AUTOCUIDADO E COMPLEXIDADE FARMACOLÓGICA EM INDIVÍDUOS COM ARTRITE REUMATOIDE

Abstract

Introduction: Rheumatoid arthritis is a chronic inflammatory disease that, due to disabling symptoms, impairs quality of life and functional capacity, leads to loss of productivity, and generates high costs for society. The impact of arthritis on individuals’ lives can negatively affect self-care. The high pharmacological complexity is suggestive of lower quality of self care. Aim: To analyze the relationship between self-care and pharmacological complexity in individuals with rheumatoid arthritis. Methodology: This research is made up of three methodological aspects. The first corresponds to a bibliometric review of Brazilian studies that used Dorothea Elizabeth Orem’s self-care deficit theory. The second is a scoping review to summarize studies relating to self-care in individuals with rheumatoid arthritis. The third consists of a cross-sectional study with patients treated in an outpatient clinic of a teaching hospital in the Mid-West region of Brazil in the year 2023. For data collection, a sociodemographic and health data form, the Appraisal of Self-Care Agency Scale – Revised and the Pharmacotherapy Complexity Index (categorized into low, intermediate and high complexities) were used. Descriptive and analytical statistics were used by means of percentiles, Shapiro-Wilk, ANOVA and Kruskal-Wallis. The project was accepted by the Ethics Committee under substantiated Opinion nº 69631023.6.0000.0021. Results: In the scoping review, 31 studies were retrieved, published between 1999 and 2022, with a predominance of cross-sectional studies and published in English. The most common factors related to pharmacological treatment and changes in self-care were: medication side effects, quantity of medication, indefinite treatment period, self-medication, knowledge of the treatment, positive effects of the treatment, as well as fear and negative beliefs. When developing the bibliometric review, 29 articles were retrieved, published from 2001 to 2022. There was a predominance of articles in Brazilian journals, in Portuguese language, with descriptive-exploratory and qualitative studies. Content analysis generated three classes: Use of theory in research, Nursing interventions and Development of instruments. The use of Orem’s theory in research continues to increase progressively, being used in parts or in full, isolated or with other theories. The use is little explored in pediatric and hebiatric studies, with a higher level of evidence. The theory is used in multiple contexts and methodologies, with results for theory and practice. Future research can develop more robust studies to strengthen self-care actions in an evidence-based practice. In the cross-sectional research, the sample consisted of 96 individuals, with self-care averages of 56.33 (Median=57.0), intermediate level, and pharmacotherapy complexity averages of 18.29 (Median=16.0), intermediate complexity. The median power scores for self-care under development were different (p=0.042), when comparing individuals with low (Median=19.50) and high (Median=21.50) complexities, from the frequency of medication doses. The median scores for lack of power for self-care were significantly different (p=0.011) between individuals with intermediate (Median=12.00) and high (Median=9.00) levels of pharmacotherapy complexity in global terms. Conclusion: The relationship between self-care and medicinal treatment for individuals with rheumatoid arthritis involves multiple variables. Possibly, an individualized approach makes it possible to understand the factors of each individual and the management to improve self-care. Higher scores for the development of power for self-care were observed among individuals with high pharmacotherapy complexity for dose frequencies, as well as lower scores for lack of power for self-care among individuals with high global pharmacotherapy complexity. These findings indicate a willingness to develop greater power for self-care among individuals with high pharmacotherapy complexity, when referring to dose frequency, and a lower inclination towards self-care, when analyzing the pharmacotherapy complexity in global terms. Further investigations should focus on the analysis of possible relationships between self-care factors and pharmacological complexity factors. In the current study, it was proposed to categorize each MRCI factor into levels of complexity, in order to enable the analysis of possible differences in self-care. Nevertheless, it is still necessary to test and consolidate the categorizations used and also expand the analysis of these relationships, in such a way as to estimate their intensity and identify interfering variables in this process, as well as investigate the effects of interventions on the self-care potential, in its different factors, when faced with different conditions of pharmacotherapy complexity.