Abordagem na gestão e no acompanhamento farmacoterapêutico em pessoas com diabetes tipo 2: aspectos da prevalência, da adesão ao tratamento e do estresse emocional ao diabetes na atenção primária à saúde

Abstract

Considering the evidence supporting the validity of a construct for diabetes-related emotional stress, which may be associated with low adherence to treatment, increasing the likelihood of complications in the general condition of people with diabetes mellitus (DM), this study aimed to identify the prevalence of emotional stress and therapeutic adherence in people with DM 2 and to follow them through Pharmacotherapeutic Accompaniment (PA). It was carried out between 2018 and 2019 in a Primary Health Care Unit - UAPS in Fortaleza. To this end, two study designs were used: one of the transversal type, to identify the prevalence of emotional stress in relation to diabetes and non-adherence to treatment, and the second design, a longitudinal study of PA (Fallow up), from type before and after, with a single group, was carried out with four meetings in the period of six months. After sample calculation for the cross-sectional study, the sociodemographic questionnaire and measurement instruments validated for Brazilian culture were applied, with the “Adherence to Treatment” scale - MATADO and MATINSULINA, for adherence to oral antidiabetics and insulin, and in the stress assessment, the “Diabetes Distress Scale - DDS”. People selected from the crosssectional study with high levels of stress and / or low adherence were invited to participate in the PA. It identified the Drug-Related Problems (PRMs), performed pharmaceutical interventions and collected laboratory samples of fasting blood glucose, postprandial blood glucose, glycated hemoglobin, lipid profile and clinical parameters of systemic arterial pressure and biochemical capillary blood glucose currently. all variables were assessed at the beginning and end of PA. Thus, it is observed that for the cross-sectional study the sample population was 249 people, with 37.3% (n = 93) the prevalence of stress in relation to DM, 18.4% (n = 45) non-adherence oral treatment and 21.3% (n = 19) non-adherence to insulins. Younger people were more prone to stress and low adherence to ADO treatment (p = 0.021). People with higher levels of stress had difficulty with diet and exercise (p = 0.002; p <0.001), respectively The highest medians of capillary blood glucose were related to people with a higher level of stress to DM (p <0.001). 112 people were eligible for the AF study, of whom 66 agreed to participate in the study and 30 finished the follow-up. After the interventions, an improvement in adherence was observed in the participants who took ADO with a variation from 60.0% to 93.3% (p = 0.006); for insulin, a variation of 33.3% starting from 91.7% at the end (p = 0.016), there was a reduction in laboratory variables with statistical significance for fasting glucose (p = 0.007) and an increase in HDLc (p = 0.024). In total, there were (164 interventions with 73 Drug-related Problems - PRM, the most frequent being PRM 1 “The patient has a health problem for not using the pharmacotherapy he needs” indicating the most involved drugs, insulin and 164 pharmaceutical interventions were carried out, most of them were accepted 87.8% (n = 144), were classified (n = 9) type of pharmacological interventions and 13 of non-pharmacological interventions. Of the proposed pharmacological interventions, “referral to the doctor for prescription change was the most frequent (n = 18). Of the nonpharmacological interventions, the most frequent was “provision of printed educational material and daily pamphlet for self-monitoring of capillary blood glucose” (n = 23). that the screening performed in the first phase of this research for PA was successful in order to identify people vulnerable to emotional suffering in diabetes and low adherence to treatment, PA and management and m health were essential services to contribute to the multiprofessional team, based on the interventions performed.