Hypertension is a common, chronic disorder which is associated with a significant risk for cardiovascular diseases. Current guidelines emphasise that lowering elevated blood pressure (BP) reduced morbidity from stroke, myocardial infarction, congestive heart failure and renal failure [1,2]. This inadequate control not only has significant consequences in terms of patient morbidity and mortality, but also in terms of health care costs [3,4]. Poor compliance with antihypertensive therapy is thought to be a major factor in the failure to control hypertension [5,6]. Between 30% and 46% of patients may be non compliant with their antihypertensive drug regimens [7,8]. There has been much debate concerning the causes of noncompliance with antihypertensive therapy. Major factors are thought to be asymptomatic nature of hypertension, unacceptable side effects of therapy, suboptimal antihypertensive efficacy, and lack of effective communication between clinician and patient.
Assessment of the control status of arterial hypertension and efforts for increasing the number of successful treated patients are the main activities of the Georgian Society of Hypertension.
Aim of the study was manifestation of the main barriers of hypertension unsuccessful control in the Georgian Population via questioning of doctors and patients. And the second one, manifestation of the factors, associated with the adherence of patients to the antihypertensive treatment via questioning of doctors and patients.
MATERIALS AND METHODS
Qualitative study. Instrument of the study – structured questionnaire. Interviewers were trained by the trainer. There was questioned 700 doctors; among them 88% (616 doctors) were general practice doctors, 12% (84 doctors) were cardiologists and 2650 patients with arterial hypertension. While the creation of questionnaires, were foreseen main tendencies, i.e. opinions of doctors and patients about hypertension management barriers in Georgian population.
According to the doctor’s questioning, in 68% of cases material status of the patient is one of the most determining factors of the compliance to the treatment.
According to the patients’ questioning, the reason of low compliance (interrupted treatment, frequent changes of drugs while the treatment etc) in 62% of cases is ineffectiveness of the antihypertensive treatment.
According to the doctor’s questioning, low awareness is on the second place (28%). There is a talk about low awareness and the factors, which are necessary to provide for the effective control of arterial hypertension.
According to the patients’ questioning, next places take negative psychological attitude to the long lasting treatment – in 52% of cases, trust to the doctor, his/her authority (36%).
Doctors, as well as patients were faithful when they indicated about the difficulties of the entire use of the hypertension treatment algorithm because of the “patient’s insubordination” and “rare contact of the doctor with the patient”. According to the patients – “I do not appeal to the family doctor, he/she was a pediatrician in the past”. In case of having the choice, 34% of questioned subjects would address to another institutions, and 38% of patients think that doctor frequently hurries while patient’s visit.
Medical personnel, as well as patients while questioning recognize communication problems and decisive role of the doctor for the maintaining an adherence to the treatment in the long lasting treatment process.
For the providing effective control of hypertension, according to the majority of the doctors’ opinions, it is mainly associated with the material status, while patients as a determinant factor consider the efficacy of the initial treatment, communication to the doctor and his/her authority (trust to the doctor). Therefore, for specific group of patients important barrier is negative psychological attitude to the long lasting treatment.
Physician’s factor is the most important in the improvement of patient’s adherence to the treatment, because of doctor’s professionalism defines different ways of creation innovation in different individuals. Physician’s role for reaching the patient’s active participation in the treatment process of the chronic disease management indeed is decisive.
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Publication: September - November/2009