Reinternação e adesão ao tratamento de pacientes com insuficiência cardíaca após orientação de alta e contato telefônico de enfermagem

• Ano de defesa: 2017
• Autor(a) principal: Oscalices, Monica Isabelle Lopes [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Heart failure; Education; Clinical trial; Nursing; Emergency nursing; Patient discharging; Insuficiência cardíaca; Educação; Ensaio clínico; Enfermagem; Enfermagem em emergência; Alta do paciente
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5666756; http://repositorio.unifesp.br/handle/11600/50439

Adherence to treatment is a challenge for patients with chronic diseases, mainly heart failure, because most patients do not recognize the signs and symptoms, end up not participating or adhere properly to the treatment. The knowledge of Heath Literacy in patients with heart failure is shown as an important tool about the complexity of the disease’s treatment, and can be improved through health education. Telephone follow-up is an extension of the discharge orientation and is considered an important tool in nursing education, which has proved to be effective in increasing adherence to the treatment of patients with heart failure, but its efficacy is not widely evaluated studied. Objectives: To compare the effectiveness of the nursing intervention in adherence to treatment, rehospitalization and mortality in patients with heart failure, and to associate the level of Heath Literacy with drug adherence, barriers to nonadherence, and rehospitalization and mortality rates of these patients. Methods: A randomized, non-blinding clinical study included 201 patients admitted to the emergency room with a diagnosis of heart failure. On discharge, patients were divided into Control Group and Intervention Group, with specific Intervention Group discharge orientation and, after 90 days, treatment adherence was evaluated through the Morisky-Green, Brief Medical Questionnaire and non-drug adherence tests. In Intervention Group, the Heath Literacy level was evaluated through the Newest Vital Sign test, and contacts were made for reorientation by telephone calls at two moments. The generalized estimating equation model (p<0.05%) was used for statistical analysis. Results: 101 patients were allocated to Control Group and 100 to Intervention Group, with a mean age of 62.6±15.2. After 90 days, Intervention Group showed greater adherence to the treatment in relation to the Control Group (p<0.001). There was a higher incidence of readmissions and death in the Control Group when purchased from the Intervention Group (p<0.01). Patients with low Heath Literacy had worse drug adherence and presence of more barriers to adherence, in addition to a higher incidence of rehospitalization and death. Conclusions: High-quality follow-up with telephone follow-up resulted in greater adherence to treatment, reduction of rehospitalizations and deaths, consideration should be given to assessing patients' Heath Literacy to direct effective health education at each level, considering that low Heath Literacy has worse outcomes, bringing the importance of the interventions performed in the adherence and mortality of patients.