ASSESSMENT OF THE CHARACTERISTICS OF ADHERENCE TO ANTIHYPERTENSIVE THERAPY AT THE OUTPATIENT STAGE

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Relevance.
Arterial hypertension is one of the most significant health problems worldwide. Various statistical data indicate a high prevalence of morbidity in various groups of the adult population. Hypertension is almost the main cause of early mortality. For example, in Russia, the effectiveness of treatment is only 26.9%. A key factor in the treatment of arterial hypertension is an increase in adherence to treatment, due to greater awareness of patients about risk factors for cardiovascular pathologies, the importance of blood pressure control and regular use of antihypotensive drugs. It follows from this that an analysis is significant, which allows not only to determine, but also to assess the level of the main features of adherence to the treatment of arterial hypertension, for the subsequent improvement of patient awareness and treatment of the disease.
The purpose of the work: it is necessary to understand how patients of cardiological and nephrological profile are committed to the treatment of arterial hypertension in direct dependence on their age, education and gender. To identify risk factors that significantly aggravate the course of the disease.
To overcome the set goals, it is necessary to analyze the following tasks:
1. To determine the specifics of adherence to hypotensive therapy in people with arterial hypertension.
2. Assessment of a group of risk factors that aggravate the course of the disease.
3. Search for patients with a very low level of adherence to therapy for hypertension.
4. Analyze the main causes of irregular medication intake
Materials and methods. This topic was considered on the basis of BUZ IN VGKP No.4. The study involved patients suffering from arterial hypertension (30 men and 30 women), an average age of 52 years, with diseases of the cardiovascular and urinary systems. Such indicators as adherence to the treatment of hypertension, age, level of education, various risk factors, awareness of them, willingness to take medications, and motivation in the treatment of the disease were evaluated.
Statistical analysis of the data was carried out using Microsoft Exel, changes p<0.04 were considered reliable.
To achieve the set goals and objectives, a questionnaire was developed to assess patient adherence to treatment. The survey was attended by 60 people who were on outpatient observation by a cardiologist, a nephrologist.
The Morisky-Green test was used - a clinical and psychological test technique designed for preliminary assessment of compliance and screening detection of insufficiently compliant patients in routine medical practice. Also, in addition to the test, in order to expand the research data, complementary questions have been developed concerning demographic information, socio-economic data (level of education), the presence of risk factors, awareness of them, willingness to take medications, and motivation in the treatment of the disease.
Test analysis of the studied patients of cardiological and neurological profile according to demographic data.
Of the total number of patients with diseases of the genitourinary system, the age of 20-30 years was registered in only one man (8%), 30-40 years – 4 people (26%), 40-50 years - 1 person 7 (7%).
According to the results of the surveyed subjects with cardiovascular pathologies, the age of 30-40 years was observed in 2 people (13%), of which the number of men is 1 person (8%), and the number of women is 1 person (8%). The age of 40-50 years accounts for only 1 woman, which was (7%.)
Based on the study data, it can be concluded that the average age of the studied nephrological profile and cardiological profile is 51-60 years.
Analysis of the interviewed patients based on the level of education.
The number of interviewed patients of a nephrologist with secondary education was -11 people (67%)., 2 people have incomplete higher education (6.5%).
The number of patients with higher education was 4 people (27%)
Of the patients with a cardiological profile, 9 people (61%) had secondary specialized education. Higher education – 6 people (46%).
Analyzing the survey data , according to the level of education , it can be concluded that most of the studied patients, both cardiological and neurological, have secondary specialized education .
Comparative analysis of the study data on adherence to prescribed antihypertensive therapy.
Analyzing the results of the Morisky-Green test, which clearly showed a fairly low level of adherence with antihypertensive therapy of 0 points in 10 out of 60 subjects, unsatisfactory adherence of 1 point in 7 patients, which was 25%. And there is absolutely insufficient adherence in 4 people out of 25 respondents, 67%, which clearly shows that patients ignore the advice and recommendations of the attending physician.
Analysis of the main reasons for non-compliance with regular intake of antihypertensive drugs.
In the study, the leading reasons for non-compliance with constancy in the medication regimen were considered. It was revealed that the main cause of drug administration disorders is the fear of side effects during prolonged use of antihypertensive therapy, which accounted for (40%) of the total number of respondents surveyed. A very important reason was the achievement of a rapid, significant effect from taking medications, which patients expect (20%). In addition, one of the reasons is the reluctance to take long-term treatment (18%), the high cost of medicines (14%), and taking several prescribed medications (8%)
The results of the questionnaire on risk factors and their adverse effect on the development of arterial hypertension and cardiovascular pathologies.
The correct assessment of risk factors, as well as their significant role in the progression of the disease, helps to determine the course of correct and effective treatment of hypertension. Smoking, alcohol consumption are among the main provocateurs in the development of hypertension. It is important for the attending physician to explain to the patient about the risks of an incorrect lifestyle. Referring to the results of the respondents using the validated Morisky-Green test, in relation to smoking, that out of the total number of patients studied, the number of people who never neglected smoking was 16 (67%), and the number of people who quit smoking after talking with their doctor was 6 (14%). The total number of patients who did not comply with the doctor's prescription and recommendations is 8 people (21%) It was found that female patients are much more likely to drink alcoholic beverages compared to men (35%).
Analyzing the research data, it can be concluded that the majority of respondents ignore the doctor's advice about maintaining a proper lifestyle.
Based on the results of the study, it is possible to identify the relationship between the wrong regimen of taking drugs and a high risk of cardiovascular pathologies and a sufficiently low level of education of patients, which indicates a connection between the education of the interviewed patients and the occurrence of uncontrolled arterial hypertension.
Results
Among the patients who were on outpatient observation by a cardiologist, a nephrologist, half of the respondents have a fairly low adherence to the prescribed therapy. For more effective treatment of patients with arterial hypertension, in addition to drug therapy aimed at persistent reduction of blood pressure, it is necessary that the patient understands the risk factors of his disease, correctly assesses the need for taking medications. In order to achieve the desired goals and objectives of the study, to increase patient adherence to treatment, it is necessary, mainly, to establish a doctor-patient contact.
Discussion
The study showed that there is a need to develop regulations for the management of outpatient patients with hypertension in conditions of low adherence and monitoring tools for patients who do not understand the importance of antihypertensive therapy.
Conclusion
The global problem of outpatient therapy of arterial hypertension is low awareness of risk factors, rather high cost of medications, fear of side effects, lack of significant effect from drug therapy, unwillingness to take long-term, regular medications. All of the above indicates a low adherence of patients to antihypertensive therapy – in 69% of cases.

About the authors

Darya Alexandrovna Martynenko

Voronezh State Medical University named after N.N. Burdenko

Email: dssaltanova@mail.ru
ORCID iD: 0000-0002-0070-1486
SPIN-code: 7402-2532

student of the 6th year , medical faculty

Russian Federation, 10 Studencheskaya str., Voronezh, 394036 , Russia

Svetlana Nikolaevna Lagutina

Voronezh State Medical University named after N.N. Burdenko

Email: svlagutina97@mail.ru
ORCID iD: 0000-0003-3730-5265
SPIN-code: 3165-2380

assistant of the department of polyclinic therapy

Russian Federation, 10 Studencheskaya str., Voronezh, 394036 , Russia

Anna Alexandrovna Zuikova

Voronezh State Medical University named after N.N. Burdenko

Email: zuikova-terapia@vrngmu.ru
ORCID iD: 0000-0002-5378-4959
SPIN-code: 7605-1630

doctor of medical sciences, professor, head of the department of polyclinic therapy

Russian Federation, 10 Studencheskaya str., Voronezh, 394036 , Russia

Olga Sergeevna Skuratova

Voronezh State Medical University named after N.N. Burdenko

Author for correspondence.
Email: prokopova15@mail.ru
ORCID iD: 0000-0002-1471-8967
SPIN-code: 5178-7940

assistant of the department of polyclinic therapy

Russian Federation, 10 Studencheskaya str., Voronezh, 394036 , Russia

References