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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

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dc.contributor.advisorMassaro Ceballos, Mónica María
dc.creatorGarcía Rodríguez, María Carmen
dc.creatorMontenegro Montúfar, Álvaro
dc.creator.degreeMagíster en Epidemiología
dc.date.accessioned2017-05-17T16:44:59Z
dc.date.available2017-05-17T16:44:59Z
dc.date.created2017-05-08
dc.date.issued2017
dc.descriptionIntroducción: 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.spa
dc.description.abstractIntroduction: 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.eng
dc.description.embargo2019-08-01 06:01:01: Script de automatizacion de embargos. info:eu-repo/date/embargoEnd/2019-05-16spa
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.48713/10336_13387
dc.identifier.urihttp://repository.urosario.edu.co/handle/10336/13387
dc.language.isospa
dc.publisherUniversidad del Rosariospa
dc.publisher.departmentFacultad de medicinaspa
dc.publisher.programMaestría en Epidemiologíaspa
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto Completo)spa
dc.rights.ccAtribución-NoComercial 2.5 Colombiaspa
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dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subjectCumplimiento de la medicaciónspa
dc.subjectTerapias crónicasspa
dc.subjectAnticonceptivosspa
dc.subjectAdherenciaspa
dc.subjectPersistenciaspa
dc.subjectProgramaspa
dc.subjectReposición gratuitaspa
dc.subjectReposición sin costospa
dc.subjectMedicamentosspa
dc.subject.ddcIncidencia & prevención de la enfermedad
dc.subject.decsEpidemiologíaspa
dc.subject.decsSalud publicaspa
dc.subject.decsMedicamentosspa
dc.subject.decsAnticonceptivosspa
dc.subject.keywordMedication complianceeng
dc.subject.keywordChronic therapieseng
dc.subject.keywordContraceptiveseng
dc.subject.keywordAdherenceeng
dc.subject.keywordPersistenceeng
dc.subject.keywordProgrameng
dc.subject.keywordFree replacementeng
dc.subject.keywordNon-cost replacementeng
dc.subject.keywordMedicationseng
dc.subject.lembEpidemiologíaspa
dc.titleAnálisis 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 Colombiaspa
dc.typemasterThesiseng
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTesis de maestríaspa
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