Avaliação de fatores relacionados à adesão medicamentosaem pacientes de um Centro de Atenção Psicossocial
DOI:
https://doi.org/10.11606/issn.1806-6976.smad.2025.224065Palavras-chave:
Transtorno Mental, Drogas Psicotrópicas, Adesão Farmacoterapêutica, Farmácia ClínicaResumo
Objetivo: avaliar os fatores relacionados à adesão medicamentosa em pacientes com transtornos mentais em um Centro de Atenção Psicossocial. Metodologia: estudo descritivo de coorte transversal, por meio da análise dos prontuários e de entrevistas semiestruturadas. Resultados: dos 50 pacientes, a maioria era do sexo feminino, solteiro, negro ou pardo, com ensino fundamental incompleto, desempregado, idade entre 50 e 59 anos. Cinquenta e oito por cento dos pacientes apresentaram boa adesão à medicação, 50% esquecem de tomar a medicação, 84% têm pensamentos mais claros medicados e 90% disseram que sua saúde dependia desses medicamentos evitando o agravamento da doença. Em 58% dos pacientes, o haloperidol foi o mais prescrito; e a principal causa de reações adversas e interações medicamentosas em 54% das prescrições. Além disso, 40% dos pacientes apresentaram dificuldade para ler a embalagem do medicamento. Conclusão: a maioria dos participantes faz uso regular dos medicamentos e reconhece sua importância. Compreendem que a interrupção do tratamento pode ocasionar agravamento do quadro clínico. Uma parcela significativa dos pacientes não possuía boa adesão à farmacoterapia, justificado pelas reações adversas e pelos efeitos colaterais, provavelmente agravados pelas interações medicamentosas. A baixa escolaridade torna-se um fator importante na adesão medicamentosa.
Downloads
Referências
Semahegn A, Torpey K, Manu A, Assefa N, Tesfaye G, Ankomah A. Psychotropic medication non-adherence and associated factors among adult patients with major psychiatric disorders: a protocol for a systematic review. Syst Rev. 2018;7(1):10. https://doi.org/10.1186/s13643-018-0676-y.
Bezerra HS, Alves RM, Souza TA, Medeiros AA, Barbosa IR. Factors associated with mental suffering in the Brazilian population: a multilevel analysis. Front Psychol. 2021;12:625191. https://doi.org/10.3389/fpsyg.2021.625191.
Weber CA, Silva AG, Nardi AE, Juruena MF. Abstinence, anti-drug psychosocial care centers and therapeutic communities: pillars for reorienting the Brazilian Mental Health and Drug Policy. Braz J Psychiatry. 2021;43(6):570-1. https://doi.org/10.1590/1516-4446-2020-1647.
Ferreira GS, Moro LM, Rocha KB. Analysis of the assumptions of the psychosocial paradigm in Psychosocial Care Centers (CAPS) in the professional’s perspective. Cien Psicol. 2022;16(2):e-2225. https://doi.org/10.22235/cp.v16i2.2225.
Moura AS, Ricci EC, Ferigato SH. Multi-professional residency programs in mental health and occupational therapy. Cad Bras Ter Ocup. 2021;29:e2951. https://doi.org/10.1590/2526-8910.ctoAO2235.
Lima ARS. Rede de atenção psicossocial (RAPS) de Aracaju após 15 anos de implantação: reencontros, novos olhares e mais desafios [thesis]. Salvador: Universidade Católica de Salvador; 2018 [cited 2024 Apr 19]. 151 p. Available from: https://ri.ucsal.br/handle/prefix/520.
Johansen SL, Robakis TK, Williams KE, Rasgon NL. Management of perinatal depression with non-drug interventions. BMJ. 2019;364:l322. https://doi.org10.1136/bmj.l322.
Dinnissen M, Dietrich A, van der Molen JH, Verhallen AN, Buiteveld Y, Jongejan S, et al. Prescribing antipsychotics in child and adolescent psychiatry: guideline adherence. Eur Child Adolesc Psychiatry. 2020;29(12):1717-27. https://doi.org/10.1007/s00787-020-01488-6.
Semahegn A, Torpey K, Manu A, Assefa N, Tesfaye G, Ankomah A. Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis. Syst Rev. 2020;9(1):17. https://doi.org/10.1186/s13643-020-1274-3.
Basit SA, Mathews N, Kunik ME. Telemedicine interventions for medication adherence in mental illness: A systematic review. Gen Hosp Psychiatry. 2020;62:28-36. https://doi.org/10.1016/j.genhosppsych.2019.11.004.
Yaegashi H, Kirino S, Remington G, Misawa F, Takeuchi H. Adherence to Oral Antipsychotics Measured by Electronic Adherence Monitoring in Schizophrenia: A Systematic Review and Meta-analysis. CNS Drugs. 2020;34(6):579-98. https://doi.org/10.1007/s40263-020-00713-9.
Ministério da Saúde (BR), Conselho Nacional de Saúde. Resolução nº 338, de 06 de maio de 2004. Aprova a Política Nacional de Assistência Farmacêutica, estabelecida com base nos seguintes princípios. Diário Oficial da União [Internet]. 2004 May 20 [cited 2024 Apr 19];seção 1:52. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/cns/2004/res0338_06_05_2004.html.
Santos JS, Oliveira MA, Brito GC, Rocha CE, Di Pietro G. Pharmaceutical intervention and medication adherence in a Psychosocial Care Center for alcohol and other drugs. Rev Conexao Cien. 2021;16(2):46-61. https://doi.org/10.24862/cco.v16i2.1350.
Santos MA, Guedes JPM, Andrade PCA, Silva WW, Cintra TRS, Leite CRIS. The role of the pharmacist in pharmacotherapeutic monitoring in mental health and chemical: a literature review. Braz J Health Rev. 2023;6(6):29265-82. https://doi.org/10.34119/bjhrv6n6-208.
Rodrigues THB, Santos DF, Morais HA, Teixeira RA, Silva FDV. From health as a constitutional right to the national pharmaceutical assistance policy. Braz J Health Rev. 2024;7(2):e68601. https://doi.org/10.34119/bjhrv7n2-261.
Rosa AR, Kapczinski F, Oliva R, Stein A, Barros HMT. Monitoring the compliance to lithium treatment. Arch Clin Psychiatry. 2006;33(5):249-61. https://doi.org/10.1590/S0101-60832006000500005.
Ministério da Saúde (BR), Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Assistência Farmacêutica e Insumos Estratégicos. Capacitação para implantação dos serviços de clínica farmacêutica [Internet]. Brasília: Ministério da Saúde; 2014 [cited 2024 Apr 19]. 308 p. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/cuidado_farmaceutico_atencao_basica_saude_2.pdf.
Merative. Micromedex [Homepage]. Ann Arbor, MI: Merative; 2022 [cited 2024 Apr 19]. Available from: https://www.micromedexsolutions.com/home/dispatch.
Vieira AC, Bressan LK, Garcia LSB. Epidemiological profile from psychiatric patients admitted involuntarily in a psychiatric hospital in the south of Santa Catarina State from 2012 until 2016. ACM Arq Catarin Med [Internet]. 2019 [cited 2024 Apr 19];48(3):45-55. Available from: https://docs.bvsalud.org/biblioref/2019/10/1023496/501-1722-1-sm.pdf.
Lor M, Koleck TA, Bakken S, Yoon S, Navarra AMD. Association between health literacy and medication adherence among hispanics with hypertension. J Racial Ethn Health Disparities. 2019;6:517-24. https://doi.org/10.1007/s40615-018-00550-z.
Harmanci P, Budak FK. The effect of psychoeducation based on motivational interview techniques on medication adherence, hope, and psychological well-being in schizophrenia patients. Clin Nurs Res. 2022;31(2):202-16. https://doi.org/10.1177/10547738211046438.
Solmi M, Miola A, Croatto G, Pigato G, Favaro A, Fornaro M, et al. How can we improve antidepressant adherence in the management of depression? A targeted review and 10 clinical recommendations. Braz J Psychiatr. 2021;43(2):189-202. https://doi.org/10.1590/1516-4446-2020-0935.
Yildiz M. Psychosocial rehabilitation interventions in the treatment of schizophrenia and bipolar disorder. Noro Psikiyatr Ars. 2021;58(Suppl 1):S77-S82. https://doi.org/10.29399/npa.27430.
Fernandes SAF, Brito GC, Dosea AS, Lyra DP Junior, Garcia-Cardenas V, Fonteles MMF. Understanding the provision of a clinical service in mental health and the role of the pharmacist: a qualitative analysis. Interface (Botucatu). 2021;25:1-18. https://doi.org/10.1590/interface.200788.
Abumadini MS. Sociodemographic characteristics of adult Saudi patients with mood disorder subtypes. Saudi J Med Med Sci. 2019;7(3):169-74. https://doi.org/10.4103/sjmms.sjmms_60_18.
Madala-Witbooi NJ, Adeniyi OV. Demographic and clinical profiles of admitted psychiatric patients of the East London Mental Health Unit in the Eastern Cape, South Africa. Medicine. 2019;98(52):e18399. https://doi.org/10.1097/MD.0000000000018399.
Brouwers EPM. Social stigma is an underestimated contributing factor to unemployment in people with mental illness or mental health issues: position paper and future directions. BMC Psychol. 2020;8(36):1-7. https://doi.org/10.1186/s40359-020-00399-0.
Zhang S, Xiang W. Income gradient in health-related quality of life—The role of social networking time. Int J Equity Health. 2019;18(44):1-10. https://doi.org/10.1186/s12939-019-0942-1.
Al-Hassany L, Kloosterboer SM, Dierckx B, Koch BC. Assessing methods of measuring medication adherence in chronically ill children–a narrative review. Patient Prefer Adherence. 2019;13:1175-89. https://doi.org/10.2147/PPA.S200058.
Murali KM, Lonergan M. Breaking the adherence barriers: Strategies to improve treatment adherence in dialysis patients. Semin Dial. 2020;33(6):475-85. https://doi.org/10.1111/sdi.12925.
Zijp TR, Izzah Z, Åberg C, Gan CT, Bakker SJL, Touw DJ, et al. Clinical Value of Emerging Bioanalytical Methods for Drug Measurements: A Scoping Review of Their Applicability for Medication Adherence and Therapeutic Drug Monitoring. Drugs. 2021;81(17):1983-2002. https://doi.org/10.1007/s40265-021-01618-7.
Silveira LP, Pádua CAM, Drummond PLM, Malta JS, Santos RMM, Costa NL, et al. Validation of an Instrument for Measuring Adherence to Treatment With Immunomodulators in Patients With Multiple Myeloma. Front Pharmacol. 2021;12:651523. https://doi.org/10.3389/fphar.2021.651523.
Teetharatkul T, Pitanupong J. Good medical adherence according to having meaning in life among Thai schizophrenic patients [Preprint]. Res Square. 2021;1-20. https://doi.org/10.21203/rs.3.rs-957298/v1.
Freire EC, Feijó CFC, Fonteles MMF, Soares JES, Carvalo TMJP. Compliance with drug therapy in patients with mood disorder at psychosocial care centers in northeastern Brazil. Rev Cienc Farm Basica Apl [Internet]. 2013 [cited 2024 Apr 19];34(4):565-70. Available from: https://rcfba.fcfar.unesp.br/index.php/ojs/article/view/182/180.
Pradhan SK, Li Y, Gantenbein AR, Angst F, Lehmann S, Shaban H. Wen Dan Tang: A Potential Jing Fang Decoction for Headache Disorders? Medicines. 2022;9(3):22. https://doi.org/10.3390/medicines9030022.
Bahta M, Ogbaghebriel A, Russom M, Tesfamariam EH, Berhe T. Impact of adverse reactions to first-generation antipsychotics on treatment adherence in outpatients with schizophrenia: a cross-sectional study. Ann Gen Psychiatry. 2021;20(1):27. https://doi.org/10.1186/s12991-021-00348-0.
Owusu E, Oluwasina F, Nkire N, Lawal MA, Agyapong VIO. Readmission of Patients to Acute Psychiatric Hospitals: Influential Factors and Interventions to Reduce Psychiatric Readmission Rates. Healthcare (Basel). 2022;10(9):1808. https://doi.org/10.3390/healthcare10091808.
Consoloni JL, M'Bailara K, Perchec C, Aouizerate B, Aubin V, Azorin JM, et al. Trajectories of medication adherence in patients with Bipolar Disorder along 2 years-follow-up. J Affect Disord. 2021;282:812-9. https://doi.org/10.1016/j.jad.2020.12.192.
Jannoo Z, Mamode Khan N. Medication Adherence and Diabetes Self-Care Activities Among Patients With Type 2 Diabetes Mellitus. Value Health Reg Issues. 2019;18:30-5. https://doi.org/10.1016/j.vhri.2018.06.003.
Ministério da Saúde (BR), Secretaria de Atenção à Saúde. Portaria nº 364, de 9 de abril de 2013. Aprova o Protocolo Clínico e Diretrizes Terapêuticas – Esquizofrenia [Internet]. Brasília: Ministério da Saúde; 2013 [cited 2024 Apr 19]. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/sas/2013/prt0364_09_04_2013.html.
Goldberg SG, Wagner K. American Psychological Association practice guidelines for psychopharmacology: Ethical practice considerations for psychologists involving psychotropic use with children and adolescents. J Clin Psychol. 2019;75(3):344-63. https://doi.org/10.1002/jclp.22705.
Varimo E, Saastamoinen LK, Rättö H, Aronen ET. Polypharmacy in children and adolescents initiating antipsychotic drug in 2008-2016: a nationwide register study. Nord J Psychiatry. 2023;77(1):14-22. https://doi.org/10.1080/08039488.2022.2042597.
Edinoff AN, Ellis ED, Nussdorf LM, Hill TW, Cornett EM, Kaye AM, et al. Antipsychotic Polypharmacy-Related Cardiovascular Morbidity and Mortality: A Comprehensive Review. Neurol Int. 2022;14(1):294-309. https://doi.org/10.3390/neurolint14010024.
Gomes D, Placido AI, Mó R, Simões JL, Amaral O, Fernandes I, et al. Daily Medication Management and Adherence in the Polymedicated Elderly: A Cross-Sectional Study in Portugal. Int J Environ Res Public Health. 2019;17(1):200. https://doi.org/10.3390/ijerph17010200.
Ensing HT, Schulte RA, Koster ES. Implementing a newly prescribed cardiovascular medicine in daily routine: The patient perspective at readmission to primary care. Res Social Adm Pharm. 2023;19(2):293-300. https://doi.org/10.1016/j.sapharm.2022.10.003.
Chan AHY, Horne R, Hankins M, Chisari C. The medication adherence report scale: a measurement tool for eliciting patients' reports of nonadherence. Br J Clin Pharmacol. 2020;86(7):1281-8. https://doi.org/10.1111/bcp.14193.
Soares VEA. Applications of instruments for the evaluation of the safety of ambulatory patients regarding the use of medicines [thesis]. São Paulo: Universidade Nove de Julho; 2019 [cited 2024 Apr 19]. 122 p. Available from: https://bibliotecatede.uninove.br/handle/tede/2128.
Alqarni AM, Alrahbeni T, Qarni AA, Qarni HMA. Adherence to diabetes medication among diabetic patients in the Bisha governorate of Saudi Arabia - a cross-sectional survey. Patient Prefer Adherence. 2018;13:63-71. https://doi.org/10.2147/PPA.S176355.
Piña IL, Di Palo KE, Brown MT, Choudhry NK, Cvengros J, Whalen D, et al. Medication adherence: Importance, issues and policy: A policy statement from the American Heart Association. Prog Cardiovasc Dis. 2021;64:111-120. https://doi.org/10.1016/j.pcad.2020.08.003.
Tavares AP. Help Medicine-Sistema de alerta de toma de medicação [thesis]. Guarda: Instituto Politécnico da Guarda; 2019 [cited 2024 Apr 19]. 130 p. Available from: https://bdigital.ipg.pt/dspace/handle/10314/4935.
Greenfield DP. Psychopharmacology for Nonpsychiatrists: A Primer. Berlin: Springer; 2022. 209 p.
Ordak M, Zmysłowska A, Bielski M, Rybak D, Tomaszewska M, Wyszomierska K, et al. Pharmacotherapy of Patients Taking New Psychoactive Substances: A Systematic Review and Analysis of Case Reports. Front Psychiatry. 2021;12:669921. https://doi.org/10.3389/fpsyt.2021.669921.
Silva SN, Lima MG, Ruas CM. Drug use in Psychosocial Care Centers: analysis of prescriptions and the profile of users in different modalities of the service. Cien Saude Colet. 2020;25(7):2871-82. https://doi.org/10.1590/1413-81232020257.23102018.
Carvalho IB, Evangelista ICM, Lopes JSL, Santos MB, Dourado CSME, Costa IKSC, et al. Study of the potential interactions of drugs subject to special control in Psychosocial Care Center (CAPS) in the city of Teresina – PI. Bol Inform Geum [Internet]. 2015 [cited 2024 Apr 19];6(1):7-15. Available from: https://revistas.ufpi.br/index.php/geum/article/view/3587/2849.
Martins RR, Silva LT, Lopes FM. Impact of medication therapy management on pharmacotherapy safety in an intensive care unit. Int J Clin Pharm. 2019;41(1):179-88. https://doi.org/10.1007/s11096-018-0763-0.
Tharanon V, Putthipokin K, Sakthong P. Drug-related problems identified during pharmaceutical care interventions in an intensive care unit at a tertiary university hospital. SAGE Open Med. 2022;10:20503121221090881. https://doi.org/10.1177/20503121221090881.
De Las Cuevas C, Motuca M, Baptista T, de Leon J. Skepticism and pharmacophobia toward medication may negatively impact adherence to psychiatric medications: a comparison among outpatient samples recruited in Spain, Argentina, and Venezuela. Patient Prefer Adherence. 2018;12:301-10. https://doi.org/10.2147/PPA.S158443.
Coutsouvelis J, Siderov J, Tey AY, Bortz HD, O’Connor SR, Rowan GD, et al. The impact of pharmacist-led strategies implemented to reduce errors related to cancer therapies: a systematic review. J Pharm Pract Res. 2020;50(6):466-80. https://doi.org/10.1002/jppr.1699.
Cosci F, Chouinard G. Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications. Psychother Psychosom. 2020;89(5):283-306. https://doi.org/10.1159/000506868.
Dokkedal-Silva V, Berro LF, Galduróz JCF, Tufik S, Andersen ML. Clonazepam: Indications, Side Effects, and Potential for Nonmedical Use. Harv Rev Psychiatry. 2019;27(5):279-89. https://doi.org/10.1097/HRP.0000000000000227.
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2025 SMAD, Revista Eletrônica Saúde Mental Álcool e Drogas (Edição em Português)
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
