Enhancing Adherence to Hypertension Treatment: Public Health Approach

1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. Methods • Study design: cross-sectionalstudy • 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

8. 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

9. “Do you think that hypertension patients should be on permanent treatment?” • 101 (45.09%) patients gave negative answer

10. Factors associated with hypertension patients’ noncompliance/compliance to treatment

11. Low adherence risk group • Short length of disease • No clinical sequelae of hypertension (asymptomatic patients)

12. 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!”

13. Health Belief Model • Patient: subjective perception of health status and disease severity • Physician: objective assessment Who is right?

14. 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

15. The cost of the medicine and adherence: myths and realities • Cost is not a major determinant • Free medications cannot guarantee adequate adherence

16. Physicians and public health professionals against low compliance – who should be the leader? • Interdisciplinary task • Public health professionals’ competence in population level influences

17. Thank you!