Avaliação da aderência no tratamento medicamentoso da hipertensão arterial em pacientes atendidos em nível secundário de atenção à saúde

Abstract

Introduction: Hypertension is prevalent in 30% of the population and is the main cause of cardiocerebrovascular diseases and deaths worldwide. Even after diagnosis, failure to control blood pressure is very frequent and one cause is nonadherence (NAd) to antihypertensive medication. The NAd behavior is multifactorial and the ecological model proposes that these factors interact with each other, having as a center the patient, subject to the influence of micro levels (professional-patient relationship), meso (health service) and macro (health system). At the secondary level of health care, severe hypertensive patients are attended, and there are no data regarding the prevalence of NAd and the associated factors, either at entry or after changing the level of follow-up. Objectives: To evaluate the prevalence of NAd to antihypertensive medication and associated factors, according to ecological model, in severe hypertensive patients referred to the secondary level of health care and after 12 months of follow-up. Methods: 485 hypertensive patients were studied at the entrance (August/2014 to March/2016) in a secondary health care program. Of these, 311 patients persisted in the program for 12 months and were reevaluated (June/2015 to May/2017). NAd was evaluated in the implementation pHAe by the Morisky Green Levine Scale self-report instrument, which classifies as non-adherent any positive response to at least one of the four questions on the scale. The health literacy was evaluated by the Short Assessmentof Health Literacy for Portuguese-Speaking Adults (SAHLPA) instrument (score ≤14, low health literacy). Satisfaction and confidence were assessed through visual scaling. The sociodemographic and clinical characteristics were obtained by interviewing and consulting the patient's electronic record. The factors associated with NAD to antihypertensive medication were studied by logistic regression at entry and after permanence in the program. which factors had the greatest effect on NAd to antihypertensive medica tWione. iRdeesnutiflitesd: The patients referred for secondary care were women (56.3%), white (53.2%), low literacy in health (70.9%), and low income (65.4%). After 12 months of follow-up in the program, we observed a reduction of the NAd to the treatment (57.1% vs. 28.3%, p < 0.0001) and failure of the blood pressure control (75.1% vs. 62.0%, p < 0.0001). In the multivariate analysis at the entrance of NAd to antihypertensives, only the patient variables were associated: low literacy in health (OR 1.62, CI 1.07-2.44, p = 0.020), family income ≥2 minimum wages OR 0.46, CI 0.22-0.93, p = 0.031), not having a home (OR 1.99, CI 1.13-3.51, p = 0.017), sedentary lifestyle (OR 1.78, CI 1.12 -2.83, p = 0.014) and treatment complexity (number of sockets ≥2 times/day) (OR 1.56: CI 1.01-2.41, p = 0.042). After 12 months, predictors of NAd at the patient level were: age (OR 1.027, CI 1.003-1.051, p = 0.023), low health literacy (OR 1,987, CI 1.009-3.913, p = 0.047), systolic blood pressure (OR 1,941, CI 1,091-3,451, p = 0,024), and at the micro level: patient satisfaction with the health team (OR 0.711; CI 0.516-0.980, p = 0.037). Conclusion: The follow-up of the patients for the secondary health care program promoted greater adherence to drug therapy and better blood pressure control. NAd was associated with modifiable variables such as treatment complexity and satisfaction with the team. These results favor the implementation of similar programs as a strategy of better treatment for this group of patients.