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      La adherencia a los medicamentos en pacientes hipertensos y en muestra de la población general Translated title: Characterization of medication adherence in a sample of the general population and another of hypertensive patients in Panama

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          Abstract

          RESUMEN Objetivo: Caracterizar la adherencia al tratamiento farmacológico en la población adulta, y en pacientes hipertensos atendidos en dos centros de atención primaria de la Caja de Seguro Social en Panamá. Métodos: Aplicación de encuesta poblacional sobre la adherencia medicamentosa a 1.200 personas en las 4 ciudades de mayor población y crecimiento económico en Panamá y otra encuesta a pacientes hipertensos atendidos en centros de atención primaria de la Seguridad Social, durante los meses de septiembre a octubre del 2016. Resultados: De 1.200 personas que participaron en la encuesta, 671 tomaban medicamentos, 54% eran mujeres y 54% con estudios universitarios. El 91% manifestaron padecer algún tipo de enfermedad y uso de diversos medicamentos. El 55% contestó que alguna vez había olvidado tomar el medicamento. Fueron 176 pacientes encuestados en los centros de atención primaria, 67% mujeres, 42% con grado universitario. El 97% eran hipertensos, 48% diabéticos. El 80% de los hipertensos tomaban diversos medicamentos. Al aplicarse el test de Morisky-Green a los pacientes, el 40% indicó haber dejado de tomar los medicamentos por lo tanto no cumplían con la farmacoterapia ordenada. De acuerdo al test de Batalla, los pacientes mostraron tener un gran conocimiento sobre su enfermedad. Conclusiones: La mayoría de la población encuestada sufría HTA y habían olvidado tomar los medicamentos. Los pacientes reconocieron padecer y conocer la hipertensión, sin embargo, no fueron adherentes al tratamiento medicamentoso. Se hace necesario una toma de conciencia y participación en el control de su enfermedad e impulsar campañas nacionales sobre la adherencia medicamentosa.

          Translated abstract

          SUMMARY Objective: To characterize adherence to pharmacological treatment in the adult population, and in hypertensive patients treated in two primary care centers of the Social Security in Panama. Methods: A survey on drug adherence was applied to 1,200 study participants in 4 major cities in Panama. The survey for hypertensive patients was applied in primary health care centers. Results: Of 1,200 study participants, 671 were taking medications, 54% were women and 54% university degrees. 91% reported suffering from some type of illness and use of various medications. 55% replied that they had once forgotten to take the medication whereas 80% of the participants said they forget medication intake frequently. There were 176 hypertensive patients survey in primary care centers, 67% women, and 42% with university degree. 97% were hypertensive and 48% diabetic. 80% of patients with hypertension took various medications. When the Morisky-Green test was applied to patients, 40% indicated that they stopped taking the medications; therefore, they did not comply with the ordered pharmacotherapy. According to the Batalla test, patients showed great knowledge about their disease. Conclusions: The majority of the population surveyed suffered from hypertension and had forgotten to take the medications. The patients recognized suffering and knowing the hypertension, however, they were not adherent to the drug treatment. Awareness and participation in the control of your disease is necessary and to promote national campaigns on drug adherence.

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          Most cited references37

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          Concurrent and Predictive Validity of a Self-reported Measure of Medication Adherence

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            Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study.

            In adults, cardiovascular risk factors reinforce each other in their effect on cardiovascular events. However, information is scant on the relation of multiple risk factors to the extent of asymptomatic atherosclerosis in young people. We performed autopsies on 204 young persons 2 to 39 years of age, who had died from various causes, principally trauma. Data on antemortem risk factors were available for 93 of these persons, who were the focus of this study. We correlated risk factors with the extent of atherosclerosis in the aorta and coronary arteries. The extent of fatty streaks and fibrous plaques in the aorta and coronary arteries increased with age. The association between fatty streaks and fibrous plaques was much stronger in the coronary arteries (r=0.60, P<0.001) than in the aorta (r=0.23, P=0.03). Among the cardiovascular risk factors, body-mass index, systolic and diastolic blood pressure, and serum concentrations of total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol, as a group, were strongly associated with the extent of lesions in the aorta and coronary arteries (canonical correlation [a measure of the association between groups of variables]: r=0.70; P<0.001). In addition, cigarette smoking increased the percentage of the intimal surface involved with fibrous plaques in the aorta (1.22 percent in smokers vs. 0.12 percent in nonsmokers, P=0.02) and fatty streaks in the coronary vessels (8.27 percent vs. 2.89 percent, P=0.04). The effect of multiple risk factors on the extent of atherosclerosis was quite evident. Subjects with 0, 1, 2, and 3 or 4 risk factors had, respectively, 19.1 percent, 30.3 percent, 37.9 percent, and 35.0 percent of the intimal surface covered with fatty streaks in the aorta (P for trend=0.01). The comparable figures for the coronary arteries were 1.3 percent, 2.5 percent, 7.9 percent, and 11.0 percent, respectively, for fatty streaks (P for trend=0.01) and 0.6 percent, 0.7 percent, 2.4 percent, and 7.2 percent for collagenous fibrous plaques (P for trend=0.003). These findings indicate that as the number of cardiovascular risk factors increases, so does the severity of asymptomatic coronary and aortic atherosclerosis in young people.
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              Interventions for helping patients to follow prescriptions for medications.

              People who are prescribed self-administered medications typically take less than half the prescribed doses. Efforts to assist patients with adherence to medications might improve the benefits and efficiency of health care, but also might increase its adverse effects. To update a review summarising the results of randomised controlled trials (RCTs) of interventions to help patients follow prescriptions for medications for medical problems, focusing on trials that measured both adherence and clinical outcomes. Computerised searches to August 2001 in MEDLINE, CINAHL, The Cochrane Library, International Pharmaceutical Abstracts (IPA) PsychInfo, and Sociofile; bibliographies in articles on patient adherence; articles in the reviewers' personal collections; and contact with authors of original and review articles on the topic. Articles were selected if they reported an unconfounded RCT of an intervention to improve adherence with prescribed medications, measuring both medication adherence and treatment outcome, with at least 80% follow-up of each group studied and, for long-term treatments, at least six months follow-up for studies with positive initial findings. Information on study design features, interventions and controls, and results were extracted by one reviewer and confirmed by at least one other reviewer. The studies were too disparate to warrant meta-analysis. For short-term treatments, one of three interventions reported in three RCTs showed an effect on both adherence and clinical outcome. Eighteen of 36 interventions for long-term treatments reported in 30 RCTs were associated with improvements in adherence, but only 16 interventions led to improvements in treatment outcomes. Almost all of the interventions that were effective for long-term care were complex, including combinations of more convenient care, information, reminders, self-monitoring, reinforcement, counselling, family therapy, and other forms of additional supervision or attention by a health care provider (physician, nurse, pharmacist or other). Even the most effective interventions did not lead to large improvements in adherence and treatment outcomes. Two studies showed that telling patients about adverse effects of treatment did not affect their adherence. The full benefits of medications cannot be realised at currently achievable levels of adherence. Current methods of improving adherence for chronic health problems are mostly complex and not very effective. Innovations to assist patients to follow medication prescriptions are needed.
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                Author and article information

                Journal
                ofil
                Revista de la OFIL
                Rev. OFIL·ILAPHAR
                Organización de Farmacéuticos Ibero-Latinoamericanos (Madrid, Madrid, Spain )
                1131-9429
                1699-714X
                2020
                : 30
                : 4
                : 313-323
                Affiliations
                [1] Panamá orgnameInstituto Conmemorativo Gorgas de Estudios de la Salud orgdiv1Departamento de Investigación y Evaluación de Tecnología Sanitaria República de Panamá
                [2] Panamá orgnameUniversidad Latina de Panamá
                [3] Panamá orgnameCaja de Seguro Social
                Article
                S1699-714X2020000400009 S1699-714X(20)03000400009
                10.4321/s1699-714x2020000400011
                7c2894e5-a0cc-4f82-b0df-3658b7ee9792

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 30 January 2020
                : 05 March 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 37, Pages: 11
                Product

                SciELO Spain

                Categories
                Originales

                Adherencia,medicamentos,hipertensión arterial,Morisky-Green,Adherence,medications,hypertension

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