Medication Adherence In Patients With Arterial Hypertension: The Relationship With Healthcare Systems’ Organizational Factors
Received 17 May 2019
Accepted for publication 1 September 2019
Published 17 October 2019 Volume 2019:13 Pages 1761—1774
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Johnny Chen
Ana Sofia Carvalho,1 Paulo Santos1,2
1Department of Medicine of Community, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of University of Porto, Porto, Portugal; 2Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
Correspondence: Ana Sofia Carvalho
Faculty of Medicine of University of Porto, Alameda Professor Hernâni Monteiro, Porto 4200-319, Portugal
Tel +351 225513600
Fax +351 225513601
Purpose: Arterial hypertension is one of the most common diseases in the world, presenting a great impact on global mortality. Despite having good medication, the best control depends on patient’s adherence. Our aim is to characterize the relationship of adherence to medication in hypertensive patients with consultation length and other organizational factors of healthcare systems.
Patients and methods: We performed a comprehensive review of literature using the MeSH terms “hypertension” and “medication adherence”. 61 articles were selected for inclusion and adherence parameters were extracted, allowing us to estimate the mean adherence for each country. The adherence was then correlated with organizational aspects of healthcare systems: consultation length, number of health providers (doctors, nurses and pharmacists), number of hospital beds, health expenditure and general government expenditure.
Results: Adherence to medication ranged between 11.8% in Indonesia and 85.0% in Australia. There is much heterogeneity in methodology, but the Morisky Medication Adherence Scale was the preferred method, used in 63.6% of the cases. We found no relation with consultation length, but a significant one with the greater number of health professionals available. Some differences were observed when considering European countries or Morisky Medication Adherence Scale alone.
Conclusion: The better the drugs, the better the control of blood pressure, if patients take them. Rather than investing in the prescription of more drugs, it is important to address non-adherence and reduce it to promote better blood pressure control. Organizational factors are relevant constraints and depend on administrative and political decisions. Although they are not always considered, they greatly impact the adherence to medication.
Keywords: high blood pressure, medication adherence, primary care, health services administration
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