CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A nÃo adesÃo do paciente portador de Diabetes Mellitus tipo 2 (DM 2) ao tratamento medicamentoso com antidiabÃticos orais vem sendo observada pelos profissionais de saÃde, constituindo-se em um dos principais problemas para a manutenÃÃo do equilÃbrio glicÃmico. AlÃm disso, sÃo muitos os fatores que podem influenciar na nÃo adesÃo do portador de DM 2 aos antidiabÃticos orais e, nÃo hà consenso acerca de quais deles tÃm maior influÃncia. Objetivou-se, com este estudo, conhecer os fatores que interferem na nÃo adesÃo do portador de DM 2 à terapÃutica medicamentosa com antidiabÃticos orais. Trata-se de um estudo nÃo-experimental, descritivo e transversal realizado com 377 pacientes nÃo aderentes ao tratamento medicamentoso, de ambos os sexos, com idade entre 18 e 92 anos. A pesquisa foi realizada durante os meses de marÃo a julho de 2009, em 12 Centros de SaÃde da FamÃlia- CSF da cidade de Fortaleza-CE, sendo escolhidas, por conveniÃncia, duas unidades de cada uma das seis regiÃes. Nos CSF foi utilizado um formulÃrio para a coleta das informaÃÃes sociodemogrÃficas, clÃnicas e medicamentosas. Os dados sofreram tripla digitaÃÃo e foram armazenados no software SPSS. A fim de se verificar a existÃncia de associaÃÃes entre as variÃveis dependentes e causais, foram feitas tabelas cruzadas e aplicaram-se os testes de 2 e o de Fisher. Para todos os testes, foi fixado o nÃvel de significÃncia de 5%. Como resultados, verificou-se que 69,5% eram do sexo feminino, 30,5% estavam na faixa etÃria de 60-69 anos, 47,7% eram brancos, 57,0% mantinham uma uniÃo consensual ou eram casados, 48,0% eram aposentados, 48,3% estavam inseridos na classe econÃmica D, 37,7% possuÃam apenas o fundamental incompleto e, 69,0% eram catÃlicos. Ao serem feitas as associaÃÃes entre a nÃo adesÃo e os fatores sociodemogrÃficos, prevaleceram os sujeitos do sexo masculino (88,5%), os de menor idade (89,8%), os com a cor de pele amarela (90,9%), os que possuÃam ensino mÃdio completo (94,1%), os casados (87,4%) e os de melhor classe econÃmica (92,9%). Em nenhum desses cruzamentos foi verificado uma associaÃÃo estatisticamente significante (p=0,386, p=0,181, p=0,635, p=0,786, p=0,846 e p=0,626), respectivamente. Os indivÃduos que possuÃam algum emprego (formal e informal) ou que eram autÃnomos, foram os pacientes que apresentaram maiores Ãndices de nÃo adesÃo aos antidiabÃticos orais (p=0,048).Quanto aos fatores clÃnicos, a nÃo adesÃo esteve associada, estatisticamente, ao nÃo comparecimento Ãs consultas (p=0,000), ao uso de outros fÃrmacos alÃm dos antidiabÃticos orais (p=0,039), ao etilismo (p=0,005) e à alteraÃÃo da glicemia (p=0,013). NÃo houve uma associaÃÃo estatisticamente significante entre a nÃo adesÃo e o recebimento de orientaÃÃes sobre como tomar os medicamentos (p=0,325), assim como o entendimento das informaÃÃes repassadas (p=0,426) e o recebimento de algum material explicativo sobre DM 2 (p=0,081). Outros estudos devem ser desenvolvidos para que novas populaÃÃes possam ser pesquisadas, novos fatores identificados e novas associaÃÃes encontradas. AlÃm disso, podem ser planejadas investigaÃÃes com o objetivo de avaliar medidas de intervenÃÃo, como estratÃgias de educaÃÃo em saÃde. / Non-compliance to drug therapy in patients with Diabetes Mellitus type 2 (DM 2) has been observed by health professionals as a major problem for the mantaining the glucose balance. In addition, there are many factors that can influence the non-compliance of patients with DM 2 to oral drugs, and there is no consensus about which ones have the most influence. This study aims to determine the factors that affect the non-compliance to drug therapy with oral antidiabetics in patients with DM 2. This is a non-experimental study, with descriptive and cross-sectional aproach, performed with 377 patients non-adherents to drug treatment, both sexes, aged between 18 and 92 years. The research was conducted during the months from March to July 2009, in 12 Family Health Centers (CSF) of Fortaleza â CE. Two units of each of the six regions have being chosen, for convenience. A formulary was used for the collection of sociodemographic, clinical and therapy information. The data were triple typing and stored in the software SPSS. In order to verify the existence of associations between dependent and causal variables, we made crossed tables and we applied the Qui-square test and Fisher test. A significance level of 5% was set for all tests. As a result, it was found that 69.5% of the sample were female, 30.5% were located in the age group of 60-69 years, 47.7% were white, 57.0% had a consensual union or were married, 48.0% were retired, 48.3% were part of the socioeconomic class D, 37.7% had, as schooling, the incomplete primary and 69.0% were catholics. By making associations between non-compliance and sociodemographic variables, prevailed male subjects (88.5%), those of younger age (89.8%), those with yellow skin (90.9%), those who had high school (94.1%), couples (87.4%) and those with a better socioeconomic status (92.9%). It wasnÂt found statistical significant associations in none of these crossings (p = 0.386, p = 0.181, p = 0.635, p = 0.786, p = 0.846 and p = 0.626, respectively). Individuals who have some employment (formal and informal) or who were self-employed, were the patients who had higher non-compliance to oral hypoglycemic agents (p = 0.048). Regarding the clinical factors, non-compliance was statistically associated with absence in consultations (p = 0.000), use of other drugs in addition to oral hypoglycemic agents (p = 0.039), use of alcohol (p = 0.005) and changes in blood glucose levels (p = 0.013). It wasnÂt found statistical association between non-compliance and the receiving of recommendations about how to take the medications (p = 0.325), as well as the understanding of the given information (p = 0.426) and the receipt of any explanatory material about DM 2 (p = 0.081). Other studies should be developed so that new populations can be investigated, new factors can be indentified and new associations can be found. Moreover, investigations with the aim of evaluate interventions, as health education strategies, can be planned.

O presente estudo foi desenvolvido com o objetivo de identificar fatores determinantes da não adesão ao tratamento dos hipertensos em município do interior de Goiás. Trata-se de um estudo de corte transversal, descritivo e de abordagem quantitativa. A coleta de dados compreendeu o período de novembro de 2012 a abril de 2013 e foi dividida em duas fases. Na primeira, buscamos os pacientes hipertensos cadastrados no SISHIPERDIA e no SIAB de cada USF do município e identificamos se permaneciam na área de abrangência da USF. Na segunda, os pacientes foram entrevistados utilizando-se um questionário que contemplou a caracterização sociodemográfica e socioeconômica, tratamento não- medicamentoso e medicamentoso. Participaram 138 pacientes hipertensos, sendo 65,9% do sexo feminino, com média de idade de 60,5 anos (DP=11,32), 71% com a escolaridade primeiro grau incompleto e renda individual de 1 a 2 salários mínimos. Em relação à ocupação, 39,9% eram aposentados e 21,7% eram do lar. Entre os fatores que contribuem para a não adesão ao tratamento 70,3% dos pacientes referiram aspectos pessoais. Foram classificados como aderentes ao tratamento não farmacológico 15,9% dos participantes e 21% seguir corretamente o tratamento farmacológico. Diante dos dados, percebemos que ainda é preciso desenvolver novas pesquisas na atenção primária, com vistas de conhecer os fatores da não adesão ao tratamento da hipertensão, e destacamos a necessidade de elaboração e execução de projetos com ações multiprofissionais que busquem estimular a adesão ao tratamento dos hipertensos assistidos no município estudado / The present study was developed with the aim of identifying determinants of non- adherence to treatment of hypertensive people in a city in the interior of Goiás. This is a cross-sectional, descriptive, quantitative study. Data collection was done from November 2012 to April 2013 and was divided into two phases. Initially, we sought for hypertensive patients registered in the SISHIPERDIA and SIAB in each municipality\'s USF and identified if they remained in the area covered by the USF. Secondly, patients were interviewed using a questionnaire that included the sociodemographic and socioeconomic characteristics, non- medicated and medicated treatment. A number of 138 hypertensive patients participated of this study, 65.9% were female, with a mean age of 60.5 years old (SD = 11.32), 71% with incomplete primary school education and individual income 1-2 minimum wages. Regarding occupation 39.9% were retired and 21.7% were housewives. Among the factors that contributed to non-adherence to treatment 70.3% of patients reported private affairs. Adherent participants in non-pharmacological treatment were 15,9% and 21% were reported as correctly following the pharmacological treatment. Based on the data, we realized that we still need to develop new researches in primary care, aiming to know the factors of non-adherence to hypertension treatment, and highlight the need for development and implementation of multidisciplinary projects with actions that seek to encourage adherence to treatment of hypertensive care in the city of the study

Introdução: apesar de todo o avanço científico e tecnológico voltado para o cuidado de pessoas com úlcera venosa crônica, muitas apresentam dificuldades para aderir ao cuidado necessário à cicatrização dessa lesão, o que traz impactos negativos às suas vidas. Objetivo: compreender a ação das pessoas com úlcera venosa crônica em relação à adesão ao cuidado orientado pelos profissionais de saúde. Método: pesquisa de abordagem fenomenológica, realizada em uma cidade do interior de Minas Gerais. Participaram cinco homens e sete mulheres com úlcera venosa crônica, com idade média de 61 anos e tempo médio da lesão de 13 anos. Para obtenção dos dados, utilizou-se a entrevista aberta com as seguintes questões norteadoras: fale-me sobre as orientações que você recebeu do profissional de saúde sobre o cuidado com a ferida. Como está sendo para você seguir estas orientações? O que você tem em vista quando procura o profissional de saúde para cuidar da sua ferida? A organização e análise foram realizadas seguindo os passos preconizados por estudiosos da fenomenologia social de Alfred Schütz. O projeto foi aprovado pelo Comitê de Ética em Pesquisa com seres humanos da Escola de Enfermagem da Universidade de São Paulo, sob o Parecer nº 1.235.302, de 18 de setembro de 2015. Resultados: o típico da ação vivida por pessoas com úlcera venosa crônica frente à adesão ao cuidado orientado pelos profissionais de saúde caracteriza-se como aquele que age em busca da adesão aos cuidados com vistas à cicatrização da úlcera venosa crônica e à manutenção da integridade da pele dos membros inferiores o maior tempo possível, vislumbrando a retomada das atividades do cotidiano. Além disso, inclui a expectativa do estabelecimento de uma boa relação interpessoal com o profissional no serviço de saúde. Embora intencionalidade se volte para a adesão ao cuidado orientado pelos profissionais de saúde, as atividades cotidianas impedem a concretização dessa intencionalidade, dificultando a realização do repouso, prática de exercícios físicos, dieta e uso da terapia compressiva. Também a falta de infraestrutura dos serviços de saúde interfere na adesão ao cuidado, o que pode dificultar a cicatrização da úlcera venosa crônica. Conclusões: a fenomenologia social de Alfred Schütz permitiu desvelar o típico da ação de pessoas com úlcera venosa crônica frente à adesão ao cuidado orientado pelos profissionais de saúde, trazendo elementos importantes para a reflexão acerca da dificuldade para a adesão a esse cuidado. A perspectiva das pessoas com úlcera venosa crônica aponta questões alocadas no universo intersubjetivo e cultural dos participantes, além daquelas relacionadas à operacionalização dos cuidados nos serviços de saúde, que precisam ser refletidas no âmbito da assistência, gestão, ensino e pesquisa na área de saúde e enfermagem. / Introduction: despite all the scientific and technological advances meant for the care of people with chronic venous ulcers, many people with this wound have difficulty adhering to the care necessary for the healing of this wound, which brings negative impacts to their lives. Objective: To understand the action of people with chronic venous ulcer in relation to adherence to care guided by health professionals. Method: phenomenological research, carried out in a city in Minas Gerais. The study included five men and seven women with chronic venous ulcers, with mean age of 61 years and mean duration of 13 years injury. To obtain the data we used the open interview with the following guiding questions: Tell me about the prescriptions you received from health professionals about the care of the wound. How it is for you to follow these recommendations? What you have in mind when looking for health professional to take care of your wound? The organization and analysis were carried out following the steps recommended by researchers of social phenomenology of Alfred Schütz. The project was approved by the Ethics Committee in Research with human beings of the University of São Paulo School of Nursing, Protocol number1,235,302, September 18, 2015. Results: the typical action experienced by people with venous ulcers front adherence to care guided by health professionals is characterized as one who acts in pursuit of adherence to care with a view to healing of chronic venous ulcers and skin integrity maintenance of the lower limbs as long as possible, seeing the resumption of daily activities. It also includes the expectation of establishing good interpersonal relationship with the professional in the health service. Although intentionality will return to adherence to care guided by health professionals, everyday activities do not allow the realization of this intention, hindering the realization of rest, physical exercise, diet and use of compression therapy. The lack of infrastructure of health services interferes with adherence to care which can hinder the healing of chronic venous ulcers. Conclusions: social phenomenology of Alfred Schütz allowed reveal the typical action of people with chronic venous ulcers front adherence to care guided by health professionals, bringing important elements for reflection on the difficulty adhering to this care. The perspective of people with chronic venous ulcers point issues allocated in the intersubjective and cultural universe of participants, as well as those related to operationalization of care in health services, which need to be reflected in assistance, management, teaching and research in health and nursing.

Both literature and practice have looked at different strategies to diminish healthcare associated costs. As an extension to this stream of research, the present three paper dissertation addresses the issue of reducing elevated healthcare costs using analytics. The first paper looks at extending the benefits of auditing algorithms from mere detection of fraudulent providers to maximizing the deterrence from inappropriate behavior. Using the structure of the physicians' network, a new auditing algorithm is developed. Evaluation of the algorithm is performed using an agent-based simulation and an analytical model. A case study is also included to illustrate the application of the algorithm in the warranty domain. The second paper relies on experimental data to build a personalized medical recommender system geared towards re-enforcing price-sensitive prescription behavior. The study analyzes the impact of time pressure, and procedure cost and prescription prevalence/popularity on the physicians' use of the system's recommendations. The third paper investigates the relationship between patients' compliance and healthcare costs. The study includes a survey of the literature along with a longitudinal analysis of patients' data to determine factors leading to patients' non-compliance, and ways to alleviate it.

Class of 2005 Abstract / Objectives: This retrospective study investigated the relationship between compliance, hospitalizations rates, and cost of care in an outpatient behavioral health facility over a 12-month period for schizophrenic patients treated with depot antipsychotic medications. Methods: Databases from COPE Behavioral Health Center in Tucson, AZ were utilized for administration of depot injections, hospitalizations, and cost of care for patients between July 1, 2003 and June 30, 2004. Results: Records were utilized for 103 patients receiving depot antipsychotics (n = 34 fluphenazine decanoate, n = 69 haloperidol decanoate). Increased number of injections received per year was associated with lower number of hospitalizations per year (p = 0.025 fluphenazine and p = 0.001 haloperidol). Also, increased number of hospitalizations was associated with increased total cost of care (p = 0.001 fluphenazine and p < 0.001 haloperidol). Implications: Patients with schizophrenia who received a greater number of depot antipsychotic injections had a lower number of hospitalizations during a 12-month period. Improved adherence with depot antipsychotics may improve clinical outcomes and reduce the total cost of care in patients with schizophrenia.

The purpose of the present study was to investigate the relationship between Self-Efficacy Theory (Bandura, 19 77) and adherence to health behavior prescription. A self report Self-Efficacy Questionnaire was developed to assess levels of efficacy. Dietary adherence was determined by self report as well as body composition assay and measurement of body weight. Levels of exercise compliance were assessed by self report in addition to a treadmill test.

Internationally, governments have recognised the constraints facing their citizens with regards to access to affordable, quality healthcare services. This development is evident in South Africa where the majority of the population have limited access to affordable, quality healthcare due to the healthcare inequality between the insured and uninsured. To address this lack of access to quality healthcare, medical experts recommend a focus on patient-centred primary healthcare as opposed to the current system of provider-centred healthcare. This research aims, through the development of a patient-centred framework, to assist in advising healthcare systems for the delivery for patientcentred primary healthcare. In order to develop a holistic view, all stakeholders involved in the delivery of healthcare were considered in answering the main research question. The study comprised of 43 interviews in total, of which 28 interviews were with uninsured patients who use healthcare facilities in South Africa and 15 medical expert interviews. This information was then consolidated into a framework, and further refined through the literature collected, to form a holistic service quality framework that allows for the delivery of patient-centred primary healthcare. The holistic service quality framework acts as a mechanism to ensure that the delivery of patient-centred primary healthcare has a positive impact on patient satisfaction. Patient satisfaction can be improved or increased through the levers, available to the providers, identified in the framework. This allows healthcare systems to improve the service quality of the healthcare delivered / Dissertation (MBA)--University of Pretoria, 2014. / zkgibs2015 / Gordon Institute of Business Science (GIBS) / Unrestricted

No description available.

Magister Scientiae (Medical Bioscience) - MSc(MBS) / Background: Veterinary medicines play an imperative role in the diagnosis, prevention and treatment of animal diseases. Many veterinary stock remedies in South Africa are available to the public without the intervention or supervision of a veterinarian or healthcare worker. Therefore, the accompanying package insert with product information and directions for use is central in promoting the safe and effective use of stock remedies. Information such as the dosage, warnings, precautions and storage instructions are essential to assist the user in their treatment decision-making. While local regulatory authority guidelines prescribe and control the minimum information that should be available in the package insert or product label, it is questioned whether the information contained in package inserts of products on the market complies with these regulatory requirements. Methodology: Using simple random sampling of veterinary stock remedies, 159 package inserts or product labels from various animal health companies were selected and evaluated against the prescribed labelling guidelines of the local regulatory authority responsible for the registration and control of stock remedies. The contents of each package insert or label in the sample were assessed for the presence of the prescribed information statements and were accordingly classified as non-compliant, partially compliant or compliant. Results: Among the 159 package inserts, 48 were for antimicrobials, 49 for ectoparasiticides, 44 for anthelmintics and the remaining 18 for endectocides. It was observed that none of the package inserts met all of the criteria and that the package inserts were inadequate in many aspects. The average percentage of compliance was 69.43%, with a range of 36.21% to 87.93%. Conclusion: The study indicated that many package inserts do not fully comply with the prescribed regulatory guidelines and that information related to the safe and appropriate use of stock remedies is insufficient.

Bakgrund: Det finns flera faktorer som påverkar compliance, bland annat stigmatisering, kognition och hälsolitteracitet. Bristande compliance är vanligt förekommande hos patienter med psykisk sjukdom och kan leda till allvarliga konsekvenser, såsom svåra insjuknanden, försämrad livskvalitet och suicid. Metoder som förbättrar compliance kan ha stor betydelse för både patienter och närstående samt kan möjliggöra att hälso- och sjukvårdens resurser kan användas mer kostnadseffektivt.Syfte: Att beskriva metoder som kan förbättra compliance hos patienter med psykisk sjukdom.Metod: Integrativ litteraturstudie valdes som design. Sökningar på artiklar som uppfyllde syftet gjordes i databaserna CINAHL och PubMed, där 16 kvantitativa artiklar identifierades. Dataanalysen utfördes med Whittemore &amp; Knalf's metod som inkluderar datareduktion, data-översikt, data-jämförelse och data-slutsats.Resultat: Studien resulterade i tre huvudkategorier: beteendeterapier, hälsopedagogik och eHälsa och deras underkategorier. Beteendeterapier inkluderade MI, KBT, KBT i kombination och positiv psykologisk terapi (PPI). Identifierade hälsopedagogiska metoder var psykoedukation i kombination samt CAE- och EDU-utbildning. eHälsa resulterade i SMS-påminnelser och smartphone-applikationer.Slutsats: Kombinerade hälsopedagogiska och beteendeinterventioner riktade till patienter och närstående i deras hemmiljö samt gruppinterventioner har bevisat god effekt på compliance. Gruppbehandling kan ge sekundära effekter på exempelvis stigmatisering och social interaktion. Interventioner, givna av specialistsjuksköterskor, är särskilt framgångsrika. Flera av metoderna är kostnadseffektiva och kräver bara några dagars utbildning för att behärska.  Nyckelord: compliance, förbättra, metoder, psykisk sjukdom / Bakground: There are several factors that can affect compliance, including stigma, cognition and health literacy. Non-compliance is common in patients with mental disorders and can lead to serious consequences, such as severe illnesses, impaired quality of life and suicide. Methods that improve compliance can be of great importance for both patients and relatives and can enable healthcare resources to be used more cost-effectively. Aim: The aim of this study was to describe methods that can improve compliance in patients with mental disorders. Method: The study was conducted as an integrative literature review. Searches for articles that met the objective were made in the databases CINAHL and PubMed, 16 quantitative articles were identified. The data analysis was performed by Whittemore &amp; Knalf's method which includes data reduction, data overview, data comparison and data conclusion. Results: The study resulted in three main categories;: behavioral therapies, health education and eHealth and their subcategories. Behavioral therapies included MI, KBT, KBT in combination and positive psychological therapy (PPI). Identified health education methods were psychoeducation in combination, CAE- and EDU-education. eHealth resultad in mobile text messaging and smartphone-applications.Conclusion: Combined health educational and behavioral interventions aimed at patients and relatives, in their home environment as well as group interventions, have proven efficacy on compliance. Group treatment can have secondary effects on, for example, stigma and social interaction. Interventions, given by specialist nurses, are particularly succesful. Several of the methods are cost-effective and require only a few days of training to master.  Keywords: compliance, improve, mental disorders, methods