Therapeutic Adherence

Context: Currently there are many investigations that are carried out around the complex problem of therapeutic adherence due to its negative consequences.

Aims: To evaluate the therapeutic adherence in patients with chronic diseases hospitalized in an Internal Medicine Service.

Methods: An observational, descriptive and transversal study was carried out in 50 patients characterized according to biosocial and clinical variables. For the determination of therapeutic adherence, the Battle test and the Morisky-Green test were used, defining the patients as adherent and non-adherent. Possible factors associated with adherence were analyzed and educational interventions were carried out. The review of the clinical histories and the interview as a working instrument were used, the statistical significance of the influence of the factors was evaluated through Chi-square.

Results: Predominance of the feminine sex, the average age of 65 years and the level of primary schooling, hypertension prevailed in 90% of patients and antihypertensive drugs as the most used drugs. 54% of adherent patients were obtained compared to 46% of non-adherent patients. Factors such as number of chronic diseases, limitation of social activity and accessibility to the pharmaceutical service were associated with therapeutic adherence. The educational interventions carried out were the talk and the advice/information.

Conclusions: The results reveal therapeutic adherence in most patients and the need to continue with health education to groups with chronic diseases.

Este estudo exploratório faz uso do método fenomenológico de investigação em psicologia, para aferir vivências intencionais que possibilitem uma maior compreensão sobre as formas de aumentar a adesão terapêutica, reduzir o dropout dos utentes e o burnout dos clínicos. Para o efeito usou-se um questionário através do qual foram recolhidas informações de 30 indivíduos, que salientam a importância de os psicólogos darem mais atenção às dimensões técnica e pessoal da consulta de psicologia, bem como a uma abordagem clínica integrada, focada não só nos aspetos negativos da personalidade, como nos positivos.
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This exploratory study makes use of the phenomenological method in psychology research to gauge intentional experiences that allow a greater understanding of the ways to increase therapeutic adherence, reduce the clients’ dropout and the clinicians’ burnout. For this purpose a questionnaire was used through which was collected information of 30 individuals, which emphasize the importance of psychologists to give more attention to the technique and personal dimensions of a psychological session, as well as to an integrated clinical approach, focused not only on the negative aspects of personality, as well as on the positive.

Objetivos: Inexistindo estudos focados na opinião pública sobre a psicologia em Portugal, definiram-se três objetivos: (1) obter opiniões sobre os psicólogos clínicos comparativamente a outros profissionais de saúde; (2) adaptar uma escala que capta atitudes sobre: tolerância ao estigma, perceção de competência dos psicólogos e intenção de adesão psicoterapêutica; (3) cruzando estas duas fontes, contribuir para uma melhor interface psicólogos-público. Métodos: Estudo quantitativo (N = 879) que usou uma escala de diferencial semântico (Nunnally & Kittross, 1958) e a Beliefs About Psychological Services ou BAPS (Ægisdóttir & Gerstein, 2009), que foi sujeita a quatro análises fatoriais. Os resultados foram analisados com os softwares IBM-SPSS e IBM-AMOS, com um nível de significância ≤ .05. Resultados: Validaram-se duas versões da BAPS: uma estrutura trifatorial com 18 itens e uma tetrafatorial com 26 itens. A opinião pública sobre os profissionais de saúde é positiva, mas os psicólogos são percecionados numa posição intermédia entre os grupos avaliados com maior e menor favorabilidade. O público perceciona utilidade nos serviços de psicologia, mas a perceção da velocidade do processo e da humanidade dos psicólogos (mas não o estigma social) poderão inviabilizar uma maior adesão terapêutica. Conclusões: Urge informar o público sobre os serviços de psicologia, pois face à elevada prevalência de perturbações mentais na população portuguesa os psicólogos clínicos são recursos humanos subaproveitados, que podem contribuir para alavancar a economia. Mas importa continuar a investir na capacidade preditiva, na investigação, na automonitorização e na atualização da formação, para aumentar a qualidade dos serviços dos psicólogos clínicos.
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Objectives: In the absence of studies focused on public opinion about psychology in Portugal, three objectives were defined: (1) to obtain opinions about clinical psychologists compared to other health professionals; (2) to adapt a scale to capture attitudes about: stigma tolerance, psychologists’ expertness, and intention of psychotherapeutic adherence; (3) by crossing these two sources, contribute to a better psychologists-public interface. Methods: Quantitative study (N = 879) that used a semantic differential scale (Nunnally & Kittross, 1958) and the Beliefs About Psychological Services or BAPS (Ægisdóttir & Gerstein, 2009), which was subjected to four factorial analyzes. The results were analyzed with IBM-SPSS and IBM-AMOS software, with a significance level ≤ .05. Results: Two versions of the BAPS were validated: a trifactorial structure with 18 items, and a tetrafactorial structure with 26 items. Public opinion on health professionals is positive, but psychologists are perceived in an intermediate position among the groups evaluated with more, and less favorability. The public perceives utility in psychological services, but the perception of the speed of the process, and the humanity of psychologists (but not the social stigma) may thwart a greater therapeutic adherence. Conclusions: It is vital to inform the public about psychology services, because given the high prevalence of mental disorders in the Portuguese population, clinical psychologists are underused human resources, which can contribute to the economic growth. But, it is important to continue investing in predictive capacity, research, self-monitoring and updating of training, to increase the quality of the services provided by clinical psychologists.

The problem of therapeutic non-adherence is a serious issue adversely affecting the adequate control and management of Type2 Diabetes (T2D).This unwelcoming situation has been studied well on various spots on the globe, with diverse results. The present study, aimed at identifying the barriers to therapeutic adherence, was conducted on a set of proven cases of T2D, managed by primary healthcare providers. The adherence rate to medication alone was 42% while to medication plus lifestyle recommendations 27%. Whereas sub-optimal health literacy, complexity of prescription and socioeconomic aspects were the main determinants, lapse on the part of healthcare system cannot be underscored. The present qualitative study was a preliminary investigation on a small sample .The magnitude of the problem necessitates that a large scale multi-centre in-depth quantitative study in 5 dimensions (recommended by WHO): socioeconomic factors, health care team and system related factors, condition related factors , therapy related factors and patient related factors, be done on priority basis. This would pave the way for planning a well-designed intervention programme.