Adesão ao tratamento da constipação intestinal crônica funcional em crianças atendidas em ambulatório de referência

• Ano de defesa: 2012
• Autor(a) principal: Silvia Aparecida Steiner
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; UFMG
• Palavras-chave em Português: Adesão ao tratamento; Constipação intestinal crônica; Criança; Terapêutica; Monitorização ambulatorial; Constipação intestinal/terapia; Adesão à medicação; Constipação; Assistência integral à saúde; Estudos de coortes; Cooperação do paciente; Epidemiologia descritiva; Adolescente; Pediatria
• Link de acesso: http://hdl.handle.net/1843/BUOS-93EM5Y

The aim of this study is to evaluate pediatric patient adherence to Chronic Functional Constipation treatment and factors related to it. Constipated patients were followed for 6 months. Data were collected from August 2009 to October 2011 at the Pediatric Gastroenterology Outpatient Clinic, Federal University of Minas Gerais, Brazil, after institutional Ethics Committee approval. Roma III Criteria were employed to define intestinal constipation, and Bristol scale for faecal characterization.The criterion used to consider the child as compliant with the treatment was the use of more than 75% of the medication, assessed by the return of empty vials /envelopes of the drug in use, based on the prescription of the last visit. Drugs were prescribed according to clinical criteria and Outpatient Clinic protocols. Medicines employed were polyethylene glycol, magnesium hydroxide, mineral oil, and Psyllium husk (natural soluble fiber). Analyzed variables were: related to the patient, caretaker, disease, therapeutic schema, and health care system. After informed consent, a structured questionnaire, with the study response variable (adherence) and independent variables, was completed at the first and sixth months of treatment. Data analysis was performed through SPSS version 15. The sample consisted of 50 children, that participated in the two study times. The mean age at admission was 77,6 ± 43,8 months and the mean age at onset of constipation symptoms was 18,8 ± 27,9 months. The treatment adherence rate was 38% in the first follow-up month and 30% at the sixth month. There was no adherence influence from sex, age, mother´s education level, previous laxatives use, emotional problems, socio-economic status, illness severity (faecal incontinence, blood stained stools, abdominal pain), and medicine administration by other caretaker (besides parents), in any study time, with no statistical significance (p>0,05). Patients that used polyethylene glycol presented more treatment adherence than those who received other prescribed medicines, with statistical significance only at the second study time (p=0,19 in the first time, and p=0,04 in the second time). This study showed poor adherence to constipation treatment in children. Health professionals may be aware of this, especially in patients that do not respond to treatment. Knowledge of adherence rate and measure methods are still a challenge in the literature however, when carefully and individually analyzed, they may provide valuable information about the failure pattern. There is a need to pursue new strategies to increase treatment adherence in chronic diseases and specially intestinal constipation in children, avoiding complications, as well as public and family resource expenditure.