Intervenção para promover a adesão medicamentosa em pacientes com doença arterial coronária
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".