Fatores associados à adesão ao tratamento em portadores de transtorno por uso de álcool e/ou outras drogas: um estudo longitudinal
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Data
2021-03-02
Autores
Possato, Renata de Almeida Moraes
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A presente pesquisa teve como objetivo identificar fatores associados à adesão ao tratamento, de pessoas com transtorno por uso de álcool e outras substâncias em um Centro de Atenção Psicossocial Álcool e Drogas (CAPS-AD). Trata-se de um estudo observacional, de corte longitudinal e prospectivo, no qual os sujeitos foram avaliados no início do tratamento, com instrumentos validados no país. Os participantes do estudo foram acompanhados através de seus prontuários individuais, para controle da frequência no serviço, até a alta, abandono do tratamento (trinta dias consecutivos de ausência) ou seguimento por três meses. Foram investigadas as seguintes variáveis explanatórias: sócio demográficas, saúde física, relacionamento familiar e afetivo, história do uso de substâncias (tempo e tipos), padrão de consumo e/ou abstinência (em dias) durante o tratamento, envolvimento atual com a justiça, histórico criminal, saúde mental, motivação para o tratamento e abstinência, apoio social e frequência ao tratamento. O apoio social foi investigado por meio da Escala de Apoio Social e a prontidão para mudança (estágios motivacionais) a partir dos escores dos instrumentos: ASI-6, URICA e SOCRATES. O desfecho do estudo foi a adesão ao tratamento definido pelo tempo de tratamento. Foi considerado abandono à falta por trinta dias consecutivos, sem justificativa ao serviço de saúde. O cálculo do tamanho amostral estimou que 200 sujeitos, permitiriam a detecção de diferenças absolutas na incidência de falha de, no mínimo, 20%. As variáveis contínuas foram descritas na forma de médias ou medianas, com intervalo de confiança de 95% ou intervalo interquartílico. No total foram entrevistados 171 sujeitos, a amostra foi descrita separadamente para homens (133) e mulheres (38). Procedeu-se a análise univariada, identificando-se as variáveis a serem inseridas no modelo multivariado. A análise multivariada foi conduzida por meio dos modelos de Regressão Logística para o desfecho binário caracterizado por adesão e não adesão. Permaneceram no modelo final as variáveis, ter feito uso de crack, nos 30 dias que antecederam a coleta de dados (OR=2,83 com IC= 1,32- 6,05) associada a não- adesão e ter vivenciado problema devido dificuldades para pensar, compreender ou lembrar, nos 30 dias que antecederam ao estudo (OR=0,51 com IC= 0,26- 0,99) e ter duas ou mais comorbidades físicas (OR=0,42 com IC= 0,19- 0,94) associadas à adesão. A associação entre o uso de crack nos 30 dias que antecederam o início do tratamento e a não adesão, ressalta a importância de repensar ações específicas para o tratamento dessa população nos CAPS-AD, visando incrementar a política pública, embora mais estudos sejam necessários investigando a temática.
The present research aimed to identify factors associated with treatment adherence, of people with alcohol and other substance use disorders at a Psychosocial Care Center for Alcohol and Drugs (CAPS-AD). This is an observational, longitudinal and prospective study, in which the subjects were evaluated at the beginning of treatment, with instruments validated in the country. The study participants were followed through their individual medical records, to control the frequency in the service, until discharge, treatment abandonment (thirty consecutive days of absence) or follow-up for three months. The following explanatory variables were investigated: socio-demographic, physical health, family and emotional relationships, history of substance use (time and types), consumption pattern and / or abstinence (in days) during treatment, current involvement with justice, criminal history, mental health, motivation for treatment and abstinence, social support and treatment frequency. Social support was investigated through the Social Support Scale and readiness for change (motivational stages) based on the scores of the instruments: ASI-6, URICA and SOCRATES. The study's outcome was adherence to treatment defined by the length of treatment. It was considered abandonment the absence for thirty consecutive days, without justification to the health service. The calculation of the sample size estimated that 200 subjects would allow the detection of absolute differences in the incidence of failure of at least 20%. Continuous variables were described as means or medians, with a 95% confidence interval or interquartile range. In total, 171 subjects were interviewed, the sample was described separately, men (133) and women (38). The univariate analysis was performed, identifying the variables to be inserted in the multivariate model. The multivariate analysis was conducted using the Logistic Regression models for the binary outcome adapted for adherence and non-adherence. The variables, to have used crack in the 30 days prior to data collection (OR = 2.83 with CI = 1.32-6.05) associated with non-adherence and to have a problem due to difficulties in think, understand or remember, in the 30 days prior to the study (OR = 0.51 with CI = 0.26-0.99) and have two or more physical comorbidities (OR = 0.42 with CI = 0.19 - 0.94) associated with adherence. The association between the use of crack in the 30 days prior to the start of treatment and non-adherence, highlights the importance of rethinking specific actions for the treatment of this population in the CAPS-AD, with the aim of to increase public policy, although more studies need to investigate the theme.
The present research aimed to identify factors associated with treatment adherence, of people with alcohol and other substance use disorders at a Psychosocial Care Center for Alcohol and Drugs (CAPS-AD). This is an observational, longitudinal and prospective study, in which the subjects were evaluated at the beginning of treatment, with instruments validated in the country. The study participants were followed through their individual medical records, to control the frequency in the service, until discharge, treatment abandonment (thirty consecutive days of absence) or follow-up for three months. The following explanatory variables were investigated: socio-demographic, physical health, family and emotional relationships, history of substance use (time and types), consumption pattern and / or abstinence (in days) during treatment, current involvement with justice, criminal history, mental health, motivation for treatment and abstinence, social support and treatment frequency. Social support was investigated through the Social Support Scale and readiness for change (motivational stages) based on the scores of the instruments: ASI-6, URICA and SOCRATES. The study's outcome was adherence to treatment defined by the length of treatment. It was considered abandonment the absence for thirty consecutive days, without justification to the health service. The calculation of the sample size estimated that 200 subjects would allow the detection of absolute differences in the incidence of failure of at least 20%. Continuous variables were described as means or medians, with a 95% confidence interval or interquartile range. In total, 171 subjects were interviewed, the sample was described separately, men (133) and women (38). The univariate analysis was performed, identifying the variables to be inserted in the multivariate model. The multivariate analysis was conducted using the Logistic Regression models for the binary outcome adapted for adherence and non-adherence. The variables, to have used crack in the 30 days prior to data collection (OR = 2.83 with CI = 1.32-6.05) associated with non-adherence and to have a problem due to difficulties in think, understand or remember, in the 30 days prior to the study (OR = 0.51 with CI = 0.26-0.99) and have two or more physical comorbidities (OR = 0.42 with CI = 0.19 - 0.94) associated with adherence. The association between the use of crack in the 30 days prior to the start of treatment and non-adherence, highlights the importance of rethinking specific actions for the treatment of this population in the CAPS-AD, with the aim of to increase public policy, although more studies need to investigate the theme.
Descrição
Palavras-chave
Transtornos relacionados ao uso de substâncias, Centros de tratamento de abuso de substâncias, Estudo longitudinal, Adesão, Substance-related disorders, Substance Abuse Treatment Centers, Longitudinal study, Adherence