Advanced nursing monitoring: At-risk patients in Primary Care
Monitoreo avanzado de enfermería: pacientes de riesgo en atención primaria
Monitoramento avançado de enfermagem: pacientes de risco na atenção primária
Layse Farias Nava; Tayse Tâmara da Paixão Duarte; Wellington Luiz de Lima; Marcia Cristina da Silva Magro
Abstract
Objective: to evaluate the effect of advanced versus usual Nursing monitoring to identify cardiovascular and renal risk, adherence to medication and practice of physical exercise in Primary Health Care.
Method: a quantitative and quasi-experimental study developed in Primary Care. In relation to the intervention, there were quarterly Nursing advanced monitoring consultations and quarterly laboratory control. For data collection, a sociodemographic questionnaire, the Morisky scale and the International Physical Activity Questionnaire were applied.
Results: the female gender predominated both in the intervention and in the control group (62.79% vs. 76.74%). The percentage of patients without cardiovascular risk in the intervention group exceeded the control group from consultation 1 to consultation 3 (0.00% - 25.58% vs. 6.98 - 2.33). Maximum adherence to medication, over time, was higher in the intervention group when compared to the control group (48.8% vs. 23.3%). The users' cardiovascular risk significantly interfered with physical activity in the intervention and control groups (p=0.0261 vs. 0.0438).
Conclusions and implications for the practice: advanced monitoring enabled better identification of at-risk patients and guidelines for the hypertensive and diabetic patients at cardiovascular and renal risk, which favored advanced monitoring and contributed to self-management of the practice of physical exercise and adherence to medication, based on Nursing consultations.
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Resumen
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Resumo
Objetivo: avaliar o efeito do monitoramento de enfermagem avançado em relação ao usual para identificação do risco cardiovascular e renal, adesão medicamentosa e prática de exercícios na atenção primária à saúde.
Método: estudo quantitativo, quase-experimental desenvolvido na Atenção primária. Em relação a intervenção, foram consultas de enfermagem trimestrais de monitoramento avançado e laboratorial trimestral. Para coleta de dados, aplicou-se questionário sociodemográfico, escala Morisky e Questionário Internacional de Atividade Física.
Resultados: sexo feminino predominou nos dois grupos intervenção e controle (62,79% vs. 76,74%). O percentual de pacientes sem risco cardiovascular do grupo intervenção superou o grupo controle da consulta 1 para consulta 3, (0,00% - 25,58% vs. 6,98 - 2,33). Adesão medicamentosa máxima, ao longo do tempo, foi superior no grupo intervenção comparado ao grupo controle (48,8% vs. 23,3%). O risco cardiovascular dos usuários interferiu na atividade física de forma significativa no grupo intervenção e controle (p=0,0261 vs. 0,0438).
Conclusões e implicações para a prática: a monitorização avançada possibilitou uma melhor identificação de pacientes de risco e orientações aos pacientes hipertensos e diabéticos com risco cardiovascular e renal, o que favoreceu o monitoramento avançado e contribuiu ao autogerenciamento da prática de exercícios e adesão medicamentosa, a partir de consultas de enfermagem.
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Referências
1 American Diabetes Association. 1. Improving care and promoting health in populations:
2 Arafat Y, Mohamed Ibrahim MI, Awaisu A, Colagiuri S, Owusu Y, Morisky DE et al. Using the transtheoretical model’s stages of change to predict medication adherence in patients with type 2 diabetes mellitus in a primary health care setting. Daru. 2019 jun 7;27(1):91-9.
3 Petersen M. Economic costs of diabetes in the U.S. in 2002. Diabetes Care. 2003;26(3):917-32.
4 American Diabetes Association. Economic costs of diabetes in the U.S. in 2007. Diabetes Care. 2008 mar 1;31(3):596-615.
5 Van Erp RMA, Van Doorn AL, Van Den Brink GT, Peters JWB, Laurant MGH, Van Vught AJ. Physician Assistants and nurse practitioners in primary care plus: a systematic review. Int J Integr Care. 2021 fev 12;21(1):6.
6 Lovink MH, Persoon A, Koopmans R, Van Vught A, Schoonhoven L, Laurant MGH. Effects of substituting nurse practitioners, physician assistants or nurses for physicians concerning healthcare for the ageing population: a systematic literature review. J Adv Nurs. 2017;73(9):2084-102.
7 Al Sadig Al Mahdi T. Overview of the course of undergraduate medical education in the Sudan. Sudan Journal of Medical Sciences. 2019 fev;14(4):188-201.
8 Gonçalves JR, Gurgel CP. Cuidados e prevenções ao diabetes no Brasil. Revista JRG de Estudos Acadêmicos. 2019 jun;2(4):1-16.
9 Cross-Denny B, Robinson MA. Using the social determinants of health as a framework to examine and address predictors of depression in later life. Aging InteR. 2017;42(4):393-412.
10 Dalmolin BB, Backes DS, Zamberlan C, Schaurich D, Colomé JS, Gehlen MH. Significados do conceito de saúde na perspectiva de docentes da área da saúde. Esc Anna Nery. 2011 jun;15(2):389-94.
11 Dineen-Griffin S, Garcia-Cardenas V, Williams K, Benrimoj SI. Helping patients help themselves: a systematic review of self-management support strategies in primary health care practice. PLoS One. 2019 Aug 1;14(8):e0220116.
12 Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67-74.
13 Matsudo S, Araújo T, Matsudo V, Andrade D, Andrade E, Oliveira LC, et al. Questionário internacional de atividade física (IPAQ): estudo de validade e reprodutibilidade no Brasil. Rev Bras Ativ Fís Saúde. 2012;6(2):5-18.
14 Hallal PC, Victora CG. Reliability and validity of the International Physical Activity Questionnaire (IPAQ). Med Sci Sports Exerc. 2004 mar;36(3):556.
15 Barros ALBL. Anamnese e exame físico: avaliação diagnóstica de enfermagem no adulto. Porto Alegre: ARTMED; 2016.
16 Governo do Distrito Federal (BR). Secretaria de Estado e Saúde. Subsecretaria de Atenção Integral à Saúde. Comissão Permanente de Protocolos de Atenção à Saúde. Protocolo de Atenção à Saúde. Manejo da Hipertensão Arterial Sistêmica e Diabetes. Mellitus na Atenção Primária à Saúde [Internet]. Brasília (DF): Secretaria de Estado e Saúde; 2018. Disponível em:
17 Jane M, Hagger M, Foster J, Ho S, Kane R, Pal S. Effects of a weight management program delivered by social media on weight and metabolic syndrome risk factors in overweight and obese adults: a randomised controlled trial. PLoS One. 2017;12(6):e0178326.
18 D’Agostino Sr RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM et al. General cardiovascular risk profile for use in primary care: the Framingham heart study. Circulation. 2008 fev 12;117(6):743-53.
19 Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL et al. Kidney Disease: Improving Global Outcomes (KDIGO). Working Group. Definition and classification of acute kidney injury. Kidney Int Suppl. [Internet]. 2012 [citado 2021 jun 15];2:19-36. Disponível em:
20 Chawla LS, Bellomo R, Bihorac A, Goldstein SL, Siew ED, Bagshaw SM et al. Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol. 2017;13(4):241-57.
21 Norful A, Martsolf G, De Jacq K, Poghosyan L. Utilization of registered nurses in primary care teams: a systematic review. Int J Nurs Stud. 2017;74:15-23.
22 Cunha CMSLM, Henriques MAP, Costa AJS. A enfermagem de saúde pública e as políticas públicas de saúde: um estudo de caso. Esc Anna Nery. 2021;25(5):e20210204.
23 Ledford CJW, Seehusen DA, Crawford PF. Toward a model of shared meaningful diagnosis. Patient Educ Couns. 2021 jan;104(1):143-8.
24 Hong YR, Cardel M, Suk R, Vaughn IA, Deshmukh AA, Fisher CL et al. Teach-back experience and hospitalization risk among patients with ambulatory care sensitive conditions: a matched cohort study. J Gen Intern Med. 2019 out;34(10):2176-84.
25 Karmali KN, Persell SD, Perel P, Lloyd-Jones DM, Berendsen MA, Huffman MD. Risk scoring for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2017;3(3):CD006887.
26 O’Neill B, Kalia S, Aliarzadeh B, Sullivan F, Moineddin R, Kelly M et al. Cardiovascular risk factor documentation and management in primary care electronic medical records among people with schizophrenia in Ontario, Canada: Retrospective cohort study. BMJ Open. 2020 out 16;10(10):e038013.
27 Donald F, Martin-Misener R, Carter N, Donald EE, Kaasalainen S, Wickson-Griffiths A et al. A systematic review of the effectiveness of advanced practice nurses in long-term care. J Adv Nurs. 2013;69(10):2148-61.
28 Miranda MV No, Rewa T, Leonello VM, Oliveira MAC. Advanced practice nursing: a possibility for Primary Health Care? Rev Bras Enferm. 2018;71(Suppl 1):716-21.
29 Levey AS, James MT. Acute kidney. Ann Intern Med. 2017 nov 7;167(9):ITC65-79.
30 Chang ET, Raja PV, Stockdale SE, Katz ML, Zulman DM, Eng JA et al. What are the key elements for implementing intensive primary care? A multisite Veterans Health Administration case study. Healthc (Amst). 2018 dez 1;6(4):231-7.
31 Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005 ago 4;353(5):487-97.
32 Mansur N, Weiss A, Hoffman A, Gruenewald T, Beloosesky Y. Continuity and adherence to long-term drug treatment by geriatric patients after hospital discharge: a prospective cohort study. Drugs Aging. 2008;25(10):861-70.
33 Fallis BA, Dhalla IA, Klemensberg J, Bell CM. Primary medication non-adherence after discharge from a general internal medicine service. PLoS One. 2013 maio 2;8(5):e61735.
34 Remondi FA, Cabrera MAS, de Souza RKT. Não adesão ao tratamento medicamentoso contínuo: Prevalência e determinantes em adultos de 40 anos e mais. Cad Saude Publica. 2014 jan;30(1):126-36.
35 Tavares NUL, Bertoldi AD, Mengue SS, Arrais PSD, Luiza VL, Oliveira MA et al. Factors associated with low adherence to medicine treatment for chronic diseases in brazil. Rev Saude Publica. 2016 dez 12;50(Suppl 2):10s.
36 Sherlock A, Brownie S. Patients’ recollection and understanding of informed consent: A literature review. ANZ J Surg. 2014 abr;84(4):207-10.
37 Jansen J, Butow PN, Van Weert JCM, Van Dulmen S, Devine RJ, Heeren TJ et al. Does age really matter? Recall of information presented to newly referred patients with cancer. J Clin Oncol. 2008 nov 20;26(33):5450-7.
38 Selic P, Svab I, Repolusk M, Gucek NK. What factors affect patients’ recall of general practitioners’ advice? BMC Fam Pract. 2011 dez 28;12(1):141.
39 McCarthy DM, Waite KR, Curtis LM, Engel KG, Baker DW, Wolf MS. What did the doctor say? Health literacy and recall of medical instructions. Med Care. 2012 abr;50(4):277-82.
40 Emmett L, Tollitt J, McCorkindale S, Sinha S, Poulikakos D. The evidence of acute kidney injury in the community and for primary care interventions. Nephron. 2017 jul 1;136(3):202-10.
41 Cunha CMSLM, Henriques MAP, Costa AJS. Public health nursing: regulation and public health policies. Rev Bras Enferm. 2020;73(6):e20190550.
Submetido em:
09/07/2021
Aceito em:
25/10/2021
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