ADHERENCE TO TREATMENT ASSESSMENT IN PATIENTS WITH CARDIOVASCULAR DISEASES FROM A CLINICAL AND PSYCHOLOGICAL PERSPECTIVE

Abstract

Introduction. The behavior of patients with cardiovascular diseases in the course of therapy is of key importance, since their survival and quality of life depend on their lifestyle and adherence to physicians’ recommendations. Adherence to treatment and its assessment is considered to be a medical problem, but numerous studies show that it is multifactorial and it must be considered from an interdisciplinary point of view. Material and Methods. CHD patients of the cardiac rehabilitation department were examined (n=112). Patients’ behavior in the therapy process, their clinical, emotional and social status and psychological characteristics were studied. Supervising doctors and clinical psychologists who followed up the patients made an expert opinion on their level of adherence to treatment and divided them into two groups. At the same time, they filled out a specific questionnaire for each patient, which contained several aspects of patients’ therapeutic behavior, both pharmacological and non-pharmacological. Results. Adherent and non-adherent patients were found to differ in all the aspects included in the questionnaire (p<0,001; p<0,05 for the indicator “alcohol consumption”). The factor analysis of all the questions from the questionnaire identified three major factors that combined various aspects of treatment adherence. Three obtained factors explain 70% of the total dispersion. The 1st one included the following aspects: regularity of cardiological examinations, regularity of blood pressure self-monitoring, intake of prescribed medications regularity; the 2nd, control (and, if necessary, reduction) of weight, following a diet, the level of physical activity; the 3rd, alcohol consumption (frequency and dose) and smoking (smoking cessation/number of cigarettes per day). Based on the three identified factors system, patients can be divided into more specific categories. Conclusion. Nevertheless, it is essential to consider not only the level of adherence to treatment and its aspects, but also the reasons of patients’ behavior: their awareness of the treatment regimen, their consciousness and motives for following the recommendations, the value of health and the subjective disease perception. It is important to take account of the factors that may interfere in adherence to treatment, and patients’ resources for an optimal therapeutic behavior. Therefore, adherence to treatment is based on both clinical and psychological aspects. Its theoretical and practical study should be based on the biopsychosocial approach to the problem and an individual approach to each patient. Acknowledgement. This research was supported by the Russian Foundation for Basic Research (RFBR) (Grant No 18-013-00689 A).