ABSTRACT
Introducción: La falta de adherencia a la terapia antihipertensiva contribuye directamente a que los pacientes coexistan con hipertensión, desencadenando mayor riesgo de morbilidad y mortalidad. Así, la falta de adherencia al tratamiento se convierte en una de las principales causas de hipertensión no controlada en la población. Evaluamos los factores asociados a la no-adherencia al tratamiento antihipertensivo en pacientes de cardiología de un hospital de EsSalud en San Juan de Lurigancho-Lima, durante el 2017. Material y Métodos: Estudio analítico-transversal, se incluyeron pacientes que acudieron a consultorio externo de cardiología con historia previa de hipertensión esencial y se excluyeron hipertensión secundaria por otras causas biológicas. Se utilizó el Test de Morisky-Green Morisky Medication Adherence Scale (MMAS-4) para evaluar la no-adherencia al tratamiento antihipertensivo. Resultados: De los 270 participantes de estudio, el 69% (n=185) eran adultos mayores de 65 años, 46% (n=124) varones y el 76% (n=118) tenían pareja estable. Entre los antecedentes clínicos, el 60% (n=122) reportó diagnóstico clínico de hipertensión arterial, el 30% (n=80) de diabetes mellitus tipo II y el 27% (n=73) no-adherencia al tratamiento. Los factores asociados a la no-adherencia de tratamiento fueron sexo masculino (ORa: 0,45, IC95% 0,20-1,04), trabajador independiente (ORa:3,88, IC95% 1,51-9,97), IMC mayor de 30 (ORa:0,23, IC95% 0,07-0,70). Conclusiones: en los pacientes con diagnóstico de hipertensión esencial existen factores de riesgo modificables y no modificables asociados a la no-adherencia al tratamiento. Se deben considerar estos factores para implementar estrategias de tamizaje y focalizar las intervenciones para adherir a los pacientes renuentes a su tratamiento.
Background:Lack of adherence to antihypertensive therapy contributes directly to patients coexisting with hypertension, triggering increased risk of morbidity and mortality. Thus, nonadherence to treatment becomes one of the main causes of uncontrolled hypertension in the population. We evaluated the factors associated with non-adherence to antihypertensive treatment in cardiology patients of an EsSalud hospital in San Juan de Lurigancho-Lima, during 2017. Material and Methods: Analytical-crossover study, patients attending cardiology outpatient clinic with previous history of essential hypertension were included and secondary hypertension due to other biological causes were excluded. The Morisky-Green Morisky Medication Adherence Scale (MMAS-4) was used to assess non-adherence to antihypertensive treatment. Results: Of the 270 study participants, 69% (n=185) were adults older than 65 years, 46% (n=124) were male and 76% (n=118) had a stable partner. Among the clinical history, 60% (n=122) reported clinical diagnosis of arterial hypertension, 30% (n=80) of type II diabetes mellitus and 27% (n=73) non-adherence to treatment. Factors associated with non-adherence to treatment were male sex (ORa: 0.45, 95%CI 0.20-1.04), self-employed (ORa:3.88, 95%CI 1.51-9.97), BMI greater than 30 (ORa:0.23, 95%CI 0.07-0.70). Conclusions: in patients with a diagnosis of essential hypertension there are modifiable and non-modifiable risk factors associated with non-adherence to treatment. These factors should be considered in order to implement screening strategies and target interventions to adhere to treatment in reluctant patients.
ABSTRACT
Objective: This Cross-sectional study appraised the levels of stress and determined their sources,symptoms and effects among the healthcare workers assigned at the infirmary and PTB cottages of the National Center for Mental Health. Methodology: Standardized scores on eight scales, measured through the Occupational Stress Assessment (OSA), a self administered instrument, of 144 respondents from the infirmary and PTB Cottages, were tested for statistically significant differences. Results: The study revealed higher men standardized scores on the negative scales of Organizational Irrationality, Lob Complexity and negative Outcome were lower for this study group than the norm. Stratification of the 8 scales with the demographic profiles and work characteristics revealed significant differences in the level of occupational stressed experience by each subgroup. Conclusion: A comparison of the OSA scales between the mean values of the norm and those obtained from the study revealed higher scores from the respondent of positive scales and lower scores from the respondents on the negative scales. Healthcare workers with ages 28-32 were the most empowered while those with ages 60-65 were the least empowered. The 60-65 aged group had the highest scores on the negative scales and lowest in exposure Management , Work and Home Supports. Occupational stress had an increased health and psychological impact among the females. The separated and widowed scored highest on negative scales and least on empowerment, Work and Home Supports and Exposure Management. The medical specialists were the most empowered, had the least scores on negative scales and highest scores on positive scales. The medical specialists were the most empowered , had the least scores on negative scales and highest score in positive scales. The medical officers had lesser scores on Empowerment Organizational Irrationality, work and Home Supports, Negative Outcome, Exposure Management and Relaxation Potential than the medical officers. Scores on negative scales were highest and scores on Empowerment, Exposure Management and Relaxation Potential were least on the 7am-3pm shift. Respondents who scored least empowerment, Organizational Irrationality and Job Complex had been absent more than once.