Adesão dos pacientes com doenças pulmonares crônicas à oxigenoterapia domiciliar prolongada

Abstract

Compliance of patients with chronic pulmonary diseases to prolonged home oxygen therapy The aim of the study was to analyse the adherence of patients with chronic lung diseases using long-term home oxygen therapy (LTOT) and registered in the Oxygen Therapy Program of the Belo Horizonte Municipal Health Department, using three different measurement methods. The study also aims to identify the main determinants of compliance to the therapy, considering the clinical and sociodemographic associated factors, such as sex gender, age, marital status, education, income, underlying disease, smoking history, comorbidities and prescriber.This is a prospective cohort study, conducted from August 2019 to May 2020. Patients with chronic lung diseases using prolonged home oxygen therapy were assessed for adherence. For this purpose, three different methods were used to measure adherence, the self-report, reading the oxygen concentrator's hour meter and analyzing the energy consumption estimate of the concentrator. All these measures were compared with the medical prescription and 80%, 90% and 100% were used arbitrarily as the cutoff point for each method. Data were collected during two home visits. From the 157 participants recruited for the study, 107 participated in the final analysis. 67 from the 107 (62,6%) were females, and 40 (37,4%) were males. The age average was 68,93 years old (± 9,6) varying from 45 to 97 years of age. The base pathology found with the most occurrence in this study was COPD 76 (71%).Adherence to the ODP found was low. Considering 80%, 90% and 100% of use according to the medical prescription, respectively, the non-adherence rate ranged from 43%(33.5-52.9); 47.7%(37.9-57.5); 50.5%(40.6-60.3) according to self-report, to 59.8%(49.9-69.2); 68.2%(58.5-76.9); 79.4 (70.5-86.6) according to the hourmeter reading, and 59.8% (49.9-69.2); 69.2%(59.5-77.7); 80.4%(71.6-87.4) according to the energy consumption calculation of the concentrator (p < 0,001). According to the results, there was an overestimation of adherence when measured by the patient statements. In the multivariate analysis, the length of the oxygen connection tube was the only factor independently associated with adherence, considering 90% adherence by the three methods (OR: 1.039(1.012-1.068) self-report; OR: 1.047(1.007-1.089) hourmeter and OR:1.054(1.006-1.105) for energy consumption.The adherence measurement verified by the hour meter of the LTOT, followed by the analysis of the electrical energy usage are methods more trustworthy than the patient statements. As an innovative alternative for the adherence, the oxygen concentrator’s electrical energy usage calculus is ideal for more precise results. Keywords: Long-term oxygen therapy. Adherence; Oxygen therapy. Chronic hypoxemia.