Por que os pacientes não seguem adequadamente as orientaçõesMédicas? Estudo dos fatores envolvidos com a má-adesão à profilaxiasecundária da febre reumática com a penicilina-G-benzatina

Abstract

INTRODUCTION: The irregular secondary prophylaxis can determine a worst prognosis of the rheumatic fever.There are few objectives studies that have been dedicated to establish the secondary prophylaxis possible risk factors.OBJECTIVES: To analyze possible factors involved with poor compliance to secondary prophylaxis of rheumatic fever SETTING: Universidade Federal de Minas Gerais, Brazil. STUDY DESIGN: Crosssectional. PATIENTS: A total of 189 patients followed-up in a rheumatic fever outpatient clinic answered a standardized questionnaire, and their injection control cards and medical charts were analyzed. Their age ranged between 8 and 27 years (mean±SD=16.8±4 years).MAIN OUTCOMES: Thirty-two variables likely associated with poor compliance to secondary prophylaxis with penicillin G benzathine were studied. Patients were considered as non-compliant when they delayed the penicillin injection beyond seven days the date scheduled in the card, at least twice. The variables associated with poor compliance with p<0.25 in the univariate analysis were tested in multivariate analysis, by means of logistic regression. RESULTS: Three variables were found to be risk factors for poor compliance: a) female gender (OR=2.20); b) greater number of missed visits (OR=2.47); c) higher injection pain score (OR=1.16). The association between poor compliance and injectionpain was a novel finding. It was also found that the addition of an anesthetic drug to the penicillin flask lowered the injection pain score (p=0.007) The variable information on rheumatic fever was shown as a protective factor against poor compliance (OR=0.74,CI=0.59-0.93). In average, the non-compliant patients had a 2.14-fold greater chance of relapse than the compliant ones (prevalence ratio =2.14, CI=1.27-3.59). CONCLUSIONS: In addition to the female gender, the beliefs, perceptions and attitudes are the main factors associated with poor compliance. The relapses and hospitalizations, more frequent between the non-compliant, probably should be consequences of the irregular prophylaxis.