ASSESSING FACTORS THAT FORM PATIENT’S ATTITUDE TO TREATMENT PRECEDING HOSPITALIZATION FOR ACUTE CORONARY SYNDROM (DATA OF QUESTIONNAIRE WITHIN THE LIS REGISTER)

Aim. To determine the most significant factors forming patient’s attitude to treatment and factors of adherence to treatment preceding hospitalization in patients with acute coronary syndrome (ACS).
Material and methods. A register of patients admitted to Lyubertsy Regional Hospital №2 for ACS from 01.12.2011 to 01.12.2012 was used in the study. A total of 272 patients (men – 157, women – 115) were enrolled into the study. Age range was between 31 and 89 years, mean age was 63.6±12.6 years. Acute myocardial infarction was diagnosed in 181 patients, unstable angina pectoris – in 91 patients. While in hospital all the patients had filled out the questionnaire on therapy adherence.
Results. Half of the 272 patients (133 persons) enrolled into the study had regularly been followed-up for chronic diseases in different medical centers; 138 patients (50.7%) had not been followed-up before the reference hospitalization. According to the valid Morisky-Green test results 120 patients (44.1%) were adherent to treatment, in 141 (51.8%) patients the adherence was unsatisfactory, 11 persons (4.1%) did not answer the test questions. Younger patients adhered to doctors’ recommendations better. According to the patients (125 patients – 46%) the most effective strategy to improve treatment adherence was the obtaining of detailed information about their disease and methods of its treatment provided by the doctor. 32 patients (11.8%) pointed out the importance of lowering drug costs. 11 patients of 272 respondents demanded more care from their doctor; 4 persons suggested that better quality of medical care organization would help to ameliorate treatment adherence. Regular follow-up for chronic diseases with detailed informing about the condition by a physician positively influences adherence to recommended therapy. Patients of commercial medical centers and patients without any medical follow-up least of all adhered to treatment.
Conclusion. Specially designed questionnaire allowed to determine the most significant factors that form patients’ attitude to therapy preceding the reference hospitalization and factors of adherence to treatment prescribed before the hospitalization. All the significant factors were related to the physician-patient relationships, what emphasizes the important role of both doctors and patients in improvement of treatment adherence.

1. World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: WHO 2003

2. Osterberg L., Blaschke Т. Adherence to Medication. New England Journal of Medicine, 2005;353:487-97

3. Haynes RB, McKibbon KA, Kanani R. Systematic review of randomized trials of interventions to assist patients to follow prescriptions for medications. Lancet 1996; 348: 383–6

4. Vander Stichele. Measurement of patient compliance and the interpretation of randomized trials. Eur J Clin Pharma, 1991; 41: 27–35

5. Haynes RB, McKibbon KA, Kanani R. Systematic review of randomized trials of interventions to assist patients to follow prescriptions for medications. Lancet 1996; 348: 383–6

6. Coronary Drug Project Group. Influence of adherence to treatment and response of cholesterol on mortality in the coronary drug project. N Engl J Med 1980;303:1038—1041

7. Cramer J.A., Blum D., Reed M. et al. The influence of comorbid depression on quality of life. Epilepsy Behav 2002;3:338—342

8. Sebaldt R., Shane L.G., Pham B.Z. et al. Impact of non-compliance and non-peristence with daily bisphosphonates on longer-term effectiveness outcomes in patients with osteoporosis treated in tertiary specialist care. J Bone Miner Res 2004;19:Suppl 1:Abstract M 423.

9. Neznanov N.G., Vid V.D. The problem of compliance in psychiatry. Psychiatry and Psychofarmacotherapy 2004; 6(4): 159-62. Russian (Незнанов Н.Г., Вид В.Д. Проблема комплаенса в клинической психиатрии. Психиатрия и Психофармакотерапия 2004; 6 (4): 159–62)

10. Marcevich S.Yu., Ginzburg M.L., Kutishenko N.P. et al. The LIS research (study of mortality among patients, undergone acute myocardial infarction in Lyubertsy district). Evaluation of drug therapy. Part

11. The treatment patients receive before myocardial infarction and how it influences in-hospital mortality. Rational Pharmacother Card 2012; 8(5): 681-84. Russian (Марцевич С.Ю., Гинзбург М.Л., Кутишенко Н.П. и др. Исследование ЛИС (Люберецкое исследование смертности больных, перенесших острый инфаркт миокарда). Оценка лекарственной терапии. Часть 1. Как лечатся больные перед инфарктом миокарда и как это влияет на смертность в стационаре. Рациональная фармакотерапия в кардиологии. 2012, 8(5): 681-84)

12. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of self-reported measure of medical adherence. Med Care 1986;24:67–74

13. Lukina Yu.V., Ginzburg M.L., Smirnov V.P. et al. Adherence to treatment preceding hospitalization in patients with acute coronary syndrome. Clinicist 2012; (2): 45-53. Russian (Лукина Ю.В., Гинзбург М.Л., Смирнов В.П. и др. Приверженность к лечению, предшествующему госпитализации, у пациентов с острым коронарным синдромом. Клиницист 2012; (2): 45-53

14. Hill M, Houston N. Adherence to antihypertensive therapy. Chapter 131: 390–2.

15. Jin J., Sklar G. E., Oh M.N.S, Li S.C. Factors affecting therapeutic compliance: A review from the patient’s perspective. Ther. Clin. Risk Manag.; 2008; V. 4(1); P. 269–286

16. Benson J, Britten N. Patients decisions about whether or not to take antihypertensive drugs: qualitative study. BMJ 2002; 325: 873

17. Conradi A.O., Polunicheva E.V. Insufficient adherence to treatment of arterial hypertension: reasons and ways of correction. Arterial Hypertension 2004; 10(3): 137-43. Russian (Конради А.О., Полуничева Е.В. Недостаточная приверженность к лечению артериальной гипертензии: причины и пути коррекции. Артериальная Гипертензия 2004; 10(3): 137–43).

18. Bell R., Kravits R., Thom D. et al. Unmet Expectations for Care and the Patient-physician Relationship. J Gen Intern Med. 2002 November; 17(11): 817–824

19. Kerse N, Buetow S, Mainous AG 3rd. Physician-patient relationship and medication compliance: a primary care investigation. Ann Fam Med. 2004 Sep-Oct;2(5):455-61.

20. Stevenson, F.A., Cox, K., Britten, N., et al. A systematic review of the research on communication between patients and health care professionals about medicines: the consequences for concordance. Health Expectations, 2004, 7: 235–245.

21. Oganov R.G., Kalinina A.M., Pozdniakov Yu.M. Preventive cardiology (guidelines for doctors). Moscow: MED-press-inform; 2007. Russian (Оганов Р.Г., Калинина А.М., Поздняков Ю.М. Профилактическая кардиология (руководство для врачей). Москва: МЕД-пресс-информ; 2007).

22. Oganov R.G., Pogosova G.V. Contemporary strategy of cardiovascular diseases prevention and treatment. Cardiology 2007; 12: 4-9. Russian (Оганов Р.Г., Погосова Г.В. Современная стратегия профилактики и лечения сердечно-сосудистых заболеваний. Кардиология 2007; (12): 4-9)

23. Petrisheva A.V., Riamzina I.N. Influence of education in School of health on cardiovascular risk factors. Preventive Medicine 2011; (6): 26-9. Russian (Петрищева А.В., Рямзина И.Н. Влияние обучения в Школе здоровья на факторы кардиоваскулярного риска. Профилактическая Медицина 2011; (6): 26-29

24. Eganian R.A., Kalinina A.M., Izmailova O.V. Influence of dietary education in School of health on kind of nutrition in patients with arterial hypertension of I-II degree. Preventive Medicine 2010; (2): 29-

25. Russian (Еганян Р.А., Калинина А.М., Измайлова О.В. Влияние диетологического обучения в Школе здоровья на характер питания больных артериальной гипертонией I-II степени. Прифилактическая Медицина 2010; (2): 29-35.