Evaluation of Treatment Adherence of Sickle Cell Pediatric patients in Use of hydroxyurea

Sickle cell disease is a genetic and chronic disease prevalent in Brazil. It is believed that about 2500 to 3000 brazilians born a year with sickle cell disease. The most common clinical complication is the vessel occlusive crisis, the blockade of microcirculation, sickling of red blood cells, local hypoxia and ischemia of tissues, resulting in acute painful crises. To control this situation, treatment with analgesics, red blood cell transfusion and hydroxyurea (HU) are recommended.The HU administration has shown excellent results through the significant increase in the hemoglobin F levels, thus contributing to decrease in vessel occlusive crises, reducing the frequency of transfusion and potentially preventing organ damage. The treatment adherence is crucial to maintain the serum level of the drug and achieve the best therapeutic results. Adherence is defined as degree of agreement between the person's behavior in relation to guidance provided by physician or other healthcare professional.Several factors influence adherence and understand them allows the professional to develop tools to assist the patient in understanding its importance.The purpose of this study was to quantify the adherence to treatment with HU and identify related causes to non-adherence in pediatric patients with sickle cell disease.

quantitative, descriptive and retrospective study involving pediatric patients 3 to 18 years seen at GRENDACC- Jundiai-SP.The information was obtained from a questionnaire applied to 19 caregivers and pharmacotherapeutic follow-up recording form (PH) available at the pharmacy for the period from may/2010 to september/2010.PH served as an instrument to measure adherence by the method pill count. Each patient has a form that is filled with information: date and amount of medication dispensed and dosage.At each visit to pharmacy, the caregiver has the bottle for refill and pill count.During the research, the form provided information to apply the formula to verify the adherence rate: quantify dispensed – number on the bottle/treatment period × 100.It was considered a good adherence who have demonstrated a adherence rate of ≥ 90%.

The caregivers were represented mostly by mothers (68%).The caregiver's educational level varied from illiterate (1/19), complete or incomplete elementary (10/19), complete or incomplete secondary (7/19) and university (1/19). Asked about the administration of HU, 95% of caregivers reported giving the medication in correct schedule and 42% forgot to give the medicine sometime during the treatment, the reason was accumulation of tasks and concerns with other family members. In the evaluation of adherence 17 PH were viable and showed that 58.8% (10/17) of patients had an rate ≥90%. The lowest rate was 63% and ocurred in only 1 patient.

Although there is no consensus regarding the optimal rate to consider a good adherence, the papers present that rates below 80% is worrying and needs intervention. In the group evaluated, 82% presented more than 80% adherence. Pharmacotherapeutic follow-up allows rapid detection of drug related problems, with immediate intervention through guidance, and if necessary, medical or psychosocial intervention. Although there are few studies about this issue in pediatric patient, the small group of subjects studied and the short period of assessment, we believe the results support the importance of a rigorous monitoring pharmacotherapeutic by visits to pharmacy to follow-up consultations. We suggest further studies with a larger sample and longer period to confirm the importance of monitoring pharmacotherapeutic tool in improving the adherence, evaluate the impact and variables that affect the non-adherence.

No relevant conflicts of interest to declare.