Estudo da adesão de crianças e adolescentes ao tratamento conservador da doença renal crônica

Abstract

This study had the objective of analyzing adherence of children and adolescents toconservative treatment of chronic kidney disease in the pediatric nephrology outpatientfacility of a university hospital in the city of Belo Horizonte, Minas Gerais State in2008/2009. A total of 75 participants were enrolled, 27 of which were patients at school age,and 48, care providers. Data collection involved interviews and patients medical recordsanalysis. Interviews provided data on the participants demographic and socioeconomicconditions; knowledge about the disease and treatment, satisfaction with the care provided byhealth professionals, drug therapy adherence, and diet were assessed through the patients selfreport. Laboratory and clinical parameters in medical and health professionals records wereutilized for laboratory parameter surveys, patients clinical characterization, and adherenceassessment. The absolute and relative frequencies of the demographic, socioeconomic andclinical variables were calculated. The continuous variables were described in terms ofaverages and percent distribution. Drug therapy adherence prevalence was calculated for eachadherence assessment method. Univariate analysis was carried out to evaluate possibleassociations between independent variables and the treatment adherence assessment methodutilized. The strength of association was measured by the prevalence ratio (PR) and calculatedby using the Poisson regression technique with robust variances, both in the univariate andmultivariate models. The level of statistical significance established was 5% (p < 0.05). Theresults show that prevalence of non-adherence to drug therapy, evaluated through self-report,was 70.8%, being associated with the participants out-of-control serum phosphorus level(PR= 1.47, IC = 1.14-1.89) and insufficient knowledge about the disease and treatment (RP=1.40, IC = 1.02-1.92). The prevalence of non-adherence to diet, evaluated through self-report,was 60%, which was associated with being male (PR=1.72, IC 1.19-2.47), schooling levelbetween the 1st and 8th grades (PR=2.68, IC 1.21-5.92), complaints of difficulty in followingtreatment (PR=1.85, IC 1.35-2.54), not knowing that treatment is lifelong (PR=1.49, IC 1.08-2.05), not knowing which food is rich in potassium (PR=1.54, IC 1.10-2.15). The prevalenceof non-adherence evaluated through analysis of laboratory and clinical parameters was 50.7%,which was associated with being out of school, pre-school or special schools (PR= 3.84, IC1.03-14.25) and not knowing that treatment is lifelong (RP= 1.62, IC 1.05-2.50). Theevaluation of non-adherence through medical records proved to be inadequate, consideringthe small number of records of professionals who evaluated this behavior. In this study, nonadherenceprevalence was high and varied according to the method applied and associatedfactors. Various factors that may interfere with adherence behavior were observed. Some aredifficult or even impossible to change, especially those associated with the families livingconditions. Poor knowledge of the disease and treatment was associated with higherprevalence of non-adherence by all methods utilized, which is notably susceptible to changewith method choice. Overall, participants were satisfied with the health care received.