A pesquisa mostra que os médicos e suas famílias são menos propensos a seguir as orientações sobre a medicina. Por que os medicamente bem informados obedecem com menos frequência?
![](data:image/jpeg;base64,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)
Os médicos e seus familiares são menos propensos do que outras pessoas a cumprir as diretrizes de medicamentos prescritos, de acordo com um estudo em larga escala de coautoria de um economista do MIT. Créditos - foto de estoque
Seguir as diretrizes estabelecidas sobre medicamentos prescritos parece ser um curso de ação óbvio, especialmente para os profissionais que prescrevem. No entanto, os médicos e seus familiares são menos propensos do que outras pessoas a cumprir essas diretrizes, de acordo com um estudo em larga escala de coautoria de um economista do MIT.
Dependendo da sua perspectiva, esse resultado pode parecer surpreendente ou pode produzir um aceno de cabeça. De qualquer maneira, o resultado é contrário às hipóteses acadêmicas anteriores. Muitos especialistas supõem que saber mais e ter uma comunicação mais fácil com os médicos leva os pacientes a seguir as instruções mais de perto.
O novo estudo é baseado em mais de uma década de dados populacionais da Suécia e inclui evidências sugestivas sobre por que os médicos e suas famílias podem ignorar os conselhos médicos. No geral, a pesquisa mostra que o restante da população adere às diretrizes gerais de medicação 54,4% do tempo, enquanto os médicos e suas famílias ficam 3,8 pontos percentuais atrás disso.
“Há muita preocupação de que as pessoas não entendam as diretrizes, que sejam muito complexas para serem seguidas, que as pessoas não confiem em seus médicos”, diz Amy Finkelstein, professora do Departamento de Economia do MIT. “Se for esse o caso, você deve ver a maior adesão quando você olha para os pacientes que são médicos ou seus parentes próximos. Ficamos surpresos ao descobrir que o oposto ocorre, que os médicos e seus parentes próximos são menos propensos a aderir às suas próprias diretrizes de medicação.”
O artigo , “A Taste of Their Own Medicine: Guideline Adherence and Access to Expertise”, foi publicado este mês na American Economic Review: Insights . Os autores são Finkelstein, o professor John e Jennie S. MacDonald de economia do MIT; Petra Persson, professora assistente de economia na Universidade de Stanford; Maria Polyakova PhD '14, professora assistente de política de saúde na Escola de Medicina da Universidade de Stanford; e Jesse M. Shapiro, professor George Gund de Economia e Administração de Empresas da Universidade de Harvard.
Milhões de pontos de dados
Para conduzir o estudo, os estudiosos examinaram dados administrativos suecos de 2005 a 2016, aplicados a 63 diretrizes de medicamentos prescritos. Os dados permitiram aos pesquisadores determinar quem é médico; o estudo definiu amplamente parentes próximos como parceiros, pais e filhos. Ao todo, a pesquisa envolveu 5.887.471 pessoas às quais se aplicava pelo menos uma das diretrizes de medicação. Dessas pessoas, 149.399 eram médicos ou familiares próximos.
Usando informações sobre compras de medicamentos prescritos, visitas hospitalares e diagnósticos, os pesquisadores puderam ver se as pessoas estavam aderindo às diretrizes de medicamentos, examinando se as decisões sobre medicamentos prescritos correspondiam às circunstâncias médicas desses pacientes. No estudo, seis diretrizes diziam respeito a antibióticos; 20 envolviam uso de medicamentos por idosos; 20 enfocavam medicamentos associados a diagnósticos específicos; e 17 sobre o uso de medicamentos prescritos durante a gravidez.
Algumas diretrizes recomendavam o uso de um determinado medicamento prescrito, como preferência por antibióticos de espectro estreito para uma infecção; outras orientações foram sobre não tomar certos medicamentos, como a recomendação de que mulheres grávidas evitem antidepressivos.
Das 63 orientações utilizadas no estudo, os médicos e seus familiares seguiram os padrões com menos frequência em 41 casos, sendo a diferença estatisticamente significativa 20 vezes. Os médicos e seus familiares seguiram as orientações com mais frequência em 22 casos, sendo a diferença estatisticamente significativa apenas três vezes.
“O que descobrimos, o que é bastante surpreendente, é que eles [médicos] são, em média, menos aderentes às diretrizes”, diz Polyakova, que recebeu seu PhD do Departamento de Economia do MIT. “Portanto, neste artigo, também estamos tentando descobrir o que os especialistas fazem de diferente”.
Excluindo outras respostas
Como os médicos e seus parentes próximos seguem as orientações médicas com menos frequência do que o restante da população, o que exatamente explica esse fenômeno? Enquanto buscava uma resposta, a equipe de pesquisa examinou e rejeitou várias hipóteses.
Primeiro, a menor adesão por parte daqueles com maior acesso à especialização não está relacionada ao status socioeconômico. Na sociedade em geral, existe uma ligação entre renda e níveis de adesão, mas os médicos e suas famílias são uma exceção a esse padrão. Como os estudiosos escrevem no artigo, “o acesso especial a médicos está associado a uma menor adesão, apesar, e não por causa, do alto status socioeconômico” dessas famílias.
Além disso, os pesquisadores não encontraram nenhuma ligação entre o estado de saúde existente e a adesão. Eles também estudaram se um maior conforto com medicamentos prescritos – por ser um médico ou parente de um – torna as pessoas mais propensas a tomar medicamentos prescritos do que as diretrizes recomendam. Este não parece ser o caso. As taxas de adesão mais baixas para médicos e seus familiares foram semelhantes em magnitude, quer as orientações se referissem a tomar a medicação ou, alternativamente, não tomar a medicação.
“Existem várias explicações alternativas de primeira ordem que poderíamos descartar”, diz Polyakova.
Resolvendo um mistério médico
Em vez disso, os pesquisadores acreditam que a resposta é que os médicos possuem “informações superiores sobre diretrizes” para medicamentos prescritos – e então utilizam essas informações para si mesmos. No estudo, a diferença na adesão às diretrizes entre especialistas e não especialistas é maior no caso dos antibióticos: os médicos e suas famílias estão 5,2 pontos percentuais a menos em conformidade do que todos os outros.
A maioria das diretrizes nesta área recomenda iniciar os pacientes com antibióticos de “espectro estreito”, que são mais direcionados, em vez de antibióticos de “espectro mais amplo”. Este último pode ter maior probabilidade de erradicar uma infecção, mas o uso maior deles também aumenta as chances de que as bactérias desenvolvam resistência a esses medicamentos valiosos, o que pode reduzir a eficácia para outros pacientes. Assim, para coisas como uma infecção do trato respiratório, as diretrizes pedem primeiro um antibiótico mais direcionado.
A questão, no entanto, é que o que é bom para o público a longo prazo – tentar drogas mais direcionadas primeiro – pode não funcionar bem para um paciente individual. Por esse motivo, é mais provável que os médicos prescrevam antibióticos de espectro mais amplo para eles e suas famílias.
“Do ponto de vista da saúde pública, o que você quer fazer é eliminá-la [a infecção] com o antibiótico de espectro estreito”, observa Finkelstein. “Mas, obviamente, qualquer paciente gostaria de eliminar essa infecção o mais rápido possível.” Portanto, ela acrescenta: "Você pode imaginar que a razão pela qual os médicos têm menos probabilidade de seguir as diretrizes do que outros pacientes é porque eles... sabem que há uma divisão entre o que é bom para eles como pacientes e o que é bom para a sociedade".
Outro dado sugestivo vem de diferentes tipos de medicamentos prescritos que normalmente são evitados durante a gravidez. Para as chamadas drogas de classe C, onde a evidência empírica sobre os perigos das drogas é um pouco mais fraca, os médicos e suas famílias têm uma taxa de adesão 2,3 pontos percentuais abaixo de outras pessoas (o que significa, neste caso, que eles são mais propensos a tomar estes medicamentos durante a gravidez). Para as chamadas drogas de classe D com evidências ligeiramente mais fortes de efeitos colaterais, essa queda é de apenas 1,2 pontos percentuais. Aqui também, o conhecimento especializado dos médicos pode estar influenciando suas ações.
“Os resultados sugerem que provavelmente o que está acontecendo é que os especialistas têm uma compreensão mais sutil de qual é o curso de ação certo para eles e como isso pode ser diferente do que as diretrizes sugerem”, diz Polyakova.
Ainda assim, as descobertas sugerem algumas tensões não resolvidas em ação. Pode ser, como sugere Polyakova, que as diretrizes sobre antibióticos devam ser mais explícitas sobre as compensações públicas e privadas envolvidas, proporcionando mais transparência para os pacientes. “Talvez seja melhor que as diretrizes sejam transparentes e digam que recomendam isso não porque [sempre] é o melhor curso de ação para você, mas porque é o melhor para a sociedade”, diz ela.
Pesquisas adicionais também podem ter como objetivo identificar áreas em que a menor adesão de especialistas às diretrizes pode estar associada a melhores resultados de saúde – para ver com que frequência os médicos têm razão, por assim dizer. Ou, como os pesquisadores escrevem no artigo, “Um caminho importante para pesquisas futuras é identificar se e quando a não adesão é do interesse do paciente”.
A pesquisa foi apoiada, em parte, pelo Population Studies and Training Center e pela Eastman Professorship na Brown University, e pelo National Institute on Aging.