| Abstract |
Introduction: Hypertension is one of the most important causes of premature morbidity and mortality worldwide and is a permanent threat to public health. The degree of adherence to therapeutic recommendations, such as the correct intake of medication, nutrition recommendations, mainly the limited intake of salt as well as the good cooperation between the patient and the therapist which is the basis for the individual's adherence and, therefore, the effective treatment of this chronic disease. Non-compliance of people with hypertension leads to persistent recurrence of the illness with subsequent complications such as cardiovascular disease, stroke and kidney disease. The complications of the disease affect the individual's way of life while reducing the life expectancy and burdening the patients’ health system. Aim: This study aims to assess the degree of compliance with the treatment of patients who visit the hypertension clinic of the University Hospital of Heraklion and investigate the factors that affect it. Methodology: Our study was a contemporary observational study using weighted questionnaires as well as open-ended questions for the collection of quality characteristics. The sample of the study was a sample of convenience and consisted of 150 people who visited the Cardiology Hypertension Clinic of the University Hospital of Heraklion, on Mondays and Wednesdays. Data collection started in September 2021 and was completed in November 2021. The selection criteria of the sample that were set as a condition for inclusion in the study was the age of the person to be over 25 years old, to have been officially diagnosed with hypertension and to receive treatment for this illness. A prerequisite was for the participants in the research to be informed about the purpose of the study and to sign the consent form for their voluntary participation in the research. The questionnaires given to the selected hypertensive patients includs: Demographic characteristics of the patients such as gender, age, educational level, marital status, occupational status, support network and heredity of hypertension. The Hill-Bone Scale has a scale of 14 Likert statements and three subscales of "salt intake", "medication intake", "visit attendance" outside the total which determines the degree of patient adherence to treatment and ranges from 14 (perfect compliance ) to 56 (zero compliance). The Charlson Comorbidity Scale predicts ten-year survival in% (0% -100%), helping the physician assess whether the presence of co-morbidities is affecting the patient's survival expectancy.The scale of determinants of treatment adherence has assessed the impact of socio-economic factors related to the health system, the impact of the relationship between the treatment- team patient, with the support network in maintaining specific intersections. The total score obtained for each identifier is divided by the number of objects in each identifier, and thus scores are created from 0 to 4. The highest scores imply the most vital identifier. Finally, participants were asked to answer five open-ended questions that evaluated: the importance of patients' general compliance, their knowledge about the disease, and the possible impact of the Covid-19 pandemic on their degree of compliance. Result: The 55.4% of the individuals were in the age group over 65 years, 70% declared married, while 75.3% lived during the period of completing the questionnaires with a partner or had a support network. Finally, 54% of people were retired, 70% had inherited hypertension, and 30.7% had diabetes mellitus as their main co-morbidity. The overall level of compliance did not prove to be affected by gender (p = 0.256), educational level (p = 0.435), marital status (p = 0.398), living conditions (p = 0.214), occupational status (p = 0.205) as well as the age group (p = 0.092). On the Hill - Bone scale and specifically on the "salt intake" subscale, a statistically significant difference was found between compliance to restricted salt intake and gender (p = 0.002) with women having better compliance 4.8 ± 1.3 compared to men 5.6 ± 1.6. In the same subscale, better compliance was observed to those engaged in housekeeping having an average of 4.2 ± 0.9 and those working outside having 5.8 ± 1.5 (p <0.001). It is also found that the age group has an effect by increasing the compliance with the dietary guidelines (p = 0.002), with better compliance to those of 76 years and over. Most of the variables ranged from week r = -0.182, p = 0.026 ("Salt intake reduction" and "Support network") to moderate correlation r = 0.513 p<0.001 ("Salt intake reduction" and "Lifestyle"). The "support network" as a compliance determinant did not show a statistically significant correlation with the other compliance variables. People that the suffered from Myocardial Infarction (p = 0.039) had better compliance with medical instructions and stated greater consistency in their visits to the hospital unit than those who did not suffer. At the same time, it was found that people suffering from the disease showed better compliance with their medication and specifically in the subscale "Medication intake" compared to those who did not suffer (p = 0.050). An important result is also found in people who did not have Peripheral Vascular Disease (PAN), who were found to have better compliance and consistency (p = 0.022) than those who had a disease. The main reasons of non-compliance stated by the open-ended questions were the reduced free time, the patient's psychology, the financial factors, and the difficulty of meeting with the treating physician. The last two factors were attributed due to the COVID-19 pandemic. In comparison, 33.8% of the person stated that a treating physician has rarely told them anything for the importance of compliance and the complications that the opposite attitude can bring. Conclusions: The population studies show that they complies quite well to hypertension, with an understanding of their need for medication compliance. There were no significant differences in overall compliance; however, individual differences with men not complying to rules such as salt use, older people being better complied to medication, were evident. Despite the high compliance, it was not claimed that doctors adequately inform about its value, while according to the results of the qualitative research, there was an effect on compliance, mainly in difficulties of access to the doctor, from the pandemic and quarantine. The average patient survival as well as the corresponding comorbidity proof to affects positive compliance, with the disease with the healthiest having less compliance in nutrition or medication hobbies. Specific cases of diseases such as peripheral vascular disease have shown that sufferers have worse compliance. The effect of family and social networks does not seem to have any effect but to limit salt intake. Barriers to access, poor relationship with medical staff and inconsistencies in visits contribute to poor compliance. The results of our study seemed to be in accordance with the international literature. Finally, it should be noted that interventions to improve compliance in people with hypertension are necessary.
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Βαθμός συμμόρφωσης στη θεραπευτική αγωγή ασθενών που επισκέπτονται το ιατρείο υπέρτασης του Πανεπιστημιακού Νοσοκομείου Ηρακλείο
