Obstacles in adherence: how to deal with it: a prospective study in Argentina
O.E.M. Dubini, F. Murano, S. Arazi Caillaud, L. Lorenzo, M. Flores, N. Olazagoitia
Hospital 'Petrona V. de Cordero', Preventive Medicine Service, San Fernando, Argentina
Background: With the advent of new treatments options, life expectancy in VIH infected patients has improved dramatically. However, many problems with the acceptance of and adherence to these treatments and impacts on the progression of the desease and mortality have been largely described before. An interdisciplinary approach to the patient has been organized at our Service to improve adherence, defined as a favorable attitude towards his treatment and follow up, with the patient as protagonist.
Methods: A prospective study has been conducted between july 2008 and december 2009 with the objective of identifying the difficulties with the treatment and intervening in order to overcome the obstacles. Seventy four HIV infected patients under HAART, with clinical charts at the hospital, were included on this study. Patients with adherence problems were selected by the clinician. We worked with individual opened interviews to detect the main and secondary problems associated with the treatment adherence a designated day of the week. If necessary, social networks interventions were planned.
Results: Fifty seven patients were referred because of conduct disorders (77%) and seventeen because of addictions. We detected denial of the infection to be the main treatment adherence problem: 39.2% (family relational problems: 21.6% and addiction: 14.9%). The secondary problems were related with family relational problems (41.4%), unemployment (11.4%) and organic deficiencies (11.4%). Interventions were adapted to the patient´s needs giving special attention to the obstacles encountered in the follow-up. We analized the impact of the intervention with a final psicological diagnosis and virological results.
Conclusions: We have observed an improvement on the patient´s adherence to treatments with an organized and integrated work of the medical team. It is important to make of the patient an active individual, independent and commited with his treatment to see results. Family and social networks are necessary if the patient needs support.
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