Intervenção educativa pró-adesão farmacológica em pacientes com leucemia mielóide crônica tratados com mesilato de imatinibe em Goiânia Goiás

• Autor(a) principal: Barbosa, Adriana do Prado
• Data de Publicação: 2015
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UFG
• Texto Completo: http://repositorio.bc.ufg.br/tede/handle/tede/4768
• topic: Educação de pacientes como assunto; Leucemia mielóide crônica BCRABL positiva; Adesão a medicação; Resultado do tratamento; Pacient education as topic; Chronic myeloid leukemia BCR-ABL positive; Medication adherence; treatment outcome; MEDICINA::ANATOMIA PATOLOGICA E PATOLOGIA CLINICA

The treatment of chronic myeloid leukemia (CML) has changed dramatically with the advent of imatinib mesylate (IM). Besides the convenience of oral use, other benefits were achieved with the new drug, with faster therapeutic responses and increased survival, giving the CML similar characteristics as chronic diseases. In this scenario, there was another challenge, drug compliance, since a significant proportion of patients fail to ingest all the prescribed doses of imatinib. The concern was to optimize the adherence of CML patients, the hematology ambulatory at the Clinical Hospital of the Federal University of Goias (HC-UFG), led the authoress to create a film cartoon, as a pro-adhesion educational intervention model. To investigate the effectiveness of this new educational material, we used in 65 patients three adherence measures, two indirect (Morisky Test and Molecular Response [MR]) and direct (plasma dosage of IM), before and after the screening of film. In univariate analysis, from the Morisky Test, the film was striking, with increased adherent patients, which increased from 15 (23.1%) to 43 (66.1%). The results of MR showed an improvement trend after the movie, because the positive molecular response (major MR or complete MR) increased from 81.5% to 86.1%. Regarding the serum levels of IM, with daily doses of 400-800 mg IM, the premovie samples showed higher average than the post-movie (2473.16 ± 1049.55 ng/ml versus 1414.72 ± 715 73 ng/ml), with a variation coefficients interpatients of 43.4% and 50.6%, respectively. This high dispersion index found has been reported by other authors. By multivariate analysis, patients were divided into three groups. The first brought together compliant patients before and after the film with a good therapeutic response (major MR) after the intervention. It was: patients over 53 years old, females, with associated diseases before and after the treatment of CML that use more than two drugs in addition to imatinib. The second group was marked by the change of not adherence pre to adherence post-film. Its features were younger than or equal to 53, the absence of other disease before the CML, the use of less than two drugs and complete molecular response after the film. In the third group, we observed patients without molecular response before and after the educational intervention and no medication adherence after the film. They had in common their age (less than or equal to 53 years), and drug discontinuation due to adverse reactions. The last represents the set of patients resistant to the educational film, drawing attention to the fact that only one pro-adhesion method may be insufficient for all individuals. It is concluded that medication adherence was higher among patients older than 53 years, the educational film is an effective proadhesion assistance and continuing education, if combined with another method, it could help maintain or enhance the benefits achieved in this work.