Treatment adherence of Chinese patients with hypertension: a longitudinal study

The relationship between hypertensive patients' satisfaction with hypertension care and their antihypertensive medication adherence

BACKGROUND

Hypertension is a common chronic disease that causes serious complications. Therefore, its management is critical. Many factors affect the management of hypertension, such as care satisfaction and antihypertensive medication adherence.

AIM

This study investigated the relationship between hypertensive patients' satisfaction with hypertension care and their antihypertensive medication adherence.

MATERIALS AND METHODS

This descriptive-correlational study was conducted between October 2016 and February 2017. A total of 407 patients meeting the inclusion criteria were enrolled in the study. The data were collected using the descriptive questionnaire, the Patient Assessment of Chronic Illness Care (PACIC) to determine care satisfaction, and the Medication Adherence Self-Efficacy Scale-Short Form (MASES-SF). Blood pressure, body height, and weight were also measured.

RESULTS

Patients had a low mean PACIC score and a good mean score on the MASES-SF. Their PACIC scores differed by age, gender, number of daily antihypertensive medications, time since last examination due to hypertension, getting information about hypertension, and blood pressure control status (p < 0.05). Their MASES-SF scores differed by perceived economic status, time since hypertension diagnosis, duration of antihypertensive medication use, time since last examination due to hypertension, and blood pressure control status. In addition, there was a weak positive and significant correlation between PACIC and MASES-SF scores (p < 0.001).

CONCLUSIONS

Patients have low satisfaction with hypertension care and good antihypertensive medication adherence. As satisfaction with hypertension care increases, adherence to antihypertensive medication increases.

Time Effects of Supportive Interaction and Facilitator Input Variety on Treatment Adherence of Young People with Chronic Health Conditions: A Dynamic Mechanism in Mutual Aid Groups

This study aims to examine the mechanism of how supportive interaction and facilitator input variety in mutual aid groups impact treatment adherence of young people with chronic health conditions, with consideration of time effects, which have been rarely studied in the existing literature. A stratified random sample of 391 individuals aged 12–45 years with chronic health conditions were recruited from mutual aid groups in Hong Kong and completed both the baseline and 12-month follow-up surveys. The results of the structural equation modeling indicated that supportive interaction and facilitator input variety positively predicted treatment adherence in a delayed condition, whereas members’ treatment adherence in the baseline survey had reversed effects on members’ supportive interaction in the follow-up survey. The findings of this study shed light on the dynamic mechanism of the mutual aid groups and provide important implications to promote better rehabilitation outcomes of young people with chronic health conditions.

Using Goal-Directed Design to Create a Mobile Health App to Improve Patient Compliance With Hypertension Self-Management: Development and Deployment

BACKGROUND

Hypertension is a lifestyle-induced chronic disease that threatens the lives of patients. Control of hypertension requires patients to follow self-management regimes; unfortunately, however, patient compliance with hypertension self-management is low, especially in developing countries. Improvement of patient compliance is premised on meeting patient needs. Mobile health apps are becoming increasingly popular for self-management of chronic diseases. However, few mobile apps have been designed to meet patient needs for hypertension self-management.

OBJECTIVE

The goal of this study was to develop a mobile health app to improve patient compliance with hypertension self-management and evaluate the effectiveness of the app in terms of patient compliance.

METHODS

The goal-directed design method was applied to guide study design. We divided the study into 4 stages. Stages 1 to 3 comprised the development process. To improve the applicability of the goal-directed design method to chronic disease management, we extracted elements of user models concerned with patient compliance and defined a concrete process for user modeling. In stage 1, personas of hypertensive patients were built using qualitative and quantitative methods. Clustering methods based on questionnaire responses were used to group patients. Qualitative interviews were conducted to identify the needs of different groups. In stage 2, several functional modules were designed to meet the needs of different groups based on the results from stage 1. In stage 3, prototypes of functional modules were designed and implemented as a real app. Stage 4 was the deployment process, in which we conducted a pilot study to investigate patient compliance after using the app. Patient compliance was calculated through the frequency with which they took blood pressure measurements. In addition, qualitative interviews were conducted to learn the underlying reasons for the compliance results.

RESULTS

In stage 1, patients were divided into 3 groups based on 82 valid questionnaire responses. Eighteen patients from the different groups (7, 5, and 6 patients) were interviewed, and the needs of the groups were summarized as follows: improve self-management ability, enhance self-management motivation, and receive self-management support. In stages 2 and 3, 6 functional modules were designed and implemented based on specified needs, and the usability of the app was improved through usability tests. In stage 4, 143 patients were recruited to use different versions of the app for 2 months. Results show that patient compliance improved as functional modules were added (P<.001) and was maintained at a high level (rate of 0.73). Interview results from 32 patients show that the design of the app met different needs; thus, patients were more compliant with it.

CONCLUSIONS

This study developed a mobile health app for hypertension self-management using the goal-directed design method. The app proved to be effective for improving patient compliance with hypertension self-management.

Suporte Social e HIV: Relações Entre Características Clínicas, Sociodemográficas e Adesão ao Tratamento

RESUMO Este estudo investigou a relação entre suporte social, características sociodemográficas, clínicas e adesão ao Tratamento Antirretroviral (TARV) utilizando o questionário Social Support Inventory for People who are HIV Positive or Have AIDS. Para isso, foram avaliados 119 usuários HIV-positivos - dos quais 53,8% eram homens. Em relação à disponibilidade e satisfação, os valores médios foram de 3,37 (DP=1,00) para o suporte instrumental e 3,48 (DP=1,06) para o suporte emocional. Observaram-se diferenças significativas na disponibilidade e satisfação do suporte social com variáveis sociodemográficas e clínicas. Verificou-se que, quanto maior a disponibilidade e a satisfação com o suporte social, maior o OR para a adesão ao tratamento. O desenvolvimento de estratégias de apoio social pode contribuir positivamente para o controle da doença e melhor qualidade de vida dos usuários.

A Proposed Middle-Range Theory of Nursing in Hypertension Care

Nursing in hypertension care comprises counselling about lifestyle changes, blood pressure measurement, and being a translator for the physician. For the patient, changing lifestyle means performing self-care. As not much in the form of research and guidelines for nurses is available, a middle-range theory of nursing in hypertension care was developed to guide nurses in their practice, in order to improve the nursing of patients and design studies for investigating nursing in hypertension care. Concepts are presented related to the patient (attitude and beliefs regarding health and sickness, autonomy, personality and traits, level of perceived vulnerability, hardiness, sense of coherence, locus of control, self-efficacy, and access to social support and network) and the nursing (applying theories and models for behavioural change in the consultation and using counselling skills, patient advocacy, empowerment, professional knowledge and health education, and supporting the patient). Then the concepts related to the consultation (communication, shared decision-making, concordance, coping, adherence, and self-care) are integrated with Orem's theory of nursing. Clinical and research implications of the theory are discussed.

Clinical use of azelnidipine in the treatment of hypertension in Chinese patients

Background

Hypertension is the most common chronic disease and the calcium channel antagonist is the most popularly used antihypertensive drug in Chinese patients. Azelnidipine is a third generation and long-acting dihydropyridine calcium channel antagonist. A series of research has demonstrated that azelnidipine produced an effective antihypertensive effect in patients with essential hypertension. Now it is need to summarize clinical use of azelnidipine in the treatment of hypertension in Chinese patients.

Methods

Relevant literature was identified by performing searches in PubMed and CNKI (China National Knowledge Infrastructure), covering the period from January 2003 (the year azelnidipine was launched) to July 2014. We included studies that described pharmacology of azelnidipine, especially the pharmacokinetics, clinical efficacy, and safety and tolerability of azelnidipine in a Chinese population. The full text of each article was strictly reviewed, and data interpretation was performed.

Results

In Chinese healthy volunteers, a single-dose oral administration of azelnidipine 8–16 mg had a peak plasma concentration of 1.66–23.06 ng/mL and time to peak plasma concentration was 2.6–4.0 hours and the area under the plasma concentration versus time curve from time 0 hour to 96 hours was 17.9–429 ng/mL·h and elimination half-life was 16.0–28.0 hours. A number of clinical trials have demonstrated that azelnidipine produced a significant reduction in blood pressure in Chinese patients with mild-to-moderate hypertension, which was similar to that of other effective antihypertensive drugs such as amlodipine, zofenopril, and nifedipine. In addition to its antihypertensive effect, azelnidipine had other cardiovascular protective effects as well, like anti-oxidative action, decreasing heart rate, and improving systolic and diastolic function. Azelnidipine was generally well tolerated in Chinese patients and no severe adverse events were observed.

Conclusion

Azelnidipine is effective and safe in the treatment of hypertension in Chinese patients.