ОЦЕНКА ВЛИЯНИЯ МЕДИКО-ПСИХОЛОГИЧЕСКОГО КОНСУЛЬТИРОВАНИЯ НА ПРИВЕРЖЕННОСТЬ ПАЦИЕНТОВ К ЛЕЧЕНИЮ АНТИГИПЕРТЕНЗИВНЫМИ ПРЕПАРАТАМИ

Введение: медицинское консультирование, направленное на пропаганду здорового образа жизни и поведения, может значительно снизить риски развития и устранить ведущие причины артериальной гипертонии (АГ). Приверженность к лечению существенно возрастает при проведении терапевтического обучения

Цель: оценка эффективности медицинского и психологического консультирования и обучения пациентов с артериальной гипертонией.

Материалы и методы: В течение 2015-2017 гг. в рамках организации школы здоровья для больных АГ было проведено 24 цикла лекций по терапевтическому обучению на базе реабилитационного центра НИИ РМЭ. Исследование включило 403 пациента. Через 3 месяца, 6 месяцев и год проводилось мониторирование АД, уровня холестерина, ИМТ, приверженности к терапии, уровня тревожности и депрессии. Дизайн исследования: контролируемое клиническое исследование с историческим контролем. Статистическая обработка: IBM SPSS Statistics 20, с определением нормальности распределения изучаемых признаков и оценкой описательных статистик числовых переменных. Качественные переменные представлены в виде абсолютных цифр и их процентов. Оценка различий в группах определена с помощью расчета критерия χ2.

Результаты: установлено статистически значимое повышение показателя приверженности к терапии с 5,7 до 13,5%, снижение удельного веса лиц со стабильно высоким АД – с 60,1% до 49,7% через 3 месяца (р<0,05). Удельный вес лиц с гиперхолестеринемией снизися с 58,3 до 47,2% (р<0,05). Физически более активными в течение года наблюдения стали 6,4% пациентов. Симптомы клинически выраженной тревоги, снизились с 10,9% до 6,9%, Признаки субклинически и клинически выраженной депрессии имели четкую тенденцию к снижению (р<0,01). Наблюдалось существенное снижение показателей тревожности на протяжении всего периода исследования (р<0,01).

Заключение: Необходимость широкого внедрения такой технологии лечебно-профилактического вмешательства, как школы здоровья для больных АГ, обусловлена важностью своевременной коррекции и профилактики осложнений АГ на уровне первичного звена здравоохранения.

Ляззат Б. Дюсенова 1,

Людмила М. Пивина 1, https://orcid.org/0000-0002-8035-4866,

Татьяна И. Белихина 2

Казбек Н. Апсаликов 3

Талгат Ж. Мулдагалиев 3

1 Государственный медицинский университет города Семей,

г. Семей, Республика Казахстан;

2 Центр ядерной медицины и экологии г. Семей,

г. Семей, Республика Казахстан;

3Научно-исследовательский институт радиационной медицины и экологии,

г. Семей, Республика Казахстан;

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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.

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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 previously 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​.uspreventiveservicestaskforce​.org/uspstf08/methods/procmanual.htm.

Rеfеrеncеs:

1.         Anikin V.V., Pushkareva O.V. Dinamika summarnogo koronarnogo riska u bol'nykh arterial'noi gipertoniei, rabotayushhikh na krupnom promyshlennom predpriyatii, na fone vnedreniya sovremennykh profilakticheskikh tekhnologii [Dynamics of total coronary risk in patients with arterial hypertension, working at a large industrial enterprise, on the background of the introduction of modern preventive technologies]. Kurskii nauchno-prakticheskii vestnik "Chelovek i ego zdorov'e" [Kursk Scientific and Practical Bulletin "The Man and His Health"] 2017. № 4. pp. 77-82. [in Russian]

2.         Li V.V. Kachestvo zhizni bol'nykh arterial'noi gipertoniei i ego dinamika pri provedenii obrazovatel'noi programmy [Quality of life of patients with the arterial hypertension and its dynamics when carrying out the educational program]. Nauka i zdravookhranenie [Science & Healthcare]. 2014. №1. pp. 31-34. [in Russian]

3.         Naumova M.A., Men'shikova L.I., Potehina N.N., Bel'skaja L.V. Opyt raboty shkoly arterial'noi gipertonii v poliklinike [Experience of the school of arterial hypertension in the polyclinic]. Ekologiya cheloveka [Human Ecology]. 2006. №2. pp. 58-60 [in Russian]

4.         Statisticheskii sbornik «Zdorov'e naseleniya RK i deyatel'nost' organizatsii zdravookhraneniya v 2016 godu» [Statistical handbook "Health of the Population of Kazakhstan and the activities of public health organizations in 2016"]. Astana: 2017 g. 356 p. [in Russian]

5.         Shupina M.I. Dinamika serdechno-sosudistykh faktorov riska i kachestva zhizni patsientov molodogo vozrasta s arterial'noi gipertoniei kak rezul'tat profilakticheskogo konsul'tirovaniya v pervichnom zvene zdravookhraneniya [Dynamics of cardiovascular risk factors and quality of life of young patients with arterial hypertension as a result of preventive counseling in primary health care]. Ratsional'naya Farmakoterapiya v Kardiologii [Rational Pharmacotherapy in Cardiology]. 2009. №4. pp. 25-32. [in Russian]

6.         American Academy of Family Physicians. Summary of Recommendations for Clinical Preventive Services. Leawood, KS: American Academy of Family Physicians; 2014. [22 July 2014]. Accessed athttp://www​.aafp.org/dam​/AAFP/documents/patient_care​/clinical_recommendations​/cps-recommendations.pdf

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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Дюсенова Л.Б., Пивина Л.М., Белихина Т.И., Апсаликов К.Н., Мулдагалиев Т.Ж. Оценка влияния медико-психологического консультирования на приверженность пациентов к лечению антигипертензивными препаратами / / Наука и Здравоохранение. 2018. 4 (Т.20). С. 34-49.

Dyussenova L.B., Pivina L.M., Belikhina T.I., Apsalikov K.N., Muldagaliev T.Zh. Evaluation of the impact of medical and psychological counselling on patient adherence to antihypertensive treatment. Nauka i Zdravookhranenie [Science & Healthcare]. 2018, (Vol.20) 4, pp. 34-49.

Дюсенова Л.Б., Пивина Л.М., Белихина Т.И., Әпсалықов Қ.Н., Молдағалиев Т.Ж. Пациенттердің гипертензияға қарсы препараттармен емдеуге бейімділігіне медициналық-психологиялық консультация берудің ықпалын бағалау / / Ғылым және Денсаулық сақтау. 2018. 4 (Т.20). Б. 34-49.