final program.qxd - Parallels Plesk Panel

PP 4.11
Self-Evaluation Investigation of patients treated by Antiretoviral Therapy
B.COUREAU*, B.PAVY*, J.JOACHIM*, T.DANTIN*, F.LANET*, R.GUILHAUMOU*,
J.GRASSI*, I.POIZOT-MARTIN**, J.A. GASTAUT**, C.PENOT RAGON*
*Pharmacie CHU Sainte Marguerite MARSEILLE **CISIH Sud CHU Sainte Marguerite
MARSEILLE
Objectives: To assess the compliance of patients undertaking highly active antiretroviral
(ARV) therapy, based on an anonym self-questionnaire, in relationship with their therapy.
Methods: Within CISIH (Centre d'Information et de Soins de l'Immunodéficience Humaine)
of Sainte-Marguerite Hospital in Marseille, the Pharmacy department has an advanced
delivery unit of antiretroviral therapy, allowing a preferential contact with the patients cared
for in this center. Patients were proposed to answer a self-evaluation questionnaire during
one month in October 2005.
The questionnaire was composed by eight items: number of ARV drugs (one drug is
considered as a brandname either it contains one, two or three molecules); quantity of
pills; frequency of daily dose; management of drugs necessiting a cold storage; impact of
adverse effects on patient adhesion to his treatment; information given to the patient
towards his therapy. Apart the auto-evaluation, the patient was free to express his feelings
towards his medical situation.
Results: Among the 350 patients receiving their medications in the unit during October
2005, 150 (43%) answered the questionnaire. We differenciated four patient compliance
categories : 48% never forgot a dose (grade 1), 36% forgot a dose less than one time a
week (grade 2), 9% forgot one dose a week (grade 3) and 7% more than one dose a week
(grade 4).
It can be correlated to the non-observance : 36% of grade 4 have to take between 6 and
10 pills a day against 19% for the grade 1. Curiously, patients less observant are those
taking less drugs : grade 4 have a maximum of 3 kinds compared with higher quantity
(maximum 6) in the other categories, that could be explained by the increase of
adherence with persistence and aggravation of symptoms.
55% of grade 4 have adverse effects versus 30% in the grade 1. There are : gastrointestinal
troubles, weariness, lipodystrophy, headache, muscular cramps the most
frequently formulated by 1/3 of patients whatever the grade of compliance.
Concerning drugs with a necessary cold storage, 100% of grade 4 declare that this
obligation is a real daily problem, furthermore in occasionnal situation like business trip.
Only 19 of the 150 patients (12,7%) declared being bad-informed about the therapy in a
global way, what is a positive point for medical center staff, but they included 45% of the
grade 4.
Finally, to the item " free appreciation about your therapy ", great majority of people
interviewed were optimistic, most of them still waiting for " a dose a day " and especially
for the vaccine.
Conclusions: Adherence impact is not always directly related to the number of drugs
composing the therapy, but is more correlated to the number of daily pills, to cold storage
constraint and patient's feeling of bad or lacking information. These data are the sensitive
points on which all medical and pharmaceutical staff must improve their actions.
“ Focusing FIRST on PEOPLE “ 192 w w w . i s h e i d . c o m