re c o m p a re d w ith th e p re s c rip tio n a n d p ro g re s s n o te s . E rro rs w e re re c o rd e d if th e p a tie n t re p o rte d u s in g o n e o r m o re n o n p re s c rib e d m e d ic in e s . C o m p lia n c e w ith th e ra p y w a s re c o rd e d if th e p a tie n t s a id th e p re s c rip tio n w a s ta k e n c o rre c tly w ith o u t in te rru p tio n a n d w ith o u t e rro r. T h e v a ria b le s w ith s ig n ific a n t d iffe re n c e s in u n iv a ria te a n a ly s is w e re fu rth e r a n a ly z e d b y m u ltiv a ria te lo g lin e a r re g re s -s io n a n a ly -s i-s . N o n c o m p lia n c e o c c u rre d in 2 8 6 (5 9 p e rc e n t) o f th e p a tie n ts , a n d w a s p re d ic te d b y th e re p o rte d d iffic u lty in ta k in g m e d ic a tio n (P < 0 .0 0 1 ), a n d b y th e la c k o f k n o w le d g e o f m e d ic a tio n n a m e s (P < 0 .0 0 1 ).T h u s , n o n c o m p lia n c e w ith m e d ic a l th e ra p y w a s c o m m o n . T h e m a in p re d ic to rs o f n o n -c o m p lia n c e w e re th e re p o rte d d iffic u lty in ta k in g m e d ic a tio n a n d in a b ility to id e n tify m e d ic in e s ' n a m e s .
U N IT E R M S : P a tie n t c o m p lia n c e . A m b u la to ry c a re . O u tp a tie n t c lin ic s .
IN T R O D U C T IO N
C
o m p lian ceis a fu n d am en talo f p atien ts w ith th e th erap eu ticstep in m ed ical care, affectin greg im en th e ev alu atio n o f eith er treatm en t o r d isease.'-4 T reatm en t co m p lian ce d ep en d s o n th e co m p lex in teractio n o f sev eral v ariab les in clu d in g : th e p atien t;5 .lJ th e p h y sician ,5 .C i.~ .lJth e d isease;5 .lJ an d th e d ru g ,C i.lJam o n g o th er facto rs.5 .lJ T h e in teractio n o f th ese v ariab les is o p erativ e in th e cu ltu ral an d so cio eco n o m ic en v iro n m en t in w h ichA d re s s fo r c o rre s p o n d e n c e :
P a u lo R o b e rto C h izzo la
In stitu to d o C o ra 9 a o H C -F M U S P . D ivisa o d e C lfn ica s A v. D r. E n e a s d e C a rva lh o A g u ia r, 4 4
S a o P a u lo /S P - B ra sil - C E P 0 5 4 0 3 -0 0 0
th e p atien ts are liv in g . D ifferen t d eg rees o f co m p lian ce are to b e ex p ected in d ifferen t p o p u latio n s. P atien ts sh o u ld b e co n sid ered p o ten tial d efau lters an d co m p lian ce sh o u ld n o t b e assu m ed .lo
In o rd er to assess th e co m p lian ce w ith p h arm aco lo g ic m ed ical treatm en t b y th e p atien ts w e care fo r, w e stu d ied th e co m p lian ce w ith m ed ical treatm en t in an o u tp atien t settin g lo cated at a tertiary card io lo g y referral cen ter in S ao P au lo , B razil.
M E T H O D S
P a tie n ts - in th e stu d y p erio d o f sev en m o n th s, 1 8 ,7 2 2 m ed ical co n su ltatio n s w ere p erfo rm ed in o n e
C H IZ Z O L A , P .R .; M A N S U R , A .J .; L U Z , P .L . & B E L L o n l, G .. C o m p lia n c e w ith p h a rm a c o lo g ic a l tre a tm e n t in o u tp a tie n ts fro m a B ra z ilia n c a rd io lo g y re fe rra l c e n te r
o u tp atien t sectio n o f th e cen ter; 5 ,8 2 2 (3 1 . I p ercen t) o f
th em w ere u n sch ed u led v isits. A m o n g th ese, 4 8 5 (8 .3
p ercen t) w ere in terv iew ed b y tw o p h y sician s g u id ed b y a q u estio n n aire (g iv en d u rin g th e m ed ical co n su ltatio n ). T w o h u n d red fifty -fiv e (5 2 .6 p ercen t) p atien ts w ere fem ale an d
2 3 0 (4 7 .4 p ercen t) w ere m ale. T h e ag es ran g ed b etw een
1 7 an d 8 6 (5 4 : t 1 5 ) y ears. D u ratio n o f fo llo w -u p ran g ed fro m o n e d ay to 1 4 .2 (3 .6 : t 3 .1 ) y ears. T h e p atien t w as in terv iew ed d u rin g th e co n su ltatio n , an d th e co m p ariso n
o f th e an sw ers w ith th e last p rescrip tio n w as n o ted .
P ro g ress n o tes in th e ch arts w ere m ad e.
O u tp atien t clin ics - o u r referral cen ter is a p u b lic
h o sp ital w ith a larg e o u tp atien t facility fo r card io lo g ical care. A sectio n o f o u r o u tp atien t clin ics p ro v id es m ed ical care fo r p atien ts w ith state h ealth in su ran ce fo r th eir first m ed ical v isit to th e h o sp ital, as w ell as fo r o u tp atien ts w h o
h av e b een o n treatm en t in th e h o sp ital an d co m e fo r
u n sch ed u led m ed ical v isits. T h e satu ratio n o f th e
ap p o in tm en t sy stem d iv erts p atien ts, w h o co m e to th e
h o sp ital fo r ap p o in tm en ts, to u n sch ed u led m ed ical v isits. T h u s, u n sch ed u led m ed ical v isits rep resen t p atien ts th at cam e to th e h o sp ital fo r m ed ical reaso n s as w ell as p atien ts w h o w ere n o t sch ed u led in th e ap p o in tm en t sy stem , an d co m e to th e h o sp ital fo r d ifferen t reaso n s.
V ariab les - A g e; sex ; d u ratio n o f fo llo w -u p ;
resid en ce; m ean s o f tran sp o rt to th e h o sp ital; ed u catio n al lev el; p ro fessio n al statu s; reaso n fo r u n sch ed u led m ed ical v isit; m ain card iac d isease an d fu n ctio n al class (N ew Y o rk H eart A sso ciatio n ); I I d u ratio n o f m ed icin e u se; n u m b er o f d ru g s p rescrib ed an d th e d aily reg im en ; h elp fro m o th ers
in tak in g m ed icin es; k n o w led g e o f th e n am e o f at least
h alf o f m ed icin es in u se, o r at least to d esig n ate h alf o f
th em ; free acq u isitio n o f th e d ru g o r n o t; rep o rted d ifficu lty
T a b le 1
F re q u e n c y o f m a in d iffic u ltie s in ta k in g m e d ic a tio n s
R e p o rte d D iffic u ltie s n %
S id e e ffe c ts o f d ru g s
45
27.6
C o s t o f d ru g s
41
25.2
N e g lig e n c e
26
15.9
R e p u ls e to m e d ic a tio n s
25
15.3
A tte n u a tio n o f s y m p to m s
12
7.4
A b s e n c e o f th e d ru g
o n th e m a rk e t
6
3.7
O th e r re a s o n s 8
4.9
T o ta l
163
100
n : n u m b e r
% : p e rc e n ta g e
in tak in g m ed ical p rescrip tio n o r n o t; in terru p tio n in tak in g th e d ru g s; an d self-assessm en t b y th e p atien t o f th eir o w n co m p lian ce.
D efin itio n s - E rro r w as reco rd ed if th e p atien t
rep o rted u sin g o n e o r m o re m ed icin es d ifferen tly th an
p rescrib ed .
C o m p lian ce w as reco rd ed if th e p atien t said h e to o k th e p rescrip tio n co rrectly , w ith o u t in terru p tio n in m ed icin e u se (rep o rted d ata), an d w ith o u t erro r (o b serv ed d ata).
N o n co m p lian ce w as reco rd ed if th e p atien t said h e
to o k th e p rescrip tio n in co rrectly , o r w ith in terru p tio n in
m ed icin e u se (rep o rted d atas), o r w ith erro r (o b serv ed
d ata).
S tatistical A n aly sis - C h i-sq u are test w as u sed fo r
u n iv ariate freq u en cies o f categ o ric v ariab les an d th e
S tu d en ts ttest fo r th e co n tin u o u s v ariab les. T h e v ariab les
w ith a sig n ifican t d ifferen ces in u n iv ariate an aly sis
(P ::;0 .2 5 ) w ere su b seq u en tly an aly zed b y m u ltiv ariate \o g -lin ear reg ressio n an aly sis.1 2
•1 3 A sig n ifican ce \ev el o f 0 .0 5 w as ad o p ted .
D em o g rap h ic an d C lin ical C h aracteristics
-R esid en ce - 3 2 I (6 6 .2 p ercen t) p atien ts liv ed in S ao P au lo C ity , 7 9 (1 6 .3 p ercen t) in th e m etro p o litan area, 5 5 (1 1 .3
p ercen t) in th e in terio r o f S ao P au lo state, an d 3 0 (6 .2
p ercen t) in o th er states.
T ran sp o rt - B u s, train o r su b w ay (p u b lic tran sp o rt) w ere u sed as tran sp o rt fo r th e v isit b y 3 5 1 (7 2 .4 p ercen t)
p atien ts, an d p riv ate car, tax i, am b u lan ce an d o th er
(in d iv id u al tran sp o rt) b y 1 3 4 (2 7 .6 p ercen t).
E d u catio n al lev el - 9 2 (1 9 p ercen t) p atien ts w ere
illiterate; 3 0 9 (6 3 .7 p ercen t) h ad a elem en tary sch o o l
ed u catio n (1 to 4 sch o o l y ears), an d 8 4 (1 7 .3 p ercen t) h ad m o re th an 4 sch o o l y ears.
P ro fessio n al statu s - 1 6 4 (3 3 .8 p ercen t) p atien ts
w ere em p lo y ed , an d 3 2 1 (6 6 .2 p ercen t) w ere u n em p lo y ed , retired o r d ep en d en t.
H eart d isease - C lin ical p ro b lem s w ere th e reaso n
fo r u n sch ed u led v isits in 2 2 0 p atien ts (4 5 .4 p ercen t).
A m o n g th ese, 1 2 3 (5 5 .9 p ercen t) w ere d u e to
card io v ascu lar co m p licatio n s, an d 9 7 (4 4 .1 p ercen t) d u e
o th er clin ical reaso n s. C au ses u n related to clin ical
p ro b lem s led to u n sch ed u led v isits in 2 6 5 (5 4 .6 p ercen t)
p atien ts. T h e d iag n o ses w ere: co ro n ary artery d isease in
1 4 5 (2 9 .9 p ercen t) p atien ts; arterial h y p erten sio n in 1 1 2 (2 3 . I p ercen t); v alv u lar h eart d isease in 1 1 0 (2 2 .7 p ercen t); card io m y o p ath y in 7 3 (1 5 . I p ercen t); an d o th er card iac d iseases in 4 5 (9 .3 p ercen t). T h e fu n ctio n al class w as I Iin 2 3 5 (4 8 .5 p ercen t) p atien ts, Iin 2 1 7 (4 4 .7 p ercen t) an d I I I o r IV in 3 3 (6 .8 p ercen t).
T reatm en t - 3 4 2 (7 0 .5 p ercen t) p atien ts w ere ab le
to id en tify at least h alf o f m ed icin es an d 1 2 1 (2 4 .9 p ercen t)
s a o P a u lo M e d ic a l J o u rn a l/R P M 1 1 4 (5 ): 1 2 5 9 -1 2 6 4 , 1 9 9 6 C H IZ Z O L A , P .R .; M A N S U R , A .J .; L U Z , P .L . & B E L L O T T I, G . - C o m p lia n c e w ith
1 2 6 1
w e re n o t. S o m e o n e 's a s s is ta n c e in ta k in g m e d ic in e o c c u rre d in 1 2 1 ( 2 4 .9 p e rc e n t) p a tie n ts . T w o h u n d re d th irty -s ix ( 4 8 .7 p e rc e n t) p a tie n ts w e re o n d ru g s fo r m o re th a n fiv e y e a rs , 1 8 9 ( 3 7 .9 p e rc e n t) fo r o n e to fiv e y e a rs , a n d 6 5 ( 1 3 .4 p e rc e n t) fo r le s s th a n o n e y e a r. M e d ic in e s w e re g iv e n fre e e s p e c ia lly in 3 1 8 ( 6 5 .6 p e rc e n t) p a tie n ts , a n d in /6 7 ( 3 4 .4 p e rc e n t), th e m e d ic in e w a s m o re fre q u e n tly p u rc h a s e d . D iffic u lty in c a rin g o u t m e d ic a l p re s c rip tio n s w a s d e n ie d in 3 2 2 ( 6 6 .4 p e rc e n t) p a tie n ts . T h e m a in c a u s e s o f re p o rte d d iffic u lty a re in T a b le I.
D r u g s - T h e n u m b e r o f th e m e d ic in e s fo r e a c h p re s c rip tio n ra n g e d fro m I to 8 ( 2 .8 :t 1 .5 ) . T h e c la s s e s o f d ru g s p re s c rib e d a re in T a b le II. T h e p re s c rib e d re g im e n s w e re to b e ta k e n o n c e a d a y fo r 7 2 9 ( 5 3 .1 p e rc e n t) d ru g s , tw ic e a d a y fo r 3 1 9 ( 2 3 .2 p e rc e n t), th re e o r m o re tim e s a d a y fo r 1 6 3 ( 1 1 .9p e rc e n t), a n d o th e r re g im e n s fo r 1 1 0 ( 8 .0
p e rc e n t), a n d in 5 2 (3 .8 p e rc e n t) it w a s u n k n o w n . T a b le 2
F re q u e n c y o f p re s c rib e d d ru g s
P h a rm a c o lo g ic a l g ro u p
D iu re tic
N o n c a rd io lo g ic d ru g s
D ig ita lic
P la te le t a tia g re g a n t
C a lc iu m c h a n e l b lo c k e rs
B e ta blockers
O th e r a n tih y p e rte n s iv e d ru g s
N itra te s
P o ta s s iu m re p la c e m e n t
In h ib ito rs o f A C E
O th e r a n tia rrh y tm ic a g e n ts
B e n z a th in e p e n ic illin
O ra l a n tic o a g u la n t
T o ta l
n : fre q u e n c y o f d ru g s
% : p e rc e n ta g e
A C E : a n g io te n s in -c o n v e rtin g e n z y m e n
356
1 8 4
1 6 4
1 2 5
96
90
7 4
7 3
5 8
5 7
4 5
3 4
1 7
1 ,3 7 3
%
2 5 .9
1 3 .4
1 1 .9
9 .1
7 .0
6 .6
5 .4
5 .3
4 .2
4 .2
3 .3
2 .5
1 .2
1 0 0 .0
p re s c rip tio n ra n g e d fro m 1 2 .5 to 1 0 0 p e rc e n t (m e a n 5 4 .7
p e rc e n t, s ta n d a rd d e v ia tio n 2 8 .3 p e rc e n t).
A fte r lo g -lin e a r re g re s s io n a n a ly s is , th e v a ria b le s w h ic h e x e rte d s ig n ific a n t in flu e n c e o n th e c o m p lia n c e
lo g (p /1 -p )= 1 .0 6 2 2 + 0 .4 1 6 0 N A M - 1 .1 3 0 7 D IF , w h e re
p : e x p e c te d p ro b a b ility
N A M : m e d ic in e s ' n a m e ; + 1 = ig n o re d
-1 = k n o w n
D IF : d iffic u lty ; + 1 = w ith o u t d iffic u lty ,
-1 = w ith d iffic u lty
w e re : th e re p o rte d d iffic u lty in ta k in g p re s c rib e d m e d ic in e s (P < O .O OI),a n d th e k n o w le d g e o f th e n a m e a t le a s t h a lf o f th e m e d ic in e s in u s e (P < O .O OI). T h e in te ra c tio n o f th e s e tw o v a ria b le s w a s n o t s ig n ific a n t.
T h e re p o rte d d i ffic u Ity in ta k i n g th e m e d ic a l p re s c rip tio n w a s m o re fre q u e n t in th e n o n c o m p lia n t g ro u p th a n in th e c o m p lia n t g ro u p . T h e re w a s a h ig h e r fre q u e n c y o f p a tie n ts w h o k n e w th e n a m e o f a t le a s t h a lf o f m e d ic i n e s in u s e in th e c o m p lia n t g ro u p , c o m p a re d to th e n o n c o m p lia n c e g ro u p (T a b le 3 ).
T h e c h a n c e o f n o n c o m p lia n c e is 9 3 .1 p e rc e n t w h e n th e p a tie n t ig n o re s th e n a m e o f a t le a s t h a lf o f m e d ic in e s in u s e a n d re p 0 l1 s d iffic u lty in ta k in g m e d ic a l p re s c rip tio n s . In c o n tra s t, th e p ro b a b ility is3 8 .1 p e rc e n t w h e n th e p a tie n t k n o w s th e n a m e o f m e d ic in e s a n d d o e s n o t re p o rt d iffic u lty . T h e o th e rs v a ria b le s : a g e ; s e x , d u ra tio n o f fo llo w u p , re s id e n c e ; m e a n s o f tra n s p o rt to c o m e to th e h o s p ita l; e d u c a tio n a l le v e l; p ro fe s s io n a l s ta tu s ; re a s o n fo r u n s c h e d u le d m e d ic a l v is it; m a in c a rd ia c d is e a s e ; th e fu n c tio n a l c la s s ; d u ra tio n o f m e d ic in e u s e ; n u m b e r o f d ru g s p re s c rib e d ; a s s is ta n c e fro m o th e rs in ta k in g m e d ic in e s ; a n d fre e a c q u is itio n o f th e d ru g d id n o t e x e rt in flu e n c e o n th e c o m p lia n c e (T a b le 3 ).
D IS C U S S IO N
R E S U L T S
N o n c o m p lia n c e o c c u rre d in2 8 6 p a tie n ts ( 5 9 p e rc e n t) a n d c o m p lia n c e in 1 9 9 ( 4 1 p e rc e n t) - (T a b le 3 ) . A m o n g th e n o n c o m p lia n t p a tie n ts , 1 9 6 ( 6 8 .5 p e rc e n t) to o k m e d ic in e s w ith e rro r a n d th e ra n g e o f e rro r o f e a c h m e d ic a l
T h e m e th o d w e u s e d fo r a s s e s s in g c o m p lia n c e w a s c h o s e n fo r its lo w c o s t a n d fe a s ib ility in ro u tin e c lin ic a l p ra c tic e .5
.x.1 4 U su ally , th e p atien ts are less co m p lian t th an s u g g e s te d b y th e in te rv ie w .x.'4 T h is m e th o d is a b le to id e n tify
2 5 to 5 0 p e rc e n t o f n o n c o m p lia n t p a tie n ts , a n d c o m p lia n c e m a y b e o v e re s tim a te d .I.'4 N o n c o m p lia n c e w a s id e n tifie d in 5 9 p e rc e n t o f o u r p a tie n ts ; a fin d in g th a t m a y b e a n u n d e re s tim a tio n . L o c a l c h a ra c te ris tic s o f th e h e a lth c a re
C H IZ Z O L A , P .R .; M A N S U R , A .J .; L U Z , P .L . & B E L L o n l, G . - C o m p lia n c e w ith p h a rm a c o lo g ic a l tre a tm e n t in o u tp a tie n ts fro m a B ra z ilia n c a rd io lo g y re fe rra l c e n te r
0 .8
0 .3 8 1
0 .1 9 0 .4 2 0 .1 8
p
0 .4 8 9 0 .1 5 7
0 .5 9 6
0 .1 1 5 0 .2 9 8
0 .4 4
0 .0 5 3
0 .1 0 3
0 .0 0 1
0 .0 6 6 1 4 .0
3 .2
(% )
5 9 .0
4 7 .9 5 2 .1
6 7 .8 3 2 .2 2 6 .2 7 3 .8 2 2 .0 6 1 .2 3 3 .9 3 6 .4 4 4 .1
5 5 .9 2 5 .5 2 8 .3 2 1 .7 1 6 .1 8 .4 4 3 .0
4 7 .9
9 .1
5 2 .4 4 7 .6 8 5 .7
1 4 .3 2 7 .6 7 2 .4 6 4 .7 3 5 .3
6 8 .9 3 1 .1 4 7 .6 4 9 .7
2 .7
n
94 percent of the studied
population w as In a
sim ilar functional class (II
II), as w as the outpatient population, and there w as
no significant difference
betw een frequency of
clinical and nonclinical
reasons for unscheduled
visits, and only halftheof
clinical reasons w ere
cardiovascular com
pli-cations. T hus, our results
m ight be useful for
planning educational
strategies for enhanced
com pliance in outpatient
clinics.
T he reported
difficulty In taking
m edicines exerted
influence on the
com pliance. T he m ain
reported difficulty w as
side effects of the drugs
(T able I). N oncom
-pliance is expected if
ad verse effects are
identified.s-7
.'s H ow ever,
in other study, one-third of patients w ho com
plai-ned of an adverse
sym ptom seldom had
their therapeutic
regim ens m odified.ls
T he cost of drugs is also
involved in noncom
-pliance.s-7
.16 T he cost of
prescriptions in the
noncom pliant group is
three tim es higher than in
< 0 .0 0 1 the com pliant group.
U sually, patients w ith
cardiac disease have the
m ost expensIve
prescriptions.7 In B razil,
the annual m edicine com sum ption per capita is U S $ 13,
and about 52 percent of population w as considered to be
out of the m arket. 17 A cquisition of drugs w as free to 65.6
percent of our patients. E ven so, in our observation, the
free drug dispensation did not influence com pliance.
2 8 6
1 6 0
7 3
8 1
62
4 6 2 4
1 2 3 1 3 7 1 4 9
1 9 4
92
7 5
2 1 1
63
1 7 5
9 7
1 0 4 1 2 6
1 3 7
26
1 5 0 1 3 6 2 4 5
4 1
7 9
2 0 7 1 8 5 1 0 1 1 9 7
89
1 3 6 1 4 2
8
5 4 .4
3 .8
Noncompliance
mean sd
1 5 .1
2 .9
(% )
4 1 .0
4 6 .7 5 3 .3
6 3 .8 3 6 .2 3 2 .7 6 7 .3 1 5 .1 6 7 .3 3 3 .7 3 0 .7 4 7 .2
5 2 .8 1 9 .6 3 2 .2 2 4 .1 1 3 .6 1 0 .6 4 7 .2
4 9 .2
3 .6
4 9 .7 5 0 .3 9 0 .5
9 .5 2 1 .1 7 8 .9 7 8 .9 2 1 .1 6 0 .8 3 9 .2
9 .5
9 0 .5 n
1 0 5
3 9 6 4 4 8
27
2 1 9 4 98 799
1 0 0 1 8 0
1 9 9
1 9
4 2
1 5 7 1 5 7
4 2
1 2 1
78
1 9
1 8 0 5 3 .4 3 .4
Compliance
mean sd
(ye a rs) (ye a rs)
II
III\IV
< 5 ye a rs > 5 ye a rs o n e to fo u r
m a le 9 3 fe m a le 1 0 6 S a o P a u lo 1 2 7 o th e r 7 2 p riva te 6 5 p u b lic 1 3 4 illite ra te 3 0 1 to 4 ye a rs 1 3 4 e m p lo ye d 6 7 re tire d /u n e m p lo ye d 6 1 clin ica l 9 4
n o n clin ica l h ip e rte n sio n co ro n a ry d ise a se va lvu la r d ise a se ca rd io m yo p a th ie s o th e rs
I
five o r m o re ye s
n o is kn o w n is n o t kn o w n fre e
p u rch a se d ye s n o
n o in fo rm a tio n
Table 3
Frequency of variables relative to compliance and noncompliance
Variables
R e sid e n ce
H e a rt d ise a se A g e
F o llo w u p
P ro fe ssio n a l S ta tu s R e a so n fo r V isit
N u m b e r o f d ru g s M e a n s o f T ra n sp o rt In stru ctio n T o ta l o f P a tie n ts
S e x
T im e o n d ru g F u n ctio n a l C la ss
sd : sta n d a rd d e via tio n ; n : n u m b e r o f p a tie n ts; % : p e rce n ta g e A ssista n ce
in ta kin g M e d icin e 's n a m e
A cq u isitio n
D ifficu lty
delivery system in the hospital, includes saturation of the
appointm ent system , w hich diverts patients w ith a variety
of m edical and nonm edical conditions to unscheduled visits.
In this context, w e should not assum e that unschedule visits
w ere associated w ith noncom pliance in our study. In fact,
1263
P a tie n ts w h o w e re n o t a b le to n a m e a t le a s t h a lf th e
d ru g s w e re m o re fre q u e n tly a s s o c ia te d w ith
n o n c o m p lia n c e . T o e n c o u ra g e c o m p lia n c e , a n e d u c a tio n a l
p ro g ra m s h o u ld c o v e r d ru g d is p e n s a tio n .7
•14 In th is c o n te x t,
in N ig e ria n p a tie n ts u n d e r tre a tm e n t fo r a rte ria l
h y p e rte n s io n , th e e c o n o m ic fa c to r w a s n o t th e m a jo r
lim ita tio n to th e c o n tro l o f b lo o d p re s s u re a fte r th e
e d u c a tio n a l p ro g ra m . IXN u rs e s v is its b e fo re o r a fte r m e d ic a l
c o n s u lta tio n a ls o e n h a n c e d c o m p lia n c e .4 W h e n p a tie n ts
u n d e rs to o d th e p u rp o s e o f th e tre a tm e n t a n d k n e w th e
n a m e s o f th e ir m e d ic a tio n s , c o m p lia n c e d w a s a ls o
o p tim iz e d .llJ A n o th e r re c o m m e n d a tio n to e n h a n c e c o m p lia n c e is to in c re a s e th e p a tie n t p a rtic ip a tio n in
m e d ic a l d e c is io n s .2 0
In o u r s tu d y , th e a g e , m e a n s o f tra n s p o rt, e d u c a tio n a l
le v e l, p ro fe s s io n a l s ta tu s , c a rd ia c d is e a s e , fu n c tio n a l
c la s s , a n d n u m b e r o f d ru g s p re s c rib e d d id n o t in flu e n c e
th e c o m p lia n c e . T h e re is n o a g re e m e n t o n th e re la tio n s h ip
b e tw e e n s o c io e c o n o m ic a n d e d u c a tio n a l le v e l in
c o m p lia n c e .5 .7.21 S e v e rity o f d is e a s e w a s n o t re la te d to
c o m p i ia n c e2 2 a n d , a c c o rd i n g to o th e r s tu d ie s , th e
fre q u e n c y o f e rro r in c re a s e d w ith th e n u m b e r o f d ru g s p re c ri b e d .5 -7 .2 1 .2 2
In a d d itio n to re p o rte d d iffic u lty in ta k in g m e d ic a tio n ,
th e s in g le v a ria b le h a v in g s ig n ific a n t in flu e n c e o n
c o m p lia n c e w a s th e k n o w le d g e o f th e n a m e o f th e d ru g .
E ffo rts in id e n tify in g n o n c o m p lia n t p a tie n ts s h o u ld in c lu d e
th e s e s p e c ific s q u e s tio n s .
In c o n c lu s io n , n o n c o m p lia n c e w ith m e d ic a l th e ra p y
w a s c o m m o n in th is s tu d ie d p o p u la tio n , in s p ite o f fre e
d ru g d is p e n s a tio n . R e p o rte d d iffic u lty in ta k in g p re s c rib e d
m e d ic in e s , a s w e ll a s th e in a b ility to id e n tify th e n a m e s o f
th e m e d ic in e s b y th e p a tie n t, w e re th e c lu e s to re v e a li'n g
n o n c o m p lia n c e . T h e s e d a ta m a y b e u s e fu l fo r
c o m p re h e n s iv e in te rv e n tio n a im e d a t im p ro v in g th e
a p p ro a c h to c o m p lia n c e a n d th e ra p e u tic s u c c e s s .
RESUlVIO
C o m 0 o b je liv o d e a v a lia r a a d e re n c ia a o tra ta m e n to m e d ic a m e n lo s o e m h o s p ita l v o lta d o p a ra 0 a te n d im e n to c a rd io l6 g ic o . fo ra m e s tu d a d o s 4 8 5 d o e n te s . 2 3 0 (4 7 .4 % ) h o m e n s e 2 5 5 (5 2 .6 % ) m u lh e re s . A s id a d e s v a ria ra m d e 1 7 a 8 6 (5 4 + 1 5 ) a n o s . F o ra m a n a lis a d o s a c a rd io p a tia . fa lo re s s o c io e c o n o m ic o s (re s id e n c ia , m e io d e tra n s p o rle . n iv e l e d u c a c io n a l, c o n d ic ;;a o p ro fis s io n a l), d ro g a s p re s c rita s , d ific u ld a d e e m to m a r a m e d ic a 9 a o , o b te n c ;;a o d o m e d ic a m e n to . e c o n h e c im e n to s o b re 0 m e d ic a m e n to . A a d e re n c ia s e fu n d a m e n to u n a re p o s ta d o p a c ie n te , q u e e ra c o m p a ra d a c o m a re c e ita e c o m a s n o ta s d a e v o lu c ;;a o c lfn ic a . F o i c o n s id e ra d o e rro q u a n d o 0p a c ie n te u s a v a a m e d ic a < ;:a od e m o d o d ife re n te d o p re s c rito . F o i c o n s id e ra d a a d e re n c ia q u a n d o 0 p a c ie n te in fo rm a v a to m a r a m e d ic a c ;;a o c o rre ta m e n to . s e m in te rru p c ;;a o e s e m e rro . A s v a ria v e is c o m d is trib u i9 a o d ife re n te n a a n a lis e u n iv a ria d a fo ra m e x a m in a d a s c o m a n a lis e m u ltiv a ria d a (re g re s s a o lo g -lin e a r). A fa lta d e a d e re n c ia a o tra ta m e n to o c o rre u e m 2 8 6 (5 9 % ) p a c ie n te s . a s fa to re s p re d ito re s d e n a o a d e re n c ia lo ra m in lo rm a < ;:a o d e d ific u ld a d e e m to m a r a m e d ic a 9 a o (p <0 .0 0 1 ) e d e s c o n h e c im e n to d o n o m e d a m e d ic a 9 a o (p < 0 .0 0 1 ). P o rla n to . a fa lta d e a d e re n c ia a o tra ta m e n to m e d ic a m e n to s o lo i fre q u e n le . a s p rin c ip a is p re d ito re s , in fo rm a c ;;a od e d ilic u ld a d e e m to m a r a m e d ic a c ;;a o , e d e s c o n h e c im e n to d o n o m e d a m e d ic a c ;;a o . p o d e m s e r o b tid o s c o m fa c ilid a d e n a p ra tic a m e d ic a .
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