The effect of physical, social and psychological factors on drug compliance in patients with mild hypertension
Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation(2008)
摘要
Abstract Background. In patients with hypertension noncompliance with drug treatment is between 15 to 54%, and has been recognised as a relevant
contributor to the burden of cardiovascular morbidity. Up to 92% of patients experience unpleasant symptoms with their condition
and, particularly in these patients, the symptoms experienced may enhance compliance.
Objective. To simultaneously assess the effects of physical, social and psychological factors on noncompliance.
Methods. Patients with mild hypertension despite drug treatment, from the departments of cardiology and internal medicine, were requested
to answer a self-administered questionnaire addressing the presence of physical symptoms as well as psychosocial factors.
The questionnaire was based on previously used test batteries and consisted of two lists of physical complaints and four lists
addressing the four domains of planned behaviour regarding medical non-adherence according to Baron and Byrne. These domains
mainly assess psychosocial factors. Each list consisted of three or more items and each item was scored on fiveto seven-point
scales. Mean scores were used for assessment. The lists were also separately assessed for internal consistency and reliability
using Cronbach’s alphas. One-way analysis of variance and multivariate analysis of variance (MANOVA) with compliance as outcome
variable and the physical, social and psychological variables as indicator variables were used for data analysis. MANOVA was
adjusted for multiple testing.
Results. Many patients experienced physical symptoms due to hypertension, such as tiredness (31%), hot flushes (28%), headache (24%),
reduced daily life energy (23%), palpitations (22%), with 95% confidence intervals between 16 to 38%. Scores for physical
symptoms and social factors did not differ between self-reported adherers (n=165) and nonadherers (n=11). However, the score
for psychological factors was significantly larger in the adherers than in the non-adherers, 5.05 versus 3.06, p<0.018. The
MANOVA showed a significant overall difference between the adherers and non-adherers in the data at p<0.012, which was mainly
due to the score for psychological factors. Conclusion. The effect of physical symptoms on non-compliance in mildly hypertensive patients is negligible. So is the effect of social
factors. Psychological factors such as lacking a sense of guilt, regret and shame are major determinants of non-compliance.
Physicians may play an educational role in improving their patients’ compliance by addressing these determinants. We should
add that the conclusions should be made with reservations, given the small number of non-adherers in our sample. (Neth Heart J 2008;16:197-200.)
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关键词
compliance,determining factors,hypertension,medications
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