Amaia Calderón-Larrañaga1, Esperanza Diaz2, Beatriz Poblador-Plou1, Luis Andrés Gimeno-Feliu3, José María Abad-Díez4, Alexandra Prados-Torres5. 1. EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/ Sinesio Delgado 4, 28029 Madrid, Spain. 2. Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, NO-5020 Bergen, Norway; Norwegian Centre for Minority Health Research (NAKMI), Oslo University Hospital, PO box 4956, NO-0424 Oslo, Norway. 3. EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/ Sinesio Delgado 4, 28029 Madrid, Spain; San Pablo Health Centre, C/ Aguadores 7, 50003 Zaragoza, Spain; University of Zaragoza-Faculty of Medicine, C/ Domingo Miral s/n, 50009 Zaragoza, Spain. 4. EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; University of Zaragoza-Faculty of Medicine, C/ Domingo Miral s/n, 50009 Zaragoza, Spain; Dpt. of Health, Welfare and Family, DG Planning and Assurance, Government of Aragon, Vía Univérsitas 36, 50009 Zaragoza, Spain. 5. EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, C/ Sinesio Delgado 4, 28029 Madrid, Spain; University of Zaragoza-Faculty of Medicine, C/ Domingo Miral s/n, 50009 Zaragoza, Spain.
Abstract
BACKGROUND: Multiple parameters influence adherence to drug treatment, including socio-economic, healthcare, condition, therapy, and patient-related factors. However, studies of the impact of patient-related factors, particularly regarding comorbid conditions, have produced conflicting results. OBJECTIVES: To analyse the association between mental and physical comorbidity and non-adherence to antihypertensive medication in patients attending primary care, after including a comprehensive range of chronic comorbidities and potential confounders. METHODS: Cross-sectional study of 113,397 adults with a diagnosis of hypertension in 2010 assigned to the public health service of a region in northeastern Spain. Pharmacy billing records were linked to data from electronic health records at individual level. Non-adherence was defined as an antihypertensive medication possession ratio (MPR) <80%. Multivariable logistic regression models were used to estimate the odds ratio for non-adherence. Potential predictors included mental and physical comorbidity, age, sex, blood pressure level, nationality, rurality, polypharmacy, and number of visits to the GP and to different specialties. RESULTS: One fifth of the study population showed poor adherence levels. Female sex, younger age, foreign nationality, living in a rural area, low blood pressure levels, polypharmacy, and mental comorbidity were positively and significantly associated with non-adherence. Conversely, non-adherence was negatively and significantly associated with the presence of cardiovascular risk factors and higher annual rates of GP visits. CONCLUSION: The majority of patient-related determinants identified here (e.g., the presence of mental comorbidity, polypharmacy, foreign nationality) underscores the need for a patient- rather than a disease-centred care approach, as well as adequate physician-patient communication.
BACKGROUND: Multiple parameters influence adherence to drug treatment, including socio-economic, healthcare, condition, therapy, and patient-related factors. However, studies of the impact of patient-related factors, particularly regarding comorbid conditions, have produced conflicting results. OBJECTIVES: To analyse the association between mental and physical comorbidity and non-adherence to antihypertensive medication in patients attending primary care, after including a comprehensive range of chronic comorbidities and potential confounders. METHODS: Cross-sectional study of 113,397 adults with a diagnosis of hypertension in 2010 assigned to the public health service of a region in northeastern Spain. Pharmacy billing records were linked to data from electronic health records at individual level. Non-adherence was defined as an antihypertensive medication possession ratio (MPR) <80%. Multivariable logistic regression models were used to estimate the odds ratio for non-adherence. Potential predictors included mental and physical comorbidity, age, sex, blood pressure level, nationality, rurality, polypharmacy, and number of visits to the GP and to different specialties. RESULTS: One fifth of the study population showed poor adherence levels. Female sex, younger age, foreign nationality, living in a rural area, low blood pressure levels, polypharmacy, and mental comorbidity were positively and significantly associated with non-adherence. Conversely, non-adherence was negatively and significantly associated with the presence of cardiovascular risk factors and higher annual rates of GP visits. CONCLUSION: The majority of patient-related determinants identified here (e.g., the presence of mental comorbidity, polypharmacy, foreign nationality) underscores the need for a patient- rather than a disease-centred care approach, as well as adequate physician-patient communication.
Authors: D M van der Laan; P J M Elders; C C L M Boons; J J Beckeringh; G Nijpels; J G Hugtenburg Journal: J Hum Hypertens Date: 2017-06-29 Impact factor: 3.012
Authors: Rosa L de Jager; Erik M van Maarseveen; Michiel L Bots; Peter J Blankestijn Journal: Br J Clin Pharmacol Date: 2017-10-10 Impact factor: 4.335
Authors: LaKeisha G Williams; Erin Peacock; Cara Joyce; Lydia A Bazzano; Daniel Sarpong; Paul K Whelton; Elizabeth W Holt; Richard Re; Edward Frohlich; Jiang He; Paul Muntner; Marie Krousel-Wood Journal: Am J Med Sci Date: 2018-07-29 Impact factor: 2.378
Authors: Walter Espeche; Martin R Salazar; Rodrigo Sabio; Alejandro Diaz; Carlos Leiva Sisnieguez; Daniel Olano; Eduardo Balbin; Nicolas Renna; Pedro Grosse; Roberto A Flores; Ana C Lagos; Pablo Ferrer; Silvia Poppe; Facundo Risso Patron; Victor D Sotnieczuk Stasiuk; Elina Valentini; Jose R Cardozo; Jose R Romano; Roberto Parodi; Horacio Carbajal Journal: J Clin Hypertens (Greenwich) Date: 2020-02-17 Impact factor: 3.738