Intervenção para promover a adesão medicamentosa em pacientes com doença arterial coronária
Notice bibliographique
Résumé
A variety of interventions, including those based on theory, has been tested to optimize the determinants of adherence behavior to drug intake, such as intention.The objective of this study was to evaluate the potential of efficacy, viability and acceptability of a nursing intervention in the activation of intention to promote adherence behavior to cardioprotective drugs in patients with ACS, followed in the basic health care.The intervention was delineated based on Sidani and Braden, according to the theoretical, empirical and experiential approaches and was divided into two stages.The first stage consisted of the experiential approach, which involved the participation of patients with ACS and nurses with expertise in the care of patients with ACS, of the basic health network.The preference evaluation technique was used to perform two groups: one with the patients and the other with the nurses, in order to identify the perception of both on the mode of application and dose of the strategy.The intervention strategy consisted in drawing up action plans and coping with barriers to adherence to cardioprotective drugs.The groups were recorded, transcribed in full and established major themes related to the adequacy of the intervention.A second researcher with experience in qualitative analysis of the data determined the agreement between them and the meanings found.In the second stage of the research, a pilot study was conducted with 45 patients with coronary disease, through three meetings to test the effectiveness potential, viability and acceptability of the intervention according to the mode of application and dose established in the experiential approach.In the first approach (T0), consent to participate in the study was obtained and sociodemographic and clinical characterization data were collected, measures of intention, adherence to cardioprotective drugs, blood pressure (BP) and peripheral pulse rate measurements (PPR), as well as blood sample collection for evaluation of the lipid profile.In T30 (thirty days after T0), the patients were submitted to the intervention that consisted in the elaboration of the action plans and the confrontation of barriers built together with the researcher.At T60 (30 days after T30), the measurements collected in T0 were repeated and a debriefing was performed with the participants to assess acceptability.To measure drug adherence, the Global Evaluation of Medication Adherence Instrument (GEMA) was used and the intention was evaluated by the Instrument of measurement of factors determining drug adherence.Feasibility was assessed by the number of invited participants who showed an interest in participating, number of eligible and non-eligible recruits and reasons for ineligibility, number of eligible participants who gave up and reasons for withdrawal, plus time spent on intervention.The data were submitted to descriptive statistical analysis, qualitative and Wilcoxon test paired to compare the measures adherence, BP, PPR and subfractions of the lipid profile.The results of the stage of the experiential approach suggest the use of the written and verbal form for the elaboration of action plans and barriers for the use of cardioprotective drugs, with a duration of approximately 30 minutes.It was also suggested a face-to-face reinforcement in the basic health unit in a thirty-day interval.In the second stage of the study, individuals enrolled for research presented a positive intention (4.9) and the potential of the intention activation strategy was verified, since only 13.3% of the participants were adherent to cardioprotective drugs at T0 and after the implementation of the intervention this percentage was to 75.6% in T60 (p-value <0.001).In addition, a reduction in systolic blood pressure was observed (difference of SBP between T60 -T0:-9.1 mmHg, p-value<0.001)and diastolic (DBP difference between T60 -T0: -8.6 mmHg, p<0.001),FPP (difference of FPP between T60 -T0: -6.6bpm, p-value <0.001) and LDLc (LDLc difference between T60 -T0: -6.2mg / dl, p-value <0.05 ) in T60 when compared to the values measured in the first meeting (T30).The findings point to feasibility of the intervention once all the patients have completed all the steps and the acceptability was proven by the patients' perception as an intervention of easy application and by their interest in maintaining the strategy even after the end of the research.This study makes available to the scientific community an intervention with evidence of potential for efficacy, high viability and acceptability, and contributes to the decision-making of health professionals about the care of the patient with chronic diseases, specifically regarding.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,012 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».