Conhecimento sobre hipertensão arterial e fatores associados à não adesão à farmacoterapia

OBJECTIVES: to identify the degree of knowledge of people with hypertension concerning the disease and to verify the factors associated with the non-adherence to anti-hypertensive drug therapy. METHOD: Cross sectional study, involving 422 people. Data collection took place at their homes, between December 2011 and March 2012, through interviews using the following instruments: Medication Adherence Questionnaire (MAQ-Q), Medication Regimen Complexity Index (MRCI) and a guide with questions related to sociodemographic profile, satisfaction with healthcare service and knowledge about the disease. RESULTS: 42.6% did not adhere to the drug therapy and 17.7% had poor knowledge about the disease. Factors associated with the non-adherence were: complex drug therapy, poor knowledge about the disease and dissatisfaction with the healthcare service. CONCLUSION: The findings reinforce that the complex drug therapy prescriptions, little knowledge about the disease and dissatisfaction with the healthcare service have influence on the process of non-adherence to anti-hypertensive drug therapy.OBJETIVOS: identificar el nivel de conocimiento de personas con hipertensión arterial acerca de la enfermedad y verificar los factores asociados a la no adhesión a la farmacoterapia antihipertensiva. MÉTODO: estudio transversal realizado en 422 individuos. Los datos fueron recolectados en los domicilios, entre diciembre de 2011 y marzo de 2012, por medio de entrevistas utilizando los instrumentos: Cuestionario de Adhesión a Medicamentos (CAM-Q), Índice de Complejidad de la Farmacoterapia y un guión con preguntas relativas al perfil sociodemográfico, satisfacción con el servicio de salud y conocimiento sobre la enfermedad. RESULTADOS: 42,6% no adherían a la farmacoterapia y 17,7% poseían conocimiento insatisfactorio sobre la enfermedad. Los factores asociados a la no adhesión fueron: farmacoterapia compleja, conocimiento insatisfactorio sobre la enfermedad e insatisfacción con el servicio de salud. CONCLUSIÓN: Los hallazgos refuerzan que prescripciones farmacológicas complejas, poco conocimiento sobre la enfermedad e insatisfacción con el servicio de salud influyen en el proceso de la no adhesión al tratamiento medicamentoso antihipertensivo.OBJETIVOS: identificar o nível de conhecimento de pessoas com hipertensão arterial acerca da doença e verificar os fatores associados à não adesão à farmacoterapia anti-hipertensiva. MÉTODO: estudo transversal, realizado com 422 indivíduos. Os dados foram coletados nos domicílios, entre dezembro de 2011 e março de 2012, por meio de entrevistas, utilizando os instrumentos: Questionário de Adesão a Medicamentos, Índice de Complexidade da Farmacoterapia e um roteiro com questões relativas ao perfil sociodemográfico, satisfação com o serviço de saúde e conhecimento sobre a doença. RESULTADOS: 42,6% não aderiram à farmacoterapia e 17,7% possuíam conhecimento insatisfatório sobre a doença. Os fatores associados à não adesão foram: farmacoterapia complexa, conhecimento insatisfatório sobre a doença e insatisfação com o serviço de saúde. CONCLUSÃO: os achados reforçam que prescrições farmacológicas complexas, pouco conhecimento sobre a doença e insatisfação com o serviço de saúde influenciam no processo de não adesão ao tratamento medicamentoso anti-hipertensivo

Multinational development and validation of an early prediction model for delirium in ICU patients

Rationale Delirium incidence in intensive care unit (ICU) patients is high and associated with poor outcome. Identification of high-risk patients may facilitate its prevention. Purpose To develop and validate a model based on data available at ICU admission to predict delirium development during a patient’s complete ICU stay and to determine the predictive value of this model in relation to the time of delirium development. Methods Prospective cohort study in 13 ICUs from seven countries. Multiple logistic regression analysis was used to develop the early prediction (E-PRE-DELIRIC) model on data of the first two-thirds and validated on data of the last one-third of the patients from every participating ICU. Results In total, 2914 patients were included. Delirium incidence was 23.6 %. The E-PRE-DELIRIC model consists of nine predictors assessed at ICU admission: age, history of cognitive impairment, history of alcohol abuse, blood urea nitrogen, admission category, urgent admission, mean arterial blood pressure, use of corticosteroids, and respiratory failure. The area under the receiver operating characteristic curve (AUROC) was 0.76 [95 % confidence interval (CI) 0.73–0.77] in the development dataset and 0.75 (95 % CI 0.71–0.79) in the validation dataset. The model was well calibrated. AUROC increased from 0.70 (95 % CI 0.67–0.74), for delirium that developed 6 days. Conclusion Patients’ delirium risk for the complete ICU length of stay can be predicted at admission using the E-PRE-DELIRIC model, allowing early preventive interventions aimed to reduce incidence and severity of ICU delirium