“It’s not all about the disease”: do treatment and socioeconomic status affect perceived impact and satisfaction of patients treated for cutaneous leishmaniasis?

Carvalho, Carolina Di Pietro; Luz, João Gabriel Guimarães; Carvalho, Amanda Gabriela de; Carvalho, Renata Di Pietro; Pires, Herton Helder Rocha; Dias, João Victor Leite

doi:10.1590/0037-8682-0253-2022

Acessibilidade / Reportar erro

Brasil

Revista da Sociedade Brasileira de Medicina Tropical

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Major Article • Rev. Soc. Bras. Med. Trop. 56 • 2023 • https://doi.org/10.1590/0037-8682-0253-2022 copy

“It’s not all about the disease”: do treatment and socioeconomic status affect perceived impact and satisfaction of patients treated for cutaneous leishmaniasis?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background:

This cross-sectional study compared the general impact of cutaneous leishmaniasis (CL) and patient satisfaction with treatment and health services as perceived by those undergoing different therapeutic regimens in an endemic region in South-Eastern Brazil. We also investigated the factors associated with both outcomes (general impact and satisfaction).

Methods:

We included 84 patients with CL treated between 2018 and 2019 with intravenous meglumine antimoniate, liposomal amphotericin B, or intralesional meglumine antimoniate therapy. Data were collected through interviews that assessed sociodemographic characteristics, comorbidity status, access and use of health services for CL diagnosis and treatment, and the items of the Cutaneous Leishmaniasis Impact Questionnaire (CLIQ). The CLIQ is a psychometric questionnaire previously validated to assess the general impact of CL on patient satisfaction with treatment and health services. Multivariate logistic regression analysis was used to identify the factors associated with high CL impact and low patient satisfaction.

Results:

The general impact of CL and patient satisfaction with treatment and health services were not significantly associated with the therapeutic regimen. High CL impact was associated with low family income (odds ratio [OR]:3.3; 95% confidence interval [CI]:1.0-10.3), occurrence of complications/adverse effects during treatment (OR:7.7; 95%CI:2.4-25.6), and additional costs during diagnosis and/or treatment (OR:12.1; 95% CI:2.8-52.4). Low satisfaction was associated with high disease impact (OR: 9.5; 95% CI:2.7-33.9), occurrence of complications/adverse effects (OR:4.2; 95% CI:1.3-13.0), and high family income (OR:7.1; 95%CI:1.7-28.2).

Conclusions:

Our data support public health policies aimed at reducing the impact of CL and its treatment as well as the use of therapy with fewer adverse effects.

Keywords:
Cutaneous leishmaniasis; Neglected diseases; Patient satisfaction; Quality of life

Variable	IV-MA	%	IL-MA	%	IV- LAB	%	All =84	%
Sex
Male	19	50	12	44.4	12	63.2	43	51.2
Female	19	50	15	55.6	7	36.8	41	48.8
Age (years)
18-20	1	2.6	1	3.7	0	0.0	2	2.4
20-30	4	10.5	3	11.1	0	0.0	7	8.3
30-40	12	31.6	5	18.5	0	0.0	17	20.2
40-50	17	44.7	1	3.7	1	5.3	19	22.6
50-60	3	7.9	5	18.5	6	31.6	14	16.7
≥ 60	1	2.6	12	44.4	12	63.2	25	29.8
Area of residence
Rural	28	73.7	22	81.5	15	78.9	65	77.4
Urban	10	26.3	5	18.5	4	21.1	19	22.6
Schoolinglevel
Illiterate	5	13.2	4	14.8	5	26.3	14	16.7
Primaryschool	17	44.7	13	55.6	11	68.4	41	48.8
High school	15	39.5	7	18.5	3	5.3	25	2.8
College	1	2.6	3	11.1	0	0.0	4	4.8
Occupation
Retired	3	7.9	8	29.6	4	21.0	15	17.9
Hoseuwife	5	13.1	2	7.4	1	5.3	8	9.5
Farmer	14	36.8	6	22.2	6	31.6	26	30.9
Notreported	6	15.8	2	7.4	4	21.0	12	14.3
Others^a	10	26.3	9	33.3	4	21.0	23	27.4
Family income (Brazilian minimum wages) ^b
< 1	15	39.5	5	18.5	7	36.8	27	32.1
1-3	21	55.3	17	63.0	11	57.9	49	58.3
3-5	2	5.3	2	7.4	1	5.3	5	6.0
≥ 5	0	0.0	3	11.1	0	0.0	3	3.6
Comorbidity ^c
Systemic arterial hypertension	8	22.9	11	39.3	7	33.3	26	31.0
Diabetes mellitus	1	2.9	2	7.1	4	19.0	7	8.3
Mental disorders	2	5.7	2	7.1	1	4.8	5	5.9
Cancer	0	0.0	0	0.0	1	4.8	1	1.2
None	24	68.6	13	46.4	8	38.1	45	53.6

Variable	IV-MA	%	IL-MA	%	IV- LAB	%	All =84	%
Time between the appearance of the cutaneous lesion and the health care seeking (months)
< 1	9	23.7	7	25.9	10	52.6	26	31
1-2	10	26.3	11	40.7	1	5.3	22	26
2-3	12	31.6	5	18.5	3	15.8	20	24
3-4	3	7.9	1	3.7	1	5.3	5	5.9
≥ 4	4	10.5	3	11.1	4	21.1	11	13
First health service sought after the appearance of the cutaneous lesion
Basic care unit	25	65.8	21	77.8	13	68.4	59	70
Referral hospital	7	18.4	2	7.4	1	5.3	10	12
Polyclinic	4	10.5	1	3.7	4	21.1	9	11
Private doctor	2	5.3	3	11.1	1	5.3	6	7.2
Diagnosis of CL confirmed in the first health service sought
Yes	14	36.8	9	33.3	10	52.6	33	39
No	24	63.2	18	66.7	9	47.4	51	61
Type of health service where the diagnosis of CL was confirmed
Public	35	92.1	5	18.5	19	100	76	91
Private	3	7.9	22	81.5	0	0	8	9.5
Diagnosis of CL confirmed in the municipality of residence
Yes	30	78.9	19	70.4	19	100	68	81
No	8	21.1	8	29.6	0	0	16	19
Approximate distance between the patient’s household and the health service where the diagnosis of CL was confirmed (km)
< 1	5	13.2	2	7.4	4	21.1	11	13
1-5	6	15.8	2	7.4	3	15.8	11	13
5-10	17	44.7	10	37	8	42.1	7	8.3
10-30	4	10.5	3	11.1	1	5.3	35	42
30-100	1	2.6	4	14.8	2	10.5	8	9.5
≥ 100	5	13.2	6	22.2	1	5.3	12	14
Provision of information about possible adverse effects during treatment
Yes	9	31	6	28.6	7	58.3	22	26
No	29	100	21	100	12	100	62	74
Occurrence of complications or adverse effects during treatment ^a
Yes	16	42.1	11	40.7	11	57.9	38	45
No	22	57.9	16	59.3	8	42.1	46	55
Approximate distance from the patient’s household to the health service where the treatment was performed (km)
< 1	3	7.9	0	0	1	5.3	4	4.8
1-5	6	15.8	1	3.7	1	5.3	8	9.6
5-10	3	7.9	2	7.4	1	5.3	6	7.1
10-30	15	39.5	13	48.1	9	47.4	37	44
30-100	6	15.8	2	7.4	4	21.1	12	14
≥ 100	5	13.2	9	33.3	3	15.8	17	20
Interruption of work/study activities during diagnosis and/or treatment
Yes	18	47.4	12	44.4	12	63.2	42	50
No	20	52.6	15	55.6	7	36.8	42	50
Additional costs incurred during diagnosis and/or treatment
Yes	33	86.8	20	74.1	10	52.6	63	75
No	5	13.2	7	25.9	9	47.4	21	25

	General impact of TL				(95% CI)		(95% CI)
Variable	High		Low		Crude OR	P	Adjusted OR	P
	n	%	n	%
Sex
Male	20	46.5	23	53.5	0.6 (0.2-1.6)	0.380	-	-
Female	23	56.1	18	43.9	1		-	-
Age group (years) ^a
<48	22	53.4	20	47.6	1	0.827	-	-
≥ 48	21	50.0	21	50.0	0.9 (0.3-2.1)		-	-
Area of residence
Rural	34	52.3	31	47.7	1.2(0.4-3.3)	0.705	-	-
Urban	9	47.4	10	52.6	1		-	-
Schooling level
Illiterate - Primary school	29	52.7	26	47.3	1.1 (0.4-2.9)	0.698	-	-
High school - College	14	48.3	15	51.7	1		-	-
Family income (Brazilian minimum wages) ^b
< 1	18	67.7	9	33.3	2.5 (0.9-6.6)	0.051	3.3 (1.0-10.3)	0.039
≥ 1	25	43.9	32	56.1	1		1	-
Comorbidity
No	21	46.7	24	53.3	1	0.373	-	-
Yes	22	56.4	17	43.6	1.4 (0.6-3.5)		-	-
Diagnosis of CL confirmed in the first health service sought
Yes	15	51.4	17	48.6	1	0.535	-	-
No	28	53.8	24	46.2	1.3 (0.5-3.1)		-	-
Approximate distance between the patient’s household and the health service where the diagnosis of CL was confirmed (km)
< 10	16	55.2	13	44.8	1	0.596	-	-
≥ 10	27	49.1	28	50.9	0.7 (0.3-1.9)		-	-
Type of treatment
Intralesional^c	12	44.4	15	55.6	1	0.395	-	-
Systemic^d	31	54.4	26	45.6	1.4 (0.5-3.7)		-	-
Occurrence of complications or adverse effects during treatment
No	16	35.6	29	64.5	1	<0.001	1	0.001
Yes	27	69.2	12	30.8	4.0 (1.6-10.1)		7.7 (2.4-25.6)
Approximate distance from the patient’s household to the health service where the treatment was performed (km)
< 10	10	55.6	8	44.4	1	0.676	-	-
≥ 10	33	50.0	33	50.0	0.8 (0.2-2.2)		-	-
Hospitalization during treatment
No	26	47.2	29	52.7	1	0.323	-	-
Yes	17	58.6	12	41.4	1.5 (0.6-3.9)		-	-
Additional costs incurred during diagnosis and/or treatment
No	4	21.1	15	78.9	1	0.003	1	0.001
Yes	39	60.0	26	40.0	5.6 (1.6-18.8)		12.1 (2.8-52.4)
Interruption of work/study activitiesduring diagnosis and/or treatment
No	15	38.5	24	61.5	1	0.030	-	-
Yes	28	62.2	17	37.8	2.6 (1.0-6.3)		-	-

	Satisfaction with treatment and health services
	High		Low		Crude OR (95% CI)	P	Adjusted OR (95% CI)	P
Variable	n	%	n	%
Sex
Male	26	60.4	17	39.6	1	0.194	-	-
Female	19	46.3	22	53.7	0.5 (0.2-1.3)		-	-
Age group (years) ^a
<48	23	54.8	19	45.2	1.1 (0.4-2.5)	0.827	-	-
≥ 48	22	52.4	20	48.6	1		-	-
Area of residence
Rural	37	54.4	28	45.6	1	0.255	-	-
Urban	8	42.1	11	57.9	0.5 (0.1-1.5)		-	-
Schooling level
Illiterate - Primary school	33	60.0	22	40.0	1	0.104	-	-
High school - College	12	41.4	17	58.6	0.4(0.1-1.1)		-	-
Family income (Brazilian minimum wages) ^b
<1	18	66.7	9	33.3	2.22 (0.8-5.7)	0.101	7.09 (1.7-28.2)	0.005
≥ 1	27	47.4	30	52.6	1		1
Comorbidity
Yes	22	56.4	17	43.6	1	0.627	-	-
No	23	51.1	22	48.9	0.8 (0.3-1.9)		-	-
Diagnosis of CL confirmed in the first health service sought
Yes	18	56.2	14	43.8	1.1 (0.4-2.8)	0.699	-	-
No	27	51.9	25	48.1	1		-	-
Approximate distance from the patient’s household to the health service where the diagnosis of CL was confirmed (km)
< 10	16	55.2	13	44.8	1	0.830	-	-
≥ 10	29	52.7	26	47.3	0.9 (0.4-2.2)		-	-
Type of treatment
Intralesional^c	14	51.9	13	48.1	1	0.828	-	-
Systemic^d	31	54.4	26	45.6	1.1 (0.4-2.7)		-	-
Occurrence of complications or adverse effects during treatment
Yes	12	30.8	27	69.2	1	<0.001	1	0.013
No	33	73.3	12	26.7	6.1 (2.3-15.9)		4.2 (1.3-13.0)
Approximate distance between the patient’s household and the health service where the treatment was performed (km)
< 10	9	50.0	9	50.0	1	0.732	-	-
≥ 10	36	54.5	30	45.5	0.8 (0.2-2.3)		-	-
Hospitalization during treatment
Yes	10	34.5	19	65.5	1	0.011	1	0.061
No	35	63.7	20	37.7	3.3 (1.2-8.5)		3.2 (0.9-10.9)
Additional costs incurred during diagnosis and/or treatment
Yes	33	50.8	32	49.2	1	0.341	-	-
No	12	63.2	7	36.9	1.6 (0.5-4.7)		-	-
Interruption of work/study activities during diagnosis and/or treatment
Yes	25	55.6	20	44.4	1	0.695	-	-
No	20	51.3	19	48.7	0.8 (0.3-1.9)		-	-
General impact of CL
High	14	32.6	29	66.4	1	<0.001	1	<0.001
Low	31	75.6	10	24.3	6.4 (2.4-16.7)		9.5 (2.7-33.9)

Sociedade Brasileira de Medicina Tropical - SBMT Caixa Postal 118, 38001-970 Uberaba MG Brazil, Tel.: +55 34 3318-5255 / +55 34 3318-5636/ +55 34 3318-5287, http://rsbmt.org.br/ - Uberaba - MG - Brazil
E-mail: rsbmt@uftm.edu.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Carolina Di Pietro Carvalho. e-mail:dipietrocarol@hotmail.com