Abstract
Background: Multiple factors have been implicated in the lack of adherence to drug therapy in hypertensive patients. Objectives: In this study we addressed the impact of psychosocial factors over adherence in a hypertensive cohort followed through a Government sponsored primary care program (PCS) in Santiago, Chile. Method: Cross-sectional study, from a cohort of 738 hypertensive patients followed through the PCS; a sub sample of 89 patients who finished the first stage of recruitment was analyzed, and their results weighted by age and gender. Surveys of family function (APGAR), social support (MOS), health self-perception and physician-patient relationship were carried out. Total family income and education level were evaluated. Therapeutic adherence was determined using the Morisky test. The analyisis was performed by logistic regression estimating age and sex adjusted odds ratio. Results: The mean age of the sample was 54.3±7.6 years, being higher in men (56.2±6.4 years vs. 52.7±8.2 years). Satisfactory blood pressure control (BP<140/90) for the group was found in 66.2% (488 of 738) (68.7% (231 of 336) in men vs. 64.1% (258 of 402) in women; p<0.05). Adherence to treatment for the group was 28.1% (207 of 738) women show higher adherence than men (39.8% (160 of 402) vs. 14.9% (50 of 336); p<0.05). The odd ratios of factors influencing therapeutic adherence are shown in Table 1. Conclusion: In addition to family income and educational level, physician-patient relationship and family function are factors that showed a significant influence on the adherence to anti-hypertensive treatment. The BP control (66.2%) observed in this cohort appeared only partially explained by adherence to therapy (28.1%). A greater observance of dietary and other unmeasured life style changes as a result of the PCS program may have been at play to explain these findings. These aspects will be explored during the follow up. Table 1. Odds -Ratios (OR) of factors influencing adherence to drug Rx in hypertensive patients Adheres to treatment Does not adhere to treatment Raw OR (IC 95%) Adjusted by age and gender OR (IC 95%) Blood pressure (>140/90 mmHg) 29.6% (61 of 208) 36.4% (193 of 530) 1.36 (0.94 - 1.97) 1.48 (1.00 - 2.19) Low education (< 8 years) 30.2% (63 of 208) 47.6% (252 of 530) 2.16 (1.46 . 3.02) 2.28 (1.54 - 3.38) Low family income (Less than 1 minimal salary) 25.4% (53 of 208) 29.6% (157 of 530) 1.22 (0.83 - 1.76) 2.19 (1.42 - 3.37) Health self-perception (Good and very good) 3.3% (7 of 208) 14.3% (76 of 530) 5.43 (1.96 - 15.04) 3.85 (1.36 - 10.93) Scarce social support (MOS < 57 global pts) 44.2% (92 of 208) 36.8% (195 of 530) 0.73 (0.52 - 1.03) 0.84 (0.58 - 1.20) Dysfunctional family (APGAR < 7 pts) 21.6% (45 of 208) 31.0% (164 of 530) 1.65 (1.09 - 2.47) 2.47 (1.59 - 3.81) Inadequate physician-patient relationship 28.4% (59 of 208) 47.3% (251 of 530) 2.26 (0.73 - 6.98) 4.36 (0.81 - 23.39)
Published Version
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