Features of patient-oriented care for patients with autoimmune diseases

Maxim Alexandrovich Yakovlev; Яковлев Максим Александрович; Anna Vasilyevna Kryuchkova; Крючкова Анна Васильевна; Olga Alekseevna Panina; Панина Ольга Алексеевна; Natalia Mikhailovna Semynina; Семынина Наталья Михайловна; Julia Victorovna Kondusova; Кондусова Юлия Викторовна

Features of patient-oriented care for patients with autoimmune diseases

Authors: Yakovlev M.A.¹, Kryuchkova A.V.¹, Panina O.A.¹, Semynina N.M.¹, Kondusova J.V.²
Affiliations:
1. Voronezh State Medical University N.N. Burdenko
2. Voronezh State Medical University named after N. N. Burdenko
Issue: Vol 13 (2024): Материалы XX Международного Бурденковского научного конгресса 18-20 апреля 2024 года
Pages: 489-491
Section: Сестринское дело
URL: https://new.vestnik-surgery.com/index.php/2415-7805/article/view/9577

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Abstract

Introduction. Patient-oriented medicine is a mechanism that can improve the quality of medical care. A personalized approach, early detection of comorbid pathology helps to increase patients' adherence to therapy and improve their quality of life. Goal. The introduction of a patient-oriented model into the practice of nurses working with patients suffering from autoimmune diseases. Materials and methods. The study included 29 patients suffering from autoimmune thyroiditis. The Beck test was used to study and identify depressive tendencies. Results. Autoimmune thyroiditis is most often affected by women over the age of 60, and the age of onset and heredity are predictors of adverse outcomes of the disease. Comorbid pathology is depression. The maximum values of depressive disorders were found in patients who had passed from 6 months to 1 year from the moment of diagnosis. Conclusions. The inclusion of elements of cognitive behavioral therapy in the care of patients with autoimmune thyroiditis will lead to the correction of depressive disorders. This will increase patients' commitment to therapy and provides justification for the introduction of a patient-oriented model into the practice of nurses working with patients suffering from autoimmune diseases.

Keywords: autoimmune thyroiditis; depression; patient-oriented care

Keywords

autoimmune thyroiditis, depression, patient-oriented care

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Introduction. Patient-oriented medicine is an urgent area at the present time. This requires a transformation of interaction towards partnership, a shift in priorities. In the last decade, scientists around the world have drawn attention to a new strategy where great attention is paid to care, with an emphasis on the patient's health. The priority national project "Health" and other national programs, government funding, which allowed the implementation of these programs, were aimed at transforming the health care system and did not focus on the personalization of medicine, on the individualization of problems. Patient-oriented medicine is recognized to solve these problems, and an appropriate approach can improve the quality of medical services. In the concept of patient-oriented medicine, a large part is occupied by solving issues of comorbid conditions, since The management tactics of such patients differs sharply from the therapy of other patients [1, 2]. Any chronic diseases, including autoimmune ones, can cause depression in a patient due to their disabling nature and/ or due to torpidity to treatment. In addition, autoimmune lesions of the thyroid gland and adrenal glands can cause depressive-phobic experiences both due to the direct pathogenic effect of autoreactive immune agents on the brain, and on the basis of hormonal, metabolic and sensory disorders. All this makes autoimmune pathology an important prerequisite for the development of depressive symptoms in patients. Depression in this pathology, as in many others, leads to distrust of medical treatment tactics. Patients do not believe in the success of drug therapy and begin to look for alternative non-traditional methods of therapy, resort to "folk" remedies. All this has a negative effect on the prognosis of the disease. If we consider depressive disorders among the general population, today about 18% have this disorder. In patients with chronic non-communicable diseases, this figure reaches 32-43%. And if targeted screening is carried out, depression is detected in 45-95% (69% on average) of patients who seek medical help from primary health care for somatic symptoms. Early detection and timely measures taken to correct depressive disorders in chronic patients will help to increase patient compliance, which dictates the need to introduce new, innovative teaching methods in medical universities and postgraduate education [3, 4]. The authors have analyzed scientific papers dealing with the problems of autoimmune diseases, but the issues of depressive disorders that reduce patients' adherence to therapy have not been sufficiently considered.
The aim of the work is a theoretical justification for the introduction of a patient-oriented model into the practice of nurses working with patients suffering from autoimmune diseases.
Materials and methods of research. The study included 29 patients aged 20-70 years with autoimmune thyroiditis. Heredity was studied, body weight and height were measured. Heart rate per minute at rest (HR) was assessed, blood pressure (SMAD), ECG/daily monitoring, general and biochemical blood analysis, hormonal profile were measured. An ultrasound of the thyroid gland was performed. The Beck test was used to study and identify depressive tendencies. The obtained data were statically processed using the Statistica for Windows 7.0 statistical analysis software package, and the Student's parametric criterion was used to estimate the average values of the studied indicators.

The results of the study. Among all autoimmune diseases, autoimmune thyroiditis accounts for 2% in the age structure of patients under 18 years old, and among children autoimmune thyroiditis is registered in 1% of cases and with increasing age, not only the number of cases of autoimmune diseases increases, but also the number of cases of autoimmune thyroiditis increases. Patients had a different period from the moment of detection of the disease: up to 2 months, from 2 to 6 months, from 6 months to 1 year, more than 1 year and more than 3 years
The average age of the patients was 46.2±1.1 years. Men made up 32% and women 68%. Thus, studies have shown that both sexes are susceptible to this pathology, but women are more likely to suffer from autoimmune thyroiditis. This is due to the peculiarities of the hormonal status of women, with a large number of hormonal changes during a woman's life.
In the diagnosis and treatment of any disease, it is of great importance to identify the etiology, because the "gold standard" of any treatment is the effect on the etiological factor of the disease. According to modern data, the mechanisms of development of autoimmune thyroiditis are: genetic predisposition (family cases), geographical location (place of residence), age of onset of the disease (the earlier the onset, the worse the prognosis), frequency of exacerbations and relapses (each exacerbation carries a deterioration in the prognosis for the future). Genetic predisposition was detected in 18 patients (62%), all patients were born and live in the Central District, the age of debut under 30 years – in 20 patients (68%), from 30 to 50 years – in 9 people (32%). Based on the data reviewed, it can be noted that the age of onset and heredity play a major role in the development of autoimmune thyroiditis.
Depressive disorders associated with chronic pathology lead to a decrease in compliance. And a decrease in patients' adherence to therapy entails the rejection of doctor's prescriptions and, as a result, the ineffectiveness of therapy. Autoimmune thyroiditis is usually accompanied by hypothyroidism, which also affects the emotional sphere of the patient, exacerbating depression. Decreased thyroid function was detected in 8 people (27%). Depressive disorders in patients develop up to 2 months after diagnosis in 20%. If the duration of the disease is 3 years or more, then the incidence of depression is 24%. But the highest values of depressive disorders were found in patients who had from 6 months to 1 year from the moment of diagnosis.
Conclusion. Autoimmune thyroiditis significantly worsens the quality of life of patients, as it is often accompanied by a hypothyroid condition and depressive disorders. According to the analysis, autoimmune thyroiditis is most often affected by women over the age of 60, predictors of adverse outcomes of the disease are the age of onset and heredity. Comorbid pathology in autoimmune diseases is depression. Its timely correction, including psychological assistance provided by a nurse in the process of caring for a patient, is an important factor in improving the quality of life of a patient with autoimmune diseases. The conducted research indicates the need to expand the knowledge of the nurse about the patient's comorbid pathology. The inclusion of elements of cognitive behavioral therapy in the care of patients with autoimmune diseases will lead to the correction of depressive disorders. This will increase patient adherence to therapy and improve the patient's quality of life.
Thus, a theoretical justification has been obtained for the introduction of a patient-oriented model into the practice of nurses working with patients suffering from autoimmune diseases.

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