Transcript Document 689963

Low Adherence of Hypertension
Patients to Treatment –
What Is To Be Done?
Clinical Problem for Public Health
Alexander V. Sergeev, MD, PhD, MPH
Irina B. Bazina, MD, PhD
Smolensk State Medical Academy
Smolensk, Russia
Hypertension: is it really dangerous?
• People don’t die of hypertension itself,
but …
they die of its complications
• Target organ damage (heart, brain,
kidneys)
• CHD and stroke are causes of disability
and death
Hypertension & Public Health
• High prevalence  burden from public
health perspective
• BP over 140/90 in over 1/3 of adult
population
• Particular concern: high prevalence
among workforce
Hypertension: actual problem for Russia
• Rise in mortality from the major
complications of hypertension – CHD
and stroke – during the last 20 years
• High prevalence among workforce
• Early disability; decreased life
expectancy
The problem of hypertension patients’ low
compliance to therapy
• Low percentage of those who take
medications regularly and have their BP
controlled effectively
• Decrease in compliance among males as
compared to 1980s
• Patients’ attitude to their health
• Low priority of health on one’s values
scale
• Being inadequately informed of disease
The result is sad: Irregular treatment
cannot stabilize BP at safe level
Objective
• To analyze the factors associated with
low adherence of hypertension patients
to treatment
• To work out recommendations on
development of population level
approaches to solving the problem of
low adherence from public health
perspective
Methods
• Study design: cross-sectional study
• Study population: essential
hypertension (stages I-III) patients of
young age (22-45 yrs old)
• Catchment area: employees of
organizations located in Smolensk
Oblast
• N=224
• Questionnaire: questions pertaining to
knowledge of hypertension and attitude
to various aspects of the disease
including the necessity of treatment
Statistical Analysis
• Binary outcome variable
• Probability of getting negative answer
to the question: “Do you think that
hypertension patients should be on
permanent treatment?”
• Multiple logistic regression –
simultaneous control for a number of
factors influencing binary outcome
variable
• SAS software, PROC GENMOD
“Do you think that hypertension patients
should be on permanent treatment?”
• 101 (45.09%) patients gave negative answer
Factors associated with hypertension patients’
noncompliance/compliance to treatment
Model parameters
OR
95% CI
1.623
(0.722, 3.651)
31-40 yrs
1.213
(0.552, 2.665)
40-45 yrs
1.085
(0.487, 2.417)
1-3 yrs
0.298
(0.128, 0.696)
>3 yrs
0.190
(0.080, 0.453)
0.292
(0.162, 0.526)
Male (vs. female) gender
Age (vs. 22-30 yrs)
Duration of disease (vs. <1 yr)
Presence (vs. absence) of the clinical
sequelae of hypertension
Low adherence risk group
• Short length of disease
• No clinical sequelae of hypertension
(asymptomatic patients)
What can be expected of risk group?
• Behavioral pattern and peculiarities of
self-perception of the disease
• Anosognosic attitude to the disease
“I feel OK even when my blood pressure
is 180/110. And 170/100 is my usual
BP. So, there is no need for treatment,
and I am not going to see the doctor!”
Health Belief Model
• Patient: subjective perception of
health status and disease severity
• Physician: objective assessment
Who is right?
What can be done to improve the
situation?
• Low effectiveness of individual level
influences
• Need for population level influences
• Information campaigns analogous to
social advertising
The cost of the medicine and adherence:
myths and realities
• Cost is not a major determinant
• Free medications cannot guarantee
adequate adherence
Physicians and public health professionals
against low compliance –
who should be the leader?
• Interdisciplinary task
• Public health professionals’
competence in population level
influences
Thank you!