A importância da equipe multidisciplinar na visão do paciente portador de Doença Inflamatória Intestinal
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Data
2021-12-17
Autores
Herrerias, Giedre Soares Prates [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Doença inflamatória intestinal (DII) caracteriza-se por inflamação crônica do intestino, e suas formas mais comuns são a Doença de Crohn (DC) e a Retocolite Ulcerativa (RCU) que necessitam de cuidado contínuo. O contato constante com a equipe multiprofissional e a qualidade do atendimento interferem na adesão ao tratamento e na qualidade de vida (QV) dos pacientes, e consequentemente, na eficácia do tratamento. Consensos internacionais recomendam que os centros de referência em DII devem ser compostos por equipe multidisciplinar, com a presença de gastroenterologista clínico, coloproctologista ou cirurgião do aparelho digestivo, nutricionista, enfermeiro e psicólogo, entre outros profissionais. O objetivo do estudo foi avaliar a importância da equipe multidisciplinar na visão dos pacientes com DII. Métodos: Foi desenvolvido um estudo transversal e descritivo, com inclusão de 114 pacientes atendidos no Ambulatório de DII do Hospital das Clínicas da Faculdade de Medicina de Botucatu. Os dados sociodemográficos e clínicos, juntamente com a relevância da equipe multidisciplinar, foram avaliados. A importância da equipe multidisciplinar foi avaliada por meio de questionário específico desenvolvido para a pesquisa com as respostas: nada importante, sem importância, importante e muito importante para cada profissional. Os pacientes listaram os profissionais em ordem de importância. A QV foi avaliada pelo questionário IBDQ. A adesão ao tratamento e o conhecimento da doença foram avaliados pelos questionários Morisky e CCKNOW, respectivamente. Resultados: Foram incluídos 69 (60,53%) pacientes com DC e 45 (39,47%) com RCU. A idade média foi de 39,16±13,50 anos, 67 (58,77%) do sexo feminino. O tempo de diagnóstico foi de 9,88±7,35 anos. Presença de comorbidades foi observada em 52,63% da amostra. Cem por cento dos pacientes realizaram consultas com o gastroenterologista clínico, e menos da metade com psicólogo (48,25%), nutricionista (47,37%), enfermeiro DII (43,86%) e coloproctologista (42,98%). Observou-se que os atendimentos do enfermeiro e coloproctologista são mais prevalentes nos pacientes com DC. As três categorias citadas como muito importante/importante foram: gastroenterologista (99,12%), coloproctologista (96,55%) e endoscopista (93,47%), em 4ª posição o enfermeiro especialista em DII (93,26%), em 6ª posição o nutricionista (90,63%) e em 10ª posição o psicólogo (84,61%). A QV foi considerada excelente ou boa em 45,61% dos pacientes. A adesão ao medicamento foi baixa em 58,88% dos pacientes. O conhecimento sobre a doença foi baixo (6,21 ± 3,99 pontos), sendo maior dentre os pacientes com DC (p = 0,01). Conclusão: Os pacientes consideraram os médicos como os profissionais mais importantes no seu atendimento. Embora o serviço conte com equipe multidisciplinar, nem todos os pacientes tiveram oportunidade de passar em consulta com todos os profissionais. A falta de contato com toda a equipe, principalmente com o enfermeiro, pode ter contribuído para a baixa adesão medicamentosa e para o baixo conhecimento da doença, impactando no controle da doença e na QV. O cuidado holístico ao paciente é recomendado, enfatizando a importância de todos os profissionais do atendimento multidisciplinar para todos os pacientes com DII.
Introduction: Inflammatory bowel disease (IBD) is characterized by chronic bowel inflammation, and its most common forms are Crohn's Disease (CD) and Ulcerative Colitis (UC) that require continuous care. The constant contact with the multidisciplinary team and the quality of care interferes in the adherence to the treatment and in the patient’s quality of life (QL), and, consequently, in the effectiveness of the treatment. International consensus recommends that IBD reference centers should be composed of a multidisciplinary team, with the presence of a gastroenterologist, coloproctologist, nutritionist, nurse and psychologist, among other professionals. The aim of the study was to assess the importance of the multidisciplinary team in the view of patients with IBD. Methods: A cross-sectional and descriptive study was carried out, including 114 patients from a tertiary center. Sociodemographic and clinical data, along with the relevance of the multidisciplinary team, were assessed. The importance of the multidisciplinary team was assessed through a questionnaire developed for the survey with the answers: nothing important, unimportant, important, and very important for each professional. Patients listed professionals in order of importance. QoL was assessed using the IBDQ questionnaire. Adherence to treatment and knowledge of the disease were assessed using the Morisky and CCKNOW questionnaires, respectively. Results: In total, 69 (60.53%) patients with CD and 45 (39.47%) with UC were included. The mean age was 39.16±13.50 years, 67 (58.77%) were female. The time from diagnosis was 9.88±7.35 years. Presence of comorbidities was observed in 52.63% of the sample. One hundred percent of patients had consultations with a clinical gastroenterologist, and less than half with a psychologist (48.25%), a nutritionist (47.37%), an IBD nurse (43.86%) and a coloproctologist (42.98%). The care provided by nurses and coloproctologists is more prevalent in patients with CD. The three categories cited as very important/important were: gastroenterologist (99.12%), coloproctologist (96.55%) and endoscopist (93.47%), in 4th position the nurse specialist in IBD (93.26%), in the 6th position the nutritionist (90.63%) and in 10th position the psychologist (84.61%). QoL was considered excellent or good in 45.61% of patients. Medication adherence was low in 58.88% of patients. Knowledge about the disease was low (6.21 ± 3.99 points), being higher among CD patients (p = 0.01). Conclusion: Patients considered doctors as the most important professionals in their care. Although the service has a multidisciplinary team, not all patients had the opportunity to consult with all professionals. The lack of contact with the entire team, especially with the nurse, may have contributed to low medication adherence and low knowledge of the disease, impacting disease control and QoL. Holistic patient care is recommended, emphasizing the importance of all professionals in multidisciplinary care for all patients with IBD.
Introduction: Inflammatory bowel disease (IBD) is characterized by chronic bowel inflammation, and its most common forms are Crohn's Disease (CD) and Ulcerative Colitis (UC) that require continuous care. The constant contact with the multidisciplinary team and the quality of care interferes in the adherence to the treatment and in the patient’s quality of life (QL), and, consequently, in the effectiveness of the treatment. International consensus recommends that IBD reference centers should be composed of a multidisciplinary team, with the presence of a gastroenterologist, coloproctologist, nutritionist, nurse and psychologist, among other professionals. The aim of the study was to assess the importance of the multidisciplinary team in the view of patients with IBD. Methods: A cross-sectional and descriptive study was carried out, including 114 patients from a tertiary center. Sociodemographic and clinical data, along with the relevance of the multidisciplinary team, were assessed. The importance of the multidisciplinary team was assessed through a questionnaire developed for the survey with the answers: nothing important, unimportant, important, and very important for each professional. Patients listed professionals in order of importance. QoL was assessed using the IBDQ questionnaire. Adherence to treatment and knowledge of the disease were assessed using the Morisky and CCKNOW questionnaires, respectively. Results: In total, 69 (60.53%) patients with CD and 45 (39.47%) with UC were included. The mean age was 39.16±13.50 years, 67 (58.77%) were female. The time from diagnosis was 9.88±7.35 years. Presence of comorbidities was observed in 52.63% of the sample. One hundred percent of patients had consultations with a clinical gastroenterologist, and less than half with a psychologist (48.25%), a nutritionist (47.37%), an IBD nurse (43.86%) and a coloproctologist (42.98%). The care provided by nurses and coloproctologists is more prevalent in patients with CD. The three categories cited as very important/important were: gastroenterologist (99.12%), coloproctologist (96.55%) and endoscopist (93.47%), in 4th position the nurse specialist in IBD (93.26%), in the 6th position the nutritionist (90.63%) and in 10th position the psychologist (84.61%). QoL was considered excellent or good in 45.61% of patients. Medication adherence was low in 58.88% of patients. Knowledge about the disease was low (6.21 ± 3.99 points), being higher among CD patients (p = 0.01). Conclusion: Patients considered doctors as the most important professionals in their care. Although the service has a multidisciplinary team, not all patients had the opportunity to consult with all professionals. The lack of contact with the entire team, especially with the nurse, may have contributed to low medication adherence and low knowledge of the disease, impacting disease control and QoL. Holistic patient care is recommended, emphasizing the importance of all professionals in multidisciplinary care for all patients with IBD.
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Palavras-chave
Doenças Inflamatórias Intestinais, Doença de Crohn, Equipes de saúde, Retocolite ulcerativa, Ulcerative colitis, Crohn's disease, Inflammatory Bowel Disease