EVALUATION OF THE IMPACT OF MEDICAL AND PSYCHOLOGICAL COUNSELLING ON PATIENT ADHERENCE TO ANTIHYPERTENSIVE TREATMENT
Introduction: medical counselling promoting healthy lifestyles and behaviour can significantly reduce developmental risk and eliminate the leading causes of hypertension (AH). Adherence to treatment can be enhanced by therapeutic education.
Aim: assessment of the effectiveness of medical and psychological counselling and training of patients with arterial hypertension.
Methods: During the period 2015-2017 24 cycles of lectures on therapeutic training were conducted on the basis of the rehabilitation centre of the SRI RME within the framework of the organization of a school of health for the patients with hypertension. The study included 403 patients. After 3 months, 6 months and one year, blood pressure, cholesterol, BMI, adherence to therapy, anxiety and depression were monitored. Study design: a controlled clinical trial with historical control. Statistical processing: IBM SPSS Statistics 20, with the definition of the normality of the distribution of the studied issues and the evaluation of descriptive statistics of numerical variables. Qualitative variables are represented in the form of absolute figures and their percentages. Evaluation of differences in groups is determined by calculating the χ2 criterion.
Results: it was shown a statistically significant increase in adherence to therapy from 5,7 to 13,5%, a decrease in the proportion of individuals with a stable high blood pressure - from 60,1% to 49,7% after 3 months (p < 0,05). The proportion of people with hypercholesterolemia decreased from 58,3 to 47,2% (p < 0,05). Physically, 6,4% of patients became more active during the year of follow-up. Symptoms of clinically expressed anxiety decreased from 10,9% to 6,9%. Signs of subclinical and clinically pronounced depression had a clear tendency to decrease (p < 0,01). There was a significant decrease in anxiety rates throughout the study period (p < 0,01).
Conclusion: The need for widespread introduction of such a technology of therapeutic and prophylactic intervention as health schools for AH patients is caused by the importance of timely correction and prevention of AH complications at the level of primary health care.
Lyazzat B. Dyussenova 1,
Lyudmila M. Pivina 1, https://orcid.org/0000-0002-8035-4866,
Tatyana I. Belikhina 2
Kazbek N. Apsalikov 3
Talgat Zh. Muldagaliev 3
1 Semey State Medical University, Kazakhstan,
Semey, Republic of Kazakhstan;
2 Centre of nuclear medicine and oncology,
Semey, Republic of Kazakhstan;
3 Research Institute for Radiation Medicine and Ecology,
Semey, Republic of Kazakhstan.
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7. American College of Physicians. ACP Clinical Practice Guidelines. Washington, DC: American College of Physicians; 2014. [22 July 2014]. Accessed at http://www.acponline.org/clinical_information/guidelines/guidelines/
8. Artinian N.T., Fletcher G.F., Mozaffarian D. et al. Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation. 2010. №122(4). Р.406–441.
9. Ayala C., Neff L.J., Croft J.B. Prevalence of self-reported high blood pressure awareness, advice received from health professionals, and actions taken to reduce high blood pressure among US adults--Healthstyles 2002. J Clin Hypertens (Greenwich). 2005. №7(9). Р.513–519.
10. Barnes P.M., Schoenborn C.A. Trends in adults receiving a recommendation for exercise or other physical activity from a physician or other health professional. NCHS Data Brief. 2012. №86. Р.1–8
11. Brettschneider C., Kohlmann S., Gierk B., Löwe B., König H.H. Depression screening with patient-targeted feedback in cardiology: The cost-effectiveness of DEPSCREEN-INFO. PLoS One. 2017. №12 (8). e0181021.
12. Carroll M.D., Kit B., Lacher D. Total and high-density lipoprotein cholesterol in adults: National Health and Nutrition Examination Survey, 2009-2010. NCHS Data Brief. 2012. №92. Р.1–8.
13. Centers for Disease Control and Prevention. Million hearts: strategies to reduce the prevalence of leading cardiovascular disease risk factors--United States, 2011. MMWR Morb Mortal Wkly Rep. 2011 №60(36). Р.1248–1251.
14. Centers for Disease Control and Prevention. Vital signs: avoidable deaths from heart disease, stroke, and hypertensive disease - United States, 2001-2010. MMWR Morb Mortal Wkly Rep. 2013. №62(35). Р.721–727.
15. Centers for Disease Control and Prevention. Vital signs: prevalence, treatment, and control of high levels of low-density lipoprotein cholesterol---United States, 1999-2002 and 2005-2008. MMWR Morb Mortal Wkly Rep. 2011.60(4). Р.109–114.
16. Chen S., Conwell Y., Xue J., Li L.W., Tang W., Bogner H.R., Dong H. Protocol of an ongoing randomized controlled trial of care management for comorbid depression and hypertension: the Chinese Older Adult Collaborations in Health (COACH) study. BMC Geriatr. 2018. №18 (1). Р.124.
17. D'Agostino R.B. Sr, Vasan R.S., Pencina M.J. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008.117(6). Р.743–53.
18. Gentil L., Vasiliadis H.M., Préville M., Berbiche D. Impact of Mental Disorders on the Association Between Adherence to Antihypertensive Agents and All-Cause Healthcare Costs. J Clin Hypertens (Greenwich). 2017. Vol.19 (1). Р.75-81.
19. Goldstein L.B., Bushnell C.D., Adams R.J. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke. Association. Stroke. 2011. №42(2). Р.517–584.
20. Eckel R.H., Jakicic J.M., Ard J.D. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014. №63(25 Pt B). Р.2960–2984.
21. Flocke S.A., Clark A., Schlessman K. Exercise, diet, and weight loss advice in the family medicine outpatient setting. Fam Med. 2005.37(6).Р.415–421.
22. Ford E.S., Bergmann M.M., Boeing H. Healthy lifestyle behaviors and all-cause mortality among adults in the United States. Prev Med. 2012. №55(1). Р.23–27.
23. Haskell W.L., Lee I.M., Pate R.R. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007. №39(8). Р.1423–1434.
24. Hennein R., Hwang S.J., Au R., Levy D., Muntner P., Fox C.S., Ma J. Barriers to medication adherence and links to cardiovascular disease risk factor control: the Framingham Heart Study. Intern Med J. 2018. Vol.48(4). Р.414-421.
25. Hirabayashi K., Kawano N., Ohtaki M., Harada Y., Harada H., Muldagaliyev T., Apsalikov K., Hoshi M. Health status of radiation exposed residents living near the Semipalatinsk Nuclear Test Site based on health assessment by interview. Hiroshima J Med Sci. 2008. Vol.57(1). Р.27-35.
26. Jacob L., Kostev K. Persistence with antihypertensive drugs in patients with depression in Germany. Int J Clin Pharmacol Ther. 2018. Vol.56(4). Р.162-168.
27. Kuklina E.V., Carroll M.D., Shaw K.M. Trends in high LDL cholesterol, cholesterol-lowering medication use, and dietary saturated-fat intake: United States, 1976-2010.NCHS Data Brief. 2013. №117. Р.1–8.
28. Lin J.S., O'Connor E.A., Evans C.V., Senger C.A., Rowland M.G., Groom H.C. Behavioral Counseling to Promote a Healthy Lifestyle for Cardiovascular Disease Prevention in Persons With Cardiovascular Risk Factors: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet] /Agency for Healthcare Research and Quality (US). 2014. Report No.: 13-05179-EF
29. Loganovsky K.N., Vasilenko Z.L. Depression and ionizing radiation. Probl Radiac Med Radiobiol. 2013. №18. Р.200-219.
30. Markabayeva A., Bauer S., Pivina L., Bjørklund G., Chirumbolo S., Kerimkulova A., Semenova Y., Belikhina T. Increased prevalence of essential hypertension in areas previosly exposed to fallout due to nuclear weapons testing at the Semipalatinsk Test Site, Kazakhstan. Environ Res. 2018. №167:129-135.
31. McNellis R.J., Ory M.G., Lin J.S., O'Connor E.A. Standards of Evidence for Behavioral Counseling Recommendations. Am J Prev Med. 2015 Sep. №49(3 Suppl 2):S150-7.
32. Morisky D.E., Ang A., Krousel-Wood M., Ward H.J. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008. №10(5). Р. 348–354.
33. Nettleton J.A., Polak J.F., Tracy R. Dietary patterns and incident cardiovascular disease in the Multi-Ethnic Study of Atherosclerosis. Am J Clin Nutr. 2009. №90(3). Р.647–654.
34. Snaith R.P., Zigmond A.S. The hospital anxiety and depression scale. Br Med J (Clin Res Ed). 1986 № 292(6516). Р. 344.
35. Son Y.J., Won M.H. Depression and medication adherence among older Korean patients with hypertension: Mediating role of self-efficacy. Int J Nurs Pract. 2017. № 23(3).
36. Spielberger C. D., Gorsuch R. L., Lushene R., Vagg P. R., & Jacobs G. A. Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press. 1983
37. Tanaka K., Shigematsu R., Henwood T., Sasai H. Exercise, diet, and weight loss. J Phys Fitness Sports Med. 2012. № 1(3). Р. 457-465.
38. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans.Washington, DC: U.S. Department of Health and Human Services; 2008.
39. U.S. Department of Health and Human Services. Washington, DC: U.S. Department of Health and Human Services; 2014. [22 July 2014]. Healthy People 2020. Accessed at http://www.healthypeople.gov/2020/topicsobjectives2020/
40. U.S. Preventive Services Task Force. Procedure Manual. Rockville, MD: U.S. Preventive Services Task Force; 2011. [22 July 2014]. Accessed at http://www.uspreventiveser vicestaskforce.org/uspstf08/methods/procmanual.htm.
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