Factors associated with adherence to pharmacological treatment among elderly persons using antihypertensive drugs

Aquino, Glenda de Almeida; Cruz, Danielle Teles da; Silvério, Marcelo Silva; Vieira, Marcel de Toledo; Bastos, Ronaldo Rocha; Leite, Isabel Cristina Gonçalves

doi:10.1590/1981-22562017020.160098

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Thematic Section - Drug use and associated risks among the elderly • Rev. bras. geriatr. gerontol. 20 (1) • Jan-Feb 2017 • https://doi.org/10.1590/1981-22562017020.160098 linkcopy

Factors associated with adherence to pharmacological treatment among elderly persons using antihypertensive drugs

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective: analyze adherence to pharmacotherapy and associated factors among elderly patients using at least one antihypertensive medication.

Methods: A cross-sectional, population-based study was performed of elderly patients resident in Juiz de Fora, Minas Gerais, Brazil. Adherence to medication was assessed with the Morisky-Green Test. Socio-demographic variables and variables related to health status, the health service and drug therapy were collected. The Poisson regression model was used to assess crude and adjusted (95% confidence interval) prevalence ratios (PR). The level of significance was tested using the Wald test.

Results: The prevalence of adherence to pharmacological therapy was 47% (95% CI: 41%-53%). The sample consisted of 279 elderly persons, the majority of whom were women (69%), described themselves as white (45.5%), and had up to four years of schooling (76.48%). Regarding pharmacological therapy, the subjects took 5.19 (±2.8) medications and 7.1 (±4.4) tablets per day.

Conclusion: a significant association was observed between adherence to pharmacological therapy and the variables positive perception of vision, positive perception of hearing and absence of frailty.

Keywords: Elderly; Hypertension; Medication Adherence.

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Universidade do Estado do Rio Janeiro Rua São Francisco Xavier, 524 - Bloco F, 20559-900 Rio de Janeiro - RJ Brasil, Tel.: (55 21) 2334-0168 - Rio de Janeiro - RJ - Brazil
E-mail: revistabgg@gmail.com

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[TFN1] Access route - Commercial pharmacy

Variable	Adherent	Non-adherent
Variable	n (%)	n (%)
Block1: Relating to socioeconomic and demographic conditions
Gender
Female	90 (32.25)	103 (36.94)
Male	41 (14.69)	45 (36.94)
Age (years)
60-69	46 (16.51)	44 (15.77)
70-79	58 (20.78)	63 (22.58)
80 or older	27 (9.67)	41 (14.69)
Skin color
White	52 (18.63)	75 (26.88)
Non-white	79 (28.33)	73 (26.16)
Schooling (years)
0	20 (7.29)	11 (3.94)
1 to 4	79 (28.83)	99 (36.42)
More than 4	30 (10.75)	35 (12.77)
Family arrangement
Lives alone	16 (5.73)	15 (5.37)
Lives with others	115 (41.22)	133 (47.68)
Marital status
Married/common law marriage	71 (25.44)	74 (26.53)
Single/widowed/separated/others	60 (21.50)	74 (26.53)
Socioeconomic level (Brazilian Association of Research Companies)
A or B	34 (12.10)	46 (16.48)
C	78 (27.95)	86 (30.93)
D or E	19 (6.81)	16 (5.73)
Block 2: Health service
Type of coverage in Unified Health System
Traditional	9 (3.23)	14 (5.00)
Family Health Strategy	115 (41.30)	123 (44.20)
Medical Center	7 (2.51)	10 (3.59)
Health plan
Yes	82 (29.30)	87 (31.10)
No	49 (17.56)	61 (21.86)
Medical consultation in previous 3 months
Yes	96 (34.40)	125 (44.80)
No	35 (12.50)	23 (8.20)
Hospitalized in previous 3 months
Yes	7 (2.48)	6 (2.12)
No	125 (44.30)	144 (51.06)
Received emergency care in previous 3 months
Yes	13 (4.60)	20 (7.09)
No	119 (42.19)	130 (46.09)
Access route - Unified Health System Unit
Yes	65 (23.30)	79 (30.00)
No	59 (23.00)	53 (20.70)
Access route - Farmácia popular (Popular pharmacy)
Yes	49 (19.00)	55 (21.50)
No	75 (29.40)	76 (29.80)
Access route - Commercial pharmacy
Yes	54 (21.10)	38 (14.90)
No	70 (27.40)	93 (36.40)
Satisfied with service
Yes	110 (39.50)	116 (41.72)
No	20 (7.19)	32 (11.51)
Block 3: Health condition
Self-reported health problem
Yes	120 (43.00)	143 (51.20)
No	11 (3.90)	5 (1.70)
Self-reported Systemic Arterial Hypertension
Yes	100 (38.02)	102 (38.78)
No	20 (7.60)	41 (15.58)
Help walking
Yes	105 (37.60)	120 (43.00)
No	26 (9.30)	28 (10.00)
Self-perception of state of health
Excellent/ very good/ good	67 (27.50)	59 (126.00)
Fair/poor	44 (18.10)	73 (30.00)
Self-perception of state of vision
Excellent/ very good/ good	61 (25.10)	47 (19.30)
Fair/poor	50 (20.50)	85 (34.90)
Self-perception of state of hearing
Excellent/ very good/ good	92 (37.70)	84 (34.40)
Fair/poor	20 (8.19)	48 (19.60)
Frailty
Not frail	53 (23.10)	35 (15.20)
Apparent to severe frailty	54 (23.50)	87 (37.90)
Block 4: Pharmacological therapy
N° of tablets taken/day
1 to 3	49 (17.56)	42 (15.03)
4 or more	82 (29.39)	106 (37.99)

Questions	Yes n (%)	No n (%)
Do you ever forget to take your medications?	113 (40,5)	166 (59,5)
Are you careless at times about taking your medication?	70 (25,1)	209 (74,9)
When you feel better do you sometimes stop taking your medication?	22 (7,9)	257 (92,1)
Sometimes if you feel worse when you take your medications, do you stop taking them?	34 (12,2)	245 (87,8)

Variables	Crude PR	CI-95%		p	Adjusted PR	CI-95%		p
Block1: Variables related to socioeconomic condition
Age (years)				0.10				0.07
60-69	1.28	0.90	1.83		1.36	0.97	1.92
70-79	1.20	0.85	1.70		1.51	0.81	2.84
80 or older	1.00
Skin color *				0.04				0.09
White	0.79	0.61	1.02		0.66	0.40	1.07
Non-white	1.00				1.00
Schooling (years)**				0.07				0.79
0	0.65	0.38	1.11		0.57	0.27	1.23
1 to 4	1.03	0.80	1.34		1.09	0.50	1.69
Older than 4	1.00				1.00
Socioeconomic level (Brazilian Association of Research Companies)**				0.16				0.55
A or B	1.14	0.77	1.69		1.16	0.72	1.85
C	1.03	0.80	1.34		1.26	0.54	1.38
D or E	1.00				1.00
Block 2: Health services
Medical consultation in previous 3 months *				0.02				0.02
Yes	1.42	1.01	1.99		2.04	1.08	3.79
No	1.00
Access route- Unified Health System Unit*				0.14				0.90
Yes	0.85	0.66	1.10		0.97	0.55	1.69
No	1.00
Access route- commercial pharmacy*				0.01				0.06
Yes	1.36	1.06	1.74		1.76	0.99	3.13
No	1.00				1.00
Satisfaction with service*				0.11				0.41
Yes	1.27	0.88	1.83		1.30	0.70	2.42
No	1.00				1.00
Block 3: Health condition
Self-reported health problem*				0.06				0.33
Yes	0.66	0.46	0.94		0.49	0.11	2.09
No	1.00				1.00
Self-reported Arterial Hypertension*				0.02				0.26
Yes	1.51	1.03	2.22		1.54	0.73	3.28
No	1.00				1.00
Perception of health*				0.01				0.88
Excellent/ very good/ good	1.41	1.06	1.88		1.06	0.52	2.16
Fair/poor	1.00				1.00
Perception of vision*				0.02				0.08
Excellent/ very good/ good	1.52	1.15	2.00		1.75	0.92	3.31
Fair/poor	1.00				1.00
Perception of hearing*				0.01				0.01
Excellent/ very good/ good	1.78	1.20	2.64		2.69	1.28	5.62
Fair/poor	1.00				1.00
Frailty*				<0.01				0.01
Not-frail	1.57	1.20	2.06		2.32	1.14	4.69
Apparent to severe frailty	1.00				1.00
Block 4: Pharmacological therapy
N° of tablets taken/day *				0.07				0.07
1 to 3	1.23	0.96	1.59		1.51	0.91	2.49
4 or more	1.00				1.00

Variables	Adjusted PR *	CI-95%		p
Perception of vision				0.02
Excellent/ very good/ good	2.14	1.08	4.27
Fair/poor	1.00
Perception of hearing				0.03
Excellent/ very good/ good	2.33	1.05	5.18
Fair/poor	1.00
Frailty				0.03
Not-frail	2.18	1.05	4.55
Apparent to severe frailty	1.00