Adherence to the Treatment of Lupus: Effects of Three Intervention Conditions

Abstract

______________________________________________________________________RESUMO: Lúpus eritematoso sistêmico (LES) é uma doença autoimune e multissistêmica. Ocorre predominantemente no gênero feminino. O tratamento é diversificado e contém regras complexas, dificultando a adesão. Esta pesquisa estudou os efeitos de três condições de intervenção sobre comportamentos de adesão ao tratamento em mulheres com LES. Trata-se de um estudo longitudinal com coleta de dados em intervalos de 30, 60, 90 e 120 dias. Participaram quinze pacientes com diagnóstico de LES, em seguimento no ambulatório de um hospital da rede pública de saúde. Utilizou-se: formulário de observação da consulta médica; protocolo de análise de prontuário; roteiros de entrevistas; checklist sobre adesão ao tratamento; formulários de registro de automonitorização; escala analógica visual de dor; Inventário Beck para depressão (BDI); questionário de avaliação de qualidade de vida SF-36 e o índice de atividade da doença (SLEDAI). As participantes foram distribuídas sequencialmente em três condições de intervenção: Condição A (n=5), rotina e entrevista; Condição B (n=5), rotina e entrevista com uso de checklist; Condição C (n=5), rotina, entrevista com uso de checklist e registros de automonitorização. Fez-se análise quanti-qualitativa, comparando-se os dados nos diferentes momentos do estudo. Como resultado observouse que, independentemente da condição à qual a participante foi exposta, houve melhora na adesão relatada, bem como no estado clínico e na qualidade de vida das participantes ao final do estudo; entretanto, as participantes da Condição C mantiveram os comportamentos de adesão instalados mesmo após a retirada do procedimento de intervenção, sugerindo melhor índice de adesão ao tratamento (média de 95,71). Palavras-chave: Lúpus Eritematoso Sistêmico, Índice de adesão, Automonitorização ______________________________________________________________________ ADHERENCE TO THE TREATMENT OF LUPUS: EFFECTS OF THREE INTERVENTION CONDITIONSABSTRACT: Systemic lupus erythematosus (SLE) is an autoimmune and multisystem disease. It occurs predominantly in women. The treatment is diverse and contains complex rules, which difficult to adhesion. This research studied the effects of three intervention conditions on behaviors adherence to treatment in women with SLE. This is a longitudinal study with data collection at 30, 60, 90 and 120 days. Participant are fifteen patients with SLE, followed at an outpatient clinic of a public hospital. We used: observation form of medical consultation; chart analysis protocol; interview scripts;  Trav.Perebebuí,2623-Marco, CEP:66087-480, Belém-Pará-Brasil.

Eff ects of Instruction and Self-Monitoring on Adherence to Treatment of Juvenile Systemic Lupus Erythematosus

“…According to Gimenes (2010, 2012) and Selvan et al (2017), recordings in self-monitoring forms favor installation of selfobservation behavior, which are requirements for contingency arrangements related to adherence to treatment, as observed by Neder et al, (2017). In this study P1, P2 and P4's reports indicated good acceptance to do the recordings in SMRFs, despite imprecisions; while P3, with the lowest TAI among the participants during the research, reported that she had had diffi culty, and even refused to fi ll out the SMRF, which could explain the results obtained.…”

“…JSLE treatment involves the association of a set of guidelines: medication administration, skin protection, well-balanced diet, physical exercises, vaccination, periodic medical examinations and frequent laboratory tests (Dunbar-Jacob, Houze, Kramer, Luyster, & McCall, 2010;Gualano et al, 2011;Klack, Bonfá, & Borba, 2012;Neder, Ferreira, & Carneiro, 2017;Silva et al, 2010). To evaluate treatment effi cacy the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) is used: a quantitative system of evaluation of lupus activity during the last 10 days, with score ranging between 0 (no characteristic of the disease is manifested) and 105 (severe manifestation of all characteristics) (Mikdashi & Nived, 2015).…”

“…Based on studies that used calculus to obtain the Treatment Adherence Index (Gomes, Ferreira, & de Souza, 2012;Martins et al, 2015;Neder et al, 2017), in this research, calculation was done by assigning the value of 1 for the corresponding reports following the instructions prescribed by the doctor; value 0.5 for reports indicating irregular following of instructions and 0 for reports showing that medical instructions had not been followed. The sum of the values was used to calculate the Treatment Adherence Index -TAI (the number of instructions followed x 100/ total number of instructions).…”

Duality of Living With Systemic Lupus Erythematosus: Fluctuating Between “Good Days” and “Bad Days”

“…SLE can affect various systems of the human body, such as the immune, circulatory, nervous, cardiopulmonary, hematological and renal systems [2][3] . Its clinical spectrum varies from mild to severe, with periods of exacerbation and remission 4 .…”