La discapacidad como barrera a la adherencia terapéutica en pacientes pluripatológicos: papel del cuidador principal / Disability as a barrier to drug adherence in polypathological patients: role of main carer

ObjetivoEstablecer los factores predictores de adherencia a la medicación en pacientes pluripatológicos polimedicados.Material y métodosEstudio transversal realizado en el área de un centro de salud dependiente de un hospital universitario. Entre marzo de 2003 y marzo de 2005 se reclutaron 265 pacientes pluripatológicos polimedicados, excluyéndose 84 pacientes por datos incompletos, no aceptar participar o exitus antes de la finalización del estudio. Investigadores diferentes de los médicos responsables encuestaron a los pacientes, estableciéndose la adherencia a la medicación por un método subjetivo mediante encuesta estructurada.ResultadosEl grado de discapacidad fue el factor determinante de adherencia. En pacientes sin cuidador e índices de Barthel inferiores a 100 la adherencia fue muy escasa y dependiente del número de fármacos. Sin embargo, en presencia de un cuidador permanente y dependencia severa el porcentaje de pacientes cumplidores fue muy superior al de los menos discapacitados e incluso que los no discapacitados, e independiente del número de fármacos.ConclusionesEn pacientes pluripatológicos polimedicados, el soporte de un cuidador puede permitir superar la barrera que supone la discapacidad para la adherencia terapéutica, obteniendo mejor adherencia que en pacientes teóricamente no dependientes. Este hecho puede ayudar a diseñar futuros estudios prospectivos sobre adherencia en esta población particularmente frágil(AU)

ObjectivesTo determine which social and individual factors may predict adherence to medication in patients with more than two chronic symptomatic diseases (polypathological patients) under polypharmacy.MethodsCross-sectional observational study. In a primary care area assigned to our teaching hospital 265 patients with multiple chronic diseases and polypharmacy were recruited over a 6 month period. 84 patients with uncompleted data or died before finishing our study were excluded.MethodsAn structured interview performed by a investigator different from responsible physicians was used.MethodsDrug adherence was assessed by a subjective method.ResultsDisability measured by Barthel index was was the main predictor of drug adherence.ResultsPatients without carer support and Barthel Index lower than 100 showed the poorer drugResultsadherence. In the later group number of drugs also affected adherence. However, in patients with carer available, medication adherence was better, mostly in more disabled ones, and unaffected by other factors.ConclusionsIn patients with multiple chronic diseases, social support by a carer may allow disabled patients to overcome the barrier of disability leading to a better drug adherence, even than non-disabled ones. These findings may help to design future prospective studies on medication adherence performed in this peculiar frail population(AU)

[Disability as a barrier to drug adherence in polypathological patients: role of main carer]. / La discapacidad como barrera a la adherencia terapéutica en pacientes pluripatológicos: papel del cuidador principal.

OBJECTIVES: To determine which social and individual factors may predict adherence to medication in patients with more than two chronic symptomatic diseases (polypathological patients) under polypharmacy. METHODS: Cross-sectional observational study. In a primary care area assigned to our teaching hospital 265 patients with multiple chronic diseases and polypharmacy were recruited over a 6 month period. 84 patients with uncompleted data or died before finishing our study were excluded. An structured interview performed by a investigator different from responsible physicians was used. Drug adherence was assessed by a subjective method. RESULTS: Disability measured by Barthel index was was the main predictor of drug adherence. Patients without carer support and Barthel Index lower than 100 showed the poorer drug adherence. In the later group number of drugs also affected adherence. However, in patients with carer available, medication adherence was better, mostly in more disabled ones, and unaffected by other factors. CONCLUSIONS: In patients with multiple chronic diseases, social support by a carer may allow disabled patients to overcome the barrier of disability leading to a better drug adherence, even than non-disabled ones. These findings may help to design future prospective studies on medication adherence performed in this peculiar frail population.