536 例风湿热巴西儿童的二级预防依从性与疾病复发。
Adherence to secondary prophylaxis and disease recurrence in 536 Brazilian children with rheumatic fever.
机构信息
Pediatric Rheumatology, Floating Hospital for Children at Tufts Medical Center, 800 Washington St, box#190, Boston, MA, 02111, USA.
出版信息
Pediatr Rheumatol Online J. 2010 Jul 26;8:22. doi: 10.1186/1546-0096-8-22.
BACKGROUND
More than 15 million people worldwide have rheumatic fever (RF) and rheumatic heart disease due to RF. Secondary prophylaxis is a critical cost-effective intervention for preventing morbidity and mortality related to RF. Ensuring adequate adherence to secondary prophylaxis for RF is a challenging task. This study aimed to describe the rates of recurrent episodes of RF, quantify adherence to secondary prophylaxis, and examine the effects of medication adherence to the rates of RF in a cohort of Brazilian children and adolescents with RF.
METHODS
This retrospective study took place in the Pediatric Rheumatology outpatient clinic at a tertiary care hospital (Instituto de Puericultura e Pediatria Martagão Gesteira) in Rio de Janeiro, Brazil, and included patients with a diagnosis of RF from 1985 to 2005.
RESULTS
536 patients with RF comprised the study sample. Recurrent episodes of RF occurred in 88 of 536 patients (16.5%). Patients with a recurrent episode of RF were younger (p < 0.0001), more frequently males (p = 0.003), and less adherent (p < 0.0001) to secondary prophylaxis than patients without RF recurrence. Non-adherence to medication at any time during follow-up was detected in 35% of patients. Rates of non-adherence were higher in the group of patients that were lost to follow-up (42%) than in the group of patients still in follow-up (32%) (p = 0.027). Appointment frequency was inadequate in 10% of patients. Higher rates of inadequate appointment frequency were observed among patients who were eventually lost to follow-up (14.5%) than in patients who were successfully followed-up (8%) (p = 0.022). 180 patients (33.5%) were lost to follow up at some point in time.
CONCLUSIONS
We recommend implementation of a registry, and a system of active search of missing patients in every service responsible for the follow-up of RF patients. Measures to increase adherence to secondary prophylaxis need to be implemented formally, once non-adherence to secondary prophylaxis is the main cause of RF recurrence. Detection of irregularity in secondary prophylaxis or in appointments should be an alert about the possibility of loss of follow-up and closer observation should be instituted.
背景
全球有超过 1500 万人患有风湿热（RF）和风湿性心脏病。二级预防是预防与 RF 相关发病率和死亡率的关键且具有成本效益的干预措施。确保充分遵守 RF 的二级预防是一项具有挑战性的任务。本研究旨在描述 RF 复发的发生率，量化对二级预防的依从性，并检查药物对巴西患有 RF 的儿童和青少年 RF 发生率的影响。
方法
本回顾性研究在巴西里约热内卢的一家三级保健医院（Instituto de Puericultura e Pediatria Martagão Gesteira）的儿科风湿病门诊进行，纳入了 1985 年至 2005 年期间被诊断为 RF 的患者。
结果
研究样本包括 536 名 RF 患者。536 名 RF 患者中有 88 名（16.5%）发生 RF 复发。RF 复发患者比未发生 RF 复发的患者年龄更小（p<0.0001），更常为男性（p=0.003），对二级预防的依从性更低（p<0.0001）。在随访期间，任何时候都有 35%的患者未遵医嘱服药。失访组患者的不遵医嘱率（42%）高于仍在随访组的患者（32%）（p=0.027）。10%的患者预约频率不足。在最终失访的患者中，预约频率不足的发生率更高（14.5%），而在成功随访的患者中，这一比例为 8%（p=0.022）。180 名（33.5%）患者在某个时间点失访。
结论
我们建议实施登记制度和主动寻找每一个负责 RF 患者随访的服务中失访患者的系统。一旦二级预防的不依从是 RF 复发的主要原因，就需要正式实施提高二级预防依从性的措施。检测二级预防或预约的不规律应警惕失访的可能性，并应进行更密切的观察。
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