Joselita Maria Magalhães Caraciolo

Assessing patient adherence to chronic diseases treatment: differentiating between epidemiological and clinical approaches

This review discusses the concepts and methods for assessing patient adherence to treatment, as applied to both epidemiological and clinical approaches within real health care practices. For the epidemiological approach, the assessment must be as accurate as possible. Self-reported questionnaires are the most feasible option in most circumstances, but most demonstrate low sensitivity combined with high specificity. We suggest that self-reported outcomes, where feasible, can increase the sensitivity for non-adherence of these questionnaires. In the clinical approach an accurate distinction between adherents and non-adherents is less useful. For the health provider, it is more important to be aware of the particular situation that each patient is currently experiencing with his/her treatment. Self-reported questionnaires applied in clinical settings can help the health provider to form an objective opinion. In any event, the patient-provider dialogue is still the best approach to assess patient adherence as well as to deliver good care.

Avaliação de serviços de assistência ambulatorial em aids, Brasil: estudo comparativo 2001/2007

OBJETIVO: Avaliar os servicos do Sistema Unico de Saude brasileiro de assistencia ambulatorial a adultos vivendo com aids em 2007 e comparar com a avaliacao de 2001. METODOS: Os 636 servicos cadastrados no Ministerio da Saude em 2007 foram convidados a responder a um questionario previamente validado (Questionario Qualiaids) com 107 questoes de multipla escolha sobre a organizacao da assistencia prestada. Analisaram-se as frequencias das respostas de 2007 comparando-as com as obtidas em 2001 na forma de variacao percentual (VP). RESULTADOS: Responderam o questionario 504 (79,2%) servicos. Cerca de 100,0% dos respondentes relataram ter pelo menos um medico, suprimento sem falhas de antirretrovirais e de exames CD4 e carga viral. Varios aspectos mostraram melhor desempenho em 2007 comparados a 2001: registro de numero de faltas a consulta medica (de 18,3 para 27,0%, VP: 47,5%), agendamento de consulta em menos de 15 dias no inicio da terapia antirretroviral (de 55,3 para 66,2%, VP: 19,7%) e participacao organizada do usuario (de 5,9 para 16,7%, VP: 183,1%). Houve manutencao de dificuldades: pequena variacao na disponibilidade de exames especializados em ate 15 dias, como endoscopia (31,9 para 34,5%, VP: 8,1%), e a piora de indicadores como tempo ideal de acesso a consultas especializadas (55,9 para 34,5% em cardiologia, VP negativa de 38,3%). O tempo medio despendido nas consultas medicas de seguimento manteve-se baixo: 15 minutos ou menos (52,5 para 49,5%, VP negativa de 5,8%). CONCLUSOES: A avaliacao de 2007 mostrou que os servicos contam com os recursos essenciais para a assistencia ambulatorial. Houve melhoras em muitos aspectos em relacao a 2001, mas persistem desafios. Pouco tempo dedicado a consulta medica pode estar vinculado ao numero insuficiente de medicos e/ou a baixa capacidade de escuta e dialogo. A acessibilidade prejudicada a consultas especializadas mostra a dificuldade das infraestruturas locais do Sistema Unico de Saude.OBJECTIVE To assess Brazilian Unified Health System outpatient services delivering care to adults living with AIDS in 2007 and to compare with the assessment conducted in 2001. METHODS The 636 health services registered in the Ministry of Health in 2007 were invited to respond to a previously validated questionnaire (Qualiaids Questionnaire) with 107 multiple-choice questions about the organization of care delivery. It analyzed the frequencies of responses to the 2007 questionnaire compared with those found in that of 2001 through percent variation (PV). RESULTS 504 (79.2%) of the services responded to the questionnaire. Almost 100.0% of the respondents reported having essential resources for outpatient care: having at least one doctor, sufficient supplies of antiretroviral drugs, CD4 and viral load tests. Many aspects displayed improvement in 2007 compared to 2001: registry of missed medical appointments (from 18.3 to 27.0%, PV: 47.5%), follow-up appointment within 15 days of starting antiretroviral treatment (from 55.3 to 66.2%, PV: 19.7%) and users organized participation (from 5.9 to 16.7%, PV: 183.1%). However, some difficulties remained: little change in the availability of specialized exams, such as endoscopy, within 15 days, (31.9 to 34.5%, PV: 8.1%) and decreases in indicators such as optimal time access to specialized appointments (55.9 to 34.5% in cardiology, negative PV: 38.3%). Mean time spent in follow-up medical appointments remained low: about 15 minutes (52.5 to 49.5%, negative PV: 5.8%). CONCLUSIONS The 2007 assessment revealed that services have essential resources for ambulatory assistance. There was some improvement in many aspects compared to 2001, although some challenges still remain. Little time dedicated to medical appointments may be linked to insufficient number of doctors and/or due to reduced capacity of listening and dialogue. Impaired access to specialized appointments reveals the difficulty local Brazilian Unified Health System facilities have regarding infrastructure.

Atividades para melhoria da adesão à TARV em serviços de saúde do SUS no estado de São Paulo, 2007

Abstract The success of antiretroviral therapy for AIDS treat-ment depends on the maintenance of high rates of adherence to drug therapy. Despite the emphasis given to the question by the Brazilian STD / AIDS Program, the adherence technologies that are in course on ou-tpatient services are not known. Based on the analysis of a semi-structured questionnaire distributed to all outpatient services of the State of Sao Paulo, this study describes the types of interventions that have been implemented. In the State of Sao Paulo, adherence to HAART is incorporated into the activities of outpatient services. Almost all services inform interventions administered to individuals, and the majority, at least one group intervention to improve adherence. However, in many outpatient services, adherence interventions, as well as the assessment of patient’s adherence, take place during nursing and medical consultations. This indicates that the adherence technology approach consists predominantly of questioning and discussions with the patient, meaning that the professionals decide when and how they address adherence. The larger and more specialized services tend to have more qualified and more specific activities.Keywords: Acquired Immunodeficiency Syndrome; Patient Compliance; Health Services Research; Anti-retroviral Therapy, Highly Active.

Assessment of outpatient services for AIDS patients, Brazil: comparative study 2001/2007

OBJETIVO: Avaliar os servicos do Sistema Unico de Saude brasileiro de assistencia ambulatorial a adultos vivendo com aids em 2007 e comparar com a avaliacao de 2001. METODOS: Os 636 servicos cadastrados no Ministerio da Saude em 2007 foram convidados a responder a um questionario previamente validado (Questionario Qualiaids) com 107 questoes de multipla escolha sobre a organizacao da assistencia prestada. Analisaram-se as frequencias das respostas de 2007 comparando-as com as obtidas em 2001 na forma de variacao percentual (VP). RESULTADOS: Responderam o questionario 504 (79,2%) servicos. Cerca de 100,0% dos respondentes relataram ter pelo menos um medico, suprimento sem falhas de antirretrovirais e de exames CD4 e carga viral. Varios aspectos mostraram melhor desempenho em 2007 comparados a 2001: registro de numero de faltas a consulta medica (de 18,3 para 27,0%, VP: 47,5%), agendamento de consulta em menos de 15 dias no inicio da terapia antirretroviral (de 55,3 para 66,2%, VP: 19,7%) e participacao organizada do usuario (de 5,9 para 16,7%, VP: 183,1%). Houve manutencao de dificuldades: pequena variacao na disponibilidade de exames especializados em ate 15 dias, como endoscopia (31,9 para 34,5%, VP: 8,1%), e a piora de indicadores como tempo ideal de acesso a consultas especializadas (55,9 para 34,5% em cardiologia, VP negativa de 38,3%). O tempo medio despendido nas consultas medicas de seguimento manteve-se baixo: 15 minutos ou menos (52,5 para 49,5%, VP negativa de 5,8%). CONCLUSOES: A avaliacao de 2007 mostrou que os servicos contam com os recursos essenciais para a assistencia ambulatorial. Houve melhoras em muitos aspectos em relacao a 2001, mas persistem desafios. Pouco tempo dedicado a consulta medica pode estar vinculado ao numero insuficiente de medicos e/ou a baixa capacidade de escuta e dialogo. A acessibilidade prejudicada a consultas especializadas mostra a dificuldade das infraestruturas locais do Sistema Unico de Saude.OBJECTIVE To assess Brazilian Unified Health System outpatient services delivering care to adults living with AIDS in 2007 and to compare with the assessment conducted in 2001. METHODS The 636 health services registered in the Ministry of Health in 2007 were invited to respond to a previously validated questionnaire (Qualiaids Questionnaire) with 107 multiple-choice questions about the organization of care delivery. It analyzed the frequencies of responses to the 2007 questionnaire compared with those found in that of 2001 through percent variation (PV). RESULTS 504 (79.2%) of the services responded to the questionnaire. Almost 100.0% of the respondents reported having essential resources for outpatient care: having at least one doctor, sufficient supplies of antiretroviral drugs, CD4 and viral load tests. Many aspects displayed improvement in 2007 compared to 2001: registry of missed medical appointments (from 18.3 to 27.0%, PV: 47.5%), follow-up appointment within 15 days of starting antiretroviral treatment (from 55.3 to 66.2%, PV: 19.7%) and users organized participation (from 5.9 to 16.7%, PV: 183.1%). However, some difficulties remained: little change in the availability of specialized exams, such as endoscopy, within 15 days, (31.9 to 34.5%, PV: 8.1%) and decreases in indicators such as optimal time access to specialized appointments (55.9 to 34.5% in cardiology, negative PV: 38.3%). Mean time spent in follow-up medical appointments remained low: about 15 minutes (52.5 to 49.5%, negative PV: 5.8%). CONCLUSIONS The 2007 assessment revealed that services have essential resources for ambulatory assistance. There was some improvement in many aspects compared to 2001, although some challenges still remain. Little time dedicated to medical appointments may be linked to insufficient number of doctors and/or due to reduced capacity of listening and dialogue. Impaired access to specialized appointments reveals the difficulty local Brazilian Unified Health System facilities have regarding infrastructure.

Evaluación de servicios de asistencia ambulatoria en sida, Brasil: estudio comparativo 2001/2007

OBJETIVO: Avaliar os servicos do Sistema Unico de Saude brasileiro de assistencia ambulatorial a adultos vivendo com aids em 2007 e comparar com a avaliacao de 2001. METODOS: Os 636 servicos cadastrados no Ministerio da Saude em 2007 foram convidados a responder a um questionario previamente validado (Questionario Qualiaids) com 107 questoes de multipla escolha sobre a organizacao da assistencia prestada. Analisaram-se as frequencias das respostas de 2007 comparando-as com as obtidas em 2001 na forma de variacao percentual (VP). RESULTADOS: Responderam o questionario 504 (79,2%) servicos. Cerca de 100,0% dos respondentes relataram ter pelo menos um medico, suprimento sem falhas de antirretrovirais e de exames CD4 e carga viral. Varios aspectos mostraram melhor desempenho em 2007 comparados a 2001: registro de numero de faltas a consulta medica (de 18,3 para 27,0%, VP: 47,5%), agendamento de consulta em menos de 15 dias no inicio da terapia antirretroviral (de 55,3 para 66,2%, VP: 19,7%) e participacao organizada do usuario (de 5,9 para 16,7%, VP: 183,1%). Houve manutencao de dificuldades: pequena variacao na disponibilidade de exames especializados em ate 15 dias, como endoscopia (31,9 para 34,5%, VP: 8,1%), e a piora de indicadores como tempo ideal de acesso a consultas especializadas (55,9 para 34,5% em cardiologia, VP negativa de 38,3%). O tempo medio despendido nas consultas medicas de seguimento manteve-se baixo: 15 minutos ou menos (52,5 para 49,5%, VP negativa de 5,8%). CONCLUSOES: A avaliacao de 2007 mostrou que os servicos contam com os recursos essenciais para a assistencia ambulatorial. Houve melhoras em muitos aspectos em relacao a 2001, mas persistem desafios. Pouco tempo dedicado a consulta medica pode estar vinculado ao numero insuficiente de medicos e/ou a baixa capacidade de escuta e dialogo. A acessibilidade prejudicada a consultas especializadas mostra a dificuldade das infraestruturas locais do Sistema Unico de Saude.OBJECTIVE To assess Brazilian Unified Health System outpatient services delivering care to adults living with AIDS in 2007 and to compare with the assessment conducted in 2001. METHODS The 636 health services registered in the Ministry of Health in 2007 were invited to respond to a previously validated questionnaire (Qualiaids Questionnaire) with 107 multiple-choice questions about the organization of care delivery. It analyzed the frequencies of responses to the 2007 questionnaire compared with those found in that of 2001 through percent variation (PV). RESULTS 504 (79.2%) of the services responded to the questionnaire. Almost 100.0% of the respondents reported having essential resources for outpatient care: having at least one doctor, sufficient supplies of antiretroviral drugs, CD4 and viral load tests. Many aspects displayed improvement in 2007 compared to 2001: registry of missed medical appointments (from 18.3 to 27.0%, PV: 47.5%), follow-up appointment within 15 days of starting antiretroviral treatment (from 55.3 to 66.2%, PV: 19.7%) and users organized participation (from 5.9 to 16.7%, PV: 183.1%). However, some difficulties remained: little change in the availability of specialized exams, such as endoscopy, within 15 days, (31.9 to 34.5%, PV: 8.1%) and decreases in indicators such as optimal time access to specialized appointments (55.9 to 34.5% in cardiology, negative PV: 38.3%). Mean time spent in follow-up medical appointments remained low: about 15 minutes (52.5 to 49.5%, negative PV: 5.8%). CONCLUSIONS The 2007 assessment revealed that services have essential resources for ambulatory assistance. There was some improvement in many aspects compared to 2001, although some challenges still remain. Little time dedicated to medical appointments may be linked to insufficient number of doctors and/or due to reduced capacity of listening and dialogue. Impaired access to specialized appointments reveals the difficulty local Brazilian Unified Health System facilities have regarding infrastructure.