Análisis de persistencia en la toma de medicamentos de uso crónico en usuarios de un programa de reposición periódica de medicamentos sin costo durante dos años en Colombia

Introducción: La adherencia y persistencia a terapias farmacológicas son unas de las estrategias de prevención secundaria más discutidas y estudiadas a nivel mundial. En las últimas décadas ha crecido enormemente el interés en el rol que desempeñan en los resultados clínicos y sociales, por lo que d...

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Autores Principales: García Rodríguez, María Carmen, Montenegro Montúfar, Álvaro
Otros Autores: Massaro Ceballos, Mónica María
Formato: Tesis de maestría (Master Thesis)
Lenguaje:Español (Spanish)
Publicado: Universidad del Rosario 2017
Materias:
Acceso en línea:http://repository.urosario.edu.co/handle/10336/13387
id ir-10336-13387
recordtype dspace
institution EdocUR - Universidad del Rosario
collection DSpace
language Español (Spanish)
topic Cumplimiento de la medicación
Terapias crónicas
Anticonceptivos
Adherencia
Persistencia
Programa
Reposición gratuita
Reposición sin costo
Medicamentos
Incidencia & prevención de la enfermedad
Epidemiología
Medication compliance
Chronic therapies
Contraceptives
Adherence
Persistence
Program
Free replacement
Non-cost replacement
Medications
Epidemiología
Salud publica
Medicamentos
Anticonceptivos
spellingShingle Cumplimiento de la medicación
Terapias crónicas
Anticonceptivos
Adherencia
Persistencia
Programa
Reposición gratuita
Reposición sin costo
Medicamentos
Incidencia & prevención de la enfermedad
Epidemiología
Medication compliance
Chronic therapies
Contraceptives
Adherence
Persistence
Program
Free replacement
Non-cost replacement
Medications
Epidemiología
Salud publica
Medicamentos
Anticonceptivos
García Rodríguez, María Carmen
Montenegro Montúfar, Álvaro
Análisis de persistencia en la toma de medicamentos de uso crónico en usuarios de un programa de reposición periódica de medicamentos sin costo durante dos años en Colombia
description Introducción: La adherencia y persistencia a terapias farmacológicas son unas de las estrategias de prevención secundaria más discutidas y estudiadas a nivel mundial. En las últimas décadas ha crecido enormemente el interés en el rol que desempeñan en los resultados clínicos y sociales, por lo que diversos estudios han estudiado el impacto de diferentes técnicas pro-adherencia Vs el manejo habitual o la no intervención, arrojando que la mayoría de estas alternativas resultan ser más eficaces que la no intervención. Sin embargo, esto continúa siendo un reto para el personal de salud y la sociedad en general, no solo por los enormes gastos en salud que genera la falta de adherencia y persistencia a la medicación prescrita, sino también por su impacto negativo en la calidad de vida y mortalidad de la población en general. Objetivo: Comparar la persistencia en la toma de medicamentos de uso crónico entre anticonceptivos, hipolipemiantes, flebotónicos, antihipertensivos y antirresortivos de un programa de reposición periódica de medicamentos sin costo, de acuerdo a variables demográficas, de dispensación y del modelo de reposición, en pacientes adultos prescritos con estas terapias y seguidos durante dos años. Pacientes y métodos: Se llevó a cabo un estudio de casos y controles anidados en una cohorte a partir de la base de datos de un programa de reposición periódica de medicamentos sin costo de operación nacional, diseñado para mejorar la adherencia y persistencia a medicamentos de varios grupos terapéuticos de uso crónico y anticonceptivos, en pacientes adultos (N= 57.576), residentes en 378 municipios de Colombia durante dos años de seguimiento. Se consideró que un paciente es persistente a una terapia prescrita cuando el tiempo durante el cual continúa con el tratamiento fuera ≥80% del periodo de seguimiento, en términos de frecuencia de recompra y tiempo de uso. Posteriormente se realizó un análisis bivariado con el fin de identificar la relación entre las variables del estudio y finalmente se evaluó el poder predictor de las variables estudiadas en la persistencia al uso de la terápia a los seis, 12 y 17 meses de tratamiento, a través de una regresión logística binaria. Resultados: Las variables predictoras más relevantes para el desenlace de persistencia a los seis, 12 y 17 meses de tratamiento fueron la edad, (para anticonceptivos, hipolipemiantes y flebotónicos), el tipo de reposición para antihipertensivos, y el tipo de entrega para los antirresortivos. Conclusión: La persistencia al uso de terapias de uso crónico y anticonceptivos, en el marco de un programa de reposición de medicamentos sin costo es de etiología multifactorial; donde están involucradas tanto variables propias del paciente como del medicamento y del modelo de reposición utilizado. La no persistencia al uso de los medicamentos estudiados fue alta en todos los grupos terapéuticos, lo cual es llamativo considerando que se trata de un programa de reposición de medicamentos totalmente gratuito.
author2 Massaro Ceballos, Mónica María
author_facet Massaro Ceballos, Mónica María
García Rodríguez, María Carmen
Montenegro Montúfar, Álvaro
format Tesis de maestría (Master Thesis)
author García Rodríguez, María Carmen
Montenegro Montúfar, Álvaro
author_sort García Rodríguez, María Carmen
title Análisis de persistencia en la toma de medicamentos de uso crónico en usuarios de un programa de reposición periódica de medicamentos sin costo durante dos años en Colombia
title_short Análisis de persistencia en la toma de medicamentos de uso crónico en usuarios de un programa de reposición periódica de medicamentos sin costo durante dos años en Colombia
title_full Análisis de persistencia en la toma de medicamentos de uso crónico en usuarios de un programa de reposición periódica de medicamentos sin costo durante dos años en Colombia
title_fullStr Análisis de persistencia en la toma de medicamentos de uso crónico en usuarios de un programa de reposición periódica de medicamentos sin costo durante dos años en Colombia
title_full_unstemmed Análisis de persistencia en la toma de medicamentos de uso crónico en usuarios de un programa de reposición periódica de medicamentos sin costo durante dos años en Colombia
title_sort análisis de persistencia en la toma de medicamentos de uso crónico en usuarios de un programa de reposición periódica de medicamentos sin costo durante dos años en colombia
publisher Universidad del Rosario
publishDate 2017
url http://repository.urosario.edu.co/handle/10336/13387
_version_ 1645140888375001088
spelling ir-10336-133872019-09-19T12:37:54Z Análisis de persistencia en la toma de medicamentos de uso crónico en usuarios de un programa de reposición periódica de medicamentos sin costo durante dos años en Colombia García Rodríguez, María Carmen Montenegro Montúfar, Álvaro Massaro Ceballos, Mónica María Cumplimiento de la medicación Terapias crónicas Anticonceptivos Adherencia Persistencia Programa Reposición gratuita Reposición sin costo Medicamentos Incidencia & prevención de la enfermedad Epidemiología Medication compliance Chronic therapies Contraceptives Adherence Persistence Program Free replacement Non-cost replacement Medications Epidemiología Salud publica Medicamentos Anticonceptivos Introducción: La adherencia y persistencia a terapias farmacológicas son unas de las estrategias de prevención secundaria más discutidas y estudiadas a nivel mundial. En las últimas décadas ha crecido enormemente el interés en el rol que desempeñan en los resultados clínicos y sociales, por lo que diversos estudios han estudiado el impacto de diferentes técnicas pro-adherencia Vs el manejo habitual o la no intervención, arrojando que la mayoría de estas alternativas resultan ser más eficaces que la no intervención. Sin embargo, esto continúa siendo un reto para el personal de salud y la sociedad en general, no solo por los enormes gastos en salud que genera la falta de adherencia y persistencia a la medicación prescrita, sino también por su impacto negativo en la calidad de vida y mortalidad de la población en general. Objetivo: Comparar la persistencia en la toma de medicamentos de uso crónico entre anticonceptivos, hipolipemiantes, flebotónicos, antihipertensivos y antirresortivos de un programa de reposición periódica de medicamentos sin costo, de acuerdo a variables demográficas, de dispensación y del modelo de reposición, en pacientes adultos prescritos con estas terapias y seguidos durante dos años. Pacientes y métodos: Se llevó a cabo un estudio de casos y controles anidados en una cohorte a partir de la base de datos de un programa de reposición periódica de medicamentos sin costo de operación nacional, diseñado para mejorar la adherencia y persistencia a medicamentos de varios grupos terapéuticos de uso crónico y anticonceptivos, en pacientes adultos (N= 57.576), residentes en 378 municipios de Colombia durante dos años de seguimiento. Se consideró que un paciente es persistente a una terapia prescrita cuando el tiempo durante el cual continúa con el tratamiento fuera ≥80% del periodo de seguimiento, en términos de frecuencia de recompra y tiempo de uso. Posteriormente se realizó un análisis bivariado con el fin de identificar la relación entre las variables del estudio y finalmente se evaluó el poder predictor de las variables estudiadas en la persistencia al uso de la terápia a los seis, 12 y 17 meses de tratamiento, a través de una regresión logística binaria. Resultados: Las variables predictoras más relevantes para el desenlace de persistencia a los seis, 12 y 17 meses de tratamiento fueron la edad, (para anticonceptivos, hipolipemiantes y flebotónicos), el tipo de reposición para antihipertensivos, y el tipo de entrega para los antirresortivos. Conclusión: La persistencia al uso de terapias de uso crónico y anticonceptivos, en el marco de un programa de reposición de medicamentos sin costo es de etiología multifactorial; donde están involucradas tanto variables propias del paciente como del medicamento y del modelo de reposición utilizado. La no persistencia al uso de los medicamentos estudiados fue alta en todos los grupos terapéuticos, lo cual es llamativo considerando que se trata de un programa de reposición de medicamentos totalmente gratuito. Introduction: Adherence and persistence to pharmacological therapies are of the most discussed and studied secondary prevention strategies worldwide. In the last decades, the interest in their role in clinical and social outcomes, has increased considerably; therefore, several research had studied the impact of different pro- adherence techniques compared to non-intervention (usual management), these alternatives have been more effective than non-intervention. However, it is still a challenge for clinicians and general society, not just because of the huge amount of health expenditures generated by the lack of adherence and persistence to prescribed medication, but also because of its negative impact on quality of life and mortality of general population. Objetive: Compare persistence to chronic contraceptives, lipid-lowerings agents, phlebotonic, antihypertensive and antiresorptive drugs in a non-cost periodic drug replacement program according to demographic, dispensing and replacement model variables in adult patients prescribed with these therapies and followed over two years. Patients and methods: A case-control study nested in a retrospective cohort was conducted from a database of a national periodic drug replacement program without costs, designed to improve drug adherence and persistence in several therapeutic groups (N = 57,576), living in 378 towns of Colombia, during a two years’ follow-up. Persistence to a prescribed therapy is defined as frequency of repurchase and duration of use greater than 80% throug the entire treatment. Subsequently, a bivariate analysis was performed to identify the association between studied variables and finally their predictive power in persistence to the evaluated therapy after 6, 12 and 17 months, through a binary logistic regression. Results: The most relevant predictor variables of persistence as an outcome at six, 12 and 17 months were: age (for contraceptives, lipid-lowering agents and phlebotonics), “type of replacement” for antihypertensives, and “type of delivery” for antiresorptives. Conclusion: Persistence to chronic therapies and contraceptives, has multifactorial etiology in a no - cost drug replacement program; where patient's, drug’s and replacement model variables are involved. Non-persistence to studied drugs was high in all therapeutic groups, which is striking considering that it is a totally free drug replacement program. 2019-08-01 06:01:01: Script de automatizacion de embargos. info:eu-repo/date/embargoEnd/2019-05-16 2017-05-08 2017-05-17T16:44:59Z info:eu-repo/semantics/masterThesis info:eu-repo/semantics/acceptedVersion http://repository.urosario.edu.co/handle/10336/13387 spa http://creativecommons.org/licenses/by-nc/2.5/co/ info:eu-repo/semantics/openAccess application/pdf Universidad del Rosario Maestría en Epidemiología Facultad de medicina instname:Universidad del Rosario reponame:Repositorio Institucional EdocUR Dilla T VA, Lizán L, Sacristán JA. . Adherencia y persistencia terapéutica: causas, consecuencias y estrategias de mejora. . Atención Primaria 41:342–8. CdlC E. El futuro de la asistencia sanitaria y de la atención a las personas mayores: garantizar la accesibilidad, la calidad y la sostenibilidad financiera. Bruselas: Comunidad Europea. 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score 12,131701