The role of compliance in improving quality of medical care

Kagramanyan, I.N.

doi:10.21518/1561-5936-2015-5-25-29

Cited by 2 publications

(9 citation statements)

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“…Recruitment process not describedRandomized non-blinded controlled intervention study6061.2 ± 1.8 (female)/61.8 ± 2.1 (male)1–2(a) patients with high and very high cardiovascular risk are included, for which adherence to therapy is particularly important, follow up period 6 mth;(b) small sample size, incorrect DBP level in inclusion criteriaKarpov et al [16]2013Patients attending any of 700 cardiologists in 51 Regions, each recruiting 3 patientsMen or women older than 18, with uncontrolled HT on treatment. Recruitment process not describedProspective observational intervention study212022–88 y2–3(a) big sample size, multicenter study;(b) relatively short follow up period 3 mth and no control groupGlezer et al [17]2016Patients attending 197 physicians in 48 RegionsMen or women aged 18–79, with essential HT, SBP ≥140 mmHg, DBP ≥90, but <110 mmHgProspective observational intervention study94056.5 ± 11.51–2(a) big sample size, multicenter study;(b) relatively short follow up period 3 mth, no control groupGlezer et al [18]2015Patients attending 243 physicians in 51 RegionsMen or women older than 18, with HT taking 2 or more antihypertensive drugs who have not reached their BP target, SBP 140–179 mmHg, DBP 90–109 mmHg, without contraindications to ACE inhibitors and calcium channel blockersProspective observational intervention study1351 included, 1061completed the protocol59.4 ± 11.1Essential HT(a) big sample size, multicenter study;(b) relatively short follow up period 3 mth, no control groupGlezer et al [19]2016Patients attending 442 physicians in 29 citiesMen or women older than 18, with HT on treatment who have not reached their BP targetProspective observational intervention study196960.1 ± 0.3No data(a) big sample size, multicenter study;(b) relatively short follow up period 3 mth, no control groupKagramanyan [20]2015Not statedThe author is affiliation at Yaroslavl State Medical UniversityMen or women aged 18–80, with grades 1–3 of HT, who visited the Municipal Clinical HospitalProspective observational intervention study5064.06 ± 0.49 (female)/61.88 ± 1.28 (male)1–3(a) studying of adherence in patients with 3 different socially significant nosologies - HT, asthma and alcohol abuse;(b) small sample size, large age range, the real number of HT patients is represented incorrectlyKaskaeva et al [21]2015Not statedMale patients aged 20–64 with grades 1–3 of HT. Recruitment process not describedNon-randomized comparison of 3 groups25020–64 y (ma...…”

Section: Methodsmentioning

confidence: 99%

Adherence to antihypertensive medication in Russia: a scoping review of studies on levels, determinants and intervention strategies published between 2000 and 2017

et al. 2019

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Background Arterial hypertension (HT) is common in the Russian adult population, with half of affected individuals inadequately controlled. Low adherence to medication seems likely to be a factor. We report a scoping review of studies on adherence to antihypertensive therapy (AHT) in Russia to determine the extent of research undertaken, the frequency of adherence among adults diagnosed with HT, methodologies used in the studies, and their ability to describe determinants of adherence. Methods A scoping review of published studies that have assessed adherence to AHT in Russian HT patients searched the main Russian and international electronic databases eLIBRARY.ru, Russian Medicine, Embase, MEDLINE for full-text reports published in the Russian language between 2000 and 2017. The last search was on November 28, 2017. Among 520 reports identified, 31 were included in the review. Results Eighteen studies assessed adherence using the 4-item Morisky Medication Adherence Scale (MMAS-4); others used bespoke questionnaires or pill counts. 25 studies assessed levels of adherence, 11 examined its determinants, and 18 examined intervention strategies. The proportion of “adherent” patients varied from 11 to 44% using the MMAS-4, from 23 to 74% when using bespoke questionnaires, and from 5 to 43% when using pill counts. Adherence was associated with sociodemographic factors, access to free drugs provided through the Medicine Assistance Scheme (MAS), use of home blood pressure (BP) monitoring, anxiety, and comorbidity. There was no evidence that adherence was associated with income or physical activity. Evidence of an association between MAS, grade of HT, or experience of hypertensive crisis was inconclusive. Various methods to improve adherence were studied including patient education (improved from 1.8 to 3.9 points, p = 0.0002 or 2.80 to 3.79 points, p < 0.0001 measured by the MMAS-4), telephone reminders (p < 0.0001), training in home BP monitoring (p < 0.05), and use of fixed-dose combinations (p < 0.05). Conclusions The main determinants of adherence to AHT are sociodemographic characteristics, the severity of HT, and presence of comorbidity. Patient education and use of fixed-dose combinations of drugs were identified as most important for improving adherence. Most studies assessing adherence use self-reported methods so there is a need for greater use of objective methods. Trial registration This scoping review has not been registered.

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Section: Methodsmentioning

confidence: 99%

Adherence to antihypertensive medication in Russia: a scoping review of studies on levels, determinants and intervention strategies published between 2000 and 2017

et al. 2019

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“…Включенные в анализ исследования существенно различались по размерам выборки: некоторые включали от нескольких сотен до нескольких тысяч человек [8][9][10][11][18][19][20], другие -намного меньше, от 30 до 70 человек [12,14,16,17,21,22,24,25]. Период наблюдения также значительно варьировал -от 6 нед [15] до 12 мес [9,10,22,25].…”

Section: Discussionunclassified

“…Достаточно часто мероприятия по повышению приверженности представляют собой обучение пациентов по специально разработанным образовательным программам [9][10][11][12][13][14][15]. Программы включают, как правило, несколько компонентов: информирование пациентов о заболевании и его лечении, обучение навыкам контроля АД и т.п., однако значимость различных элементов программы для достижения оптимального эффекта не изучалась.…”

Section: Discussionunclassified

“…В пяти исследованиях оценивались обучающие программы, позволяющие повысить информированность пациентов [11][12][13][14][15]. При этом приверженность к терапии по шкале МГ-4 повышалась, в частности, с 2,80 до 3,79 баллов (р<0,0001) [11], или с 1,8 до 3,9 баллов (р=0,0002) [15], а доля приверженных пациентов с показателем 4 балла увеличилась с 38,6 до 57,9% (р=0,04) [13].…”

Section: нерандомизированные интервенционные исследованияunclassified

“…При этом приверженность к терапии по шкале МГ-4 повышалась, в частности, с 2,80 до 3,79 баллов (р<0,0001) [11], или с 1,8 до 3,9 баллов (р=0,0002) [15], а доля приверженных пациентов с показателем 4 балла увеличилась с 38,6 до 57,9% (р=0,04) [13]. Приверженность, оцениваемая по разработанному оригинальному опроснику, увеличилась с 27 до 67% (р<0,05) [12]. Доля пациентов, ежедневно измеряющих АД, увеличилась с 28,8 до 65,4% (р<0,05), ежедневно принимающих антигипертензивные препараты -с 38,5 до 82,7% (р<0,05) [14].…”

Section: нерандомизированные интервенционные исследованияunclassified

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Adherence to Antihypertensive Therapy: A Systematic Review of Russian Prospective Studies from 2000 to 2019

Bochkareva¹,

Butina²,

Kim³

et al. 2020

Racionalʹnaâ farmakoterapiâ v kardiologii

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Russia belongs to countries with a high prevalence of arterial hypertension (AH), which is the main cause of premature death in the Russian population. The level of blood pressure (BP) is controlled in less than a third of patients, which may be due to poor adherence to medical recommendations and irregular medication. The manuscript provides a review of studies evaluating the effectiveness of measures to improve adherence to antihypertensive therapy (AHT).Aim. To prepare a systematic review of Russian studies to assess the effectiveness of measures to increase adherence to AHT, to determine/describe the main directions of the intervention and the methodological level.Material and methods. The search for full-text articles on adherence to AHT published in Russian in the period from 2000 to 2019 was carried out in the main Russian and international electronic databases eLIBRARY.ru, Embase, Russian Medicine, MEDLINE. Of the 563 publications found, 20 were included in the review.Results. In 14 studies, adherence was assessed using the 4-item Morisky Medication Adherence Scale (MMAS-4), other studies used bespoke questionnaires or pill counts. Two studies examined factors associated with adherence. The observation period was up 6 weeks to 12 months, the number of participants is 30-2435 people. A higher adherence was noted in women, people over 50 years old, with higher education, working, with concomitant diabetes mellitus and a history of myocardial infarction. Patient education was effective interventions to improve adherence (in particular, in studies, improvement on the MMAS-4 from 1.8 to 3.9 points, p=0.0002 or from 2.80 to 3.79 points, p<0.0001), telephone reminders (p<0.0001), training in self-measurement of blood pressure (p<0.05) and fixed combinations of drugs (p<0.05).Conclusion. The most effective ways to improve adherence are patient education and the use of drugs fixed combinations. In most studies, subjective methods of adherence assessing were used.

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The role of compliance in improving quality of medical care

Cited by 2 publications

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Adherence to antihypertensive medication in Russia: a scoping review of studies on levels, determinants and intervention strategies published between 2000 and 2017

Adherence to antihypertensive medication in Russia: a scoping review of studies on levels, determinants and intervention strategies published between 2000 and 2017

Adherence to Antihypertensive Therapy: A Systematic Review of Russian Prospective Studies from 2000 to 2019

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