Adherence to antihypertensive medication in Russia: A scoping review of studies on levels, determinants and intervention strategies published between 2000 and 2017
AuthorBochkareva, Elena Viktorovna; Butina, Ekaterina Kronidovna; Kim, Irina Vitalievna; Kontsevaya, Anna Vasilievna; Drapkina, Oxana Mikhailovna; Leon, David Adrew; McKee, Martin
Background - Arterial hypertension (HT) is common in the Russian adult population, with half of affected individuals inadequately controlled. Low adherence to medication seems likely to be a factor. We report a scoping review of studies on adherence to antihypertensive therapy (AHT) in Russia to determine the extent of research undertaken, the frequency of adherence among adults diagnosed with HT, methodologies used in the studies, and their ability to describe determinants of adherence.
Methods - A scoping review of published studies that have assessed adherence to AHT in Russian HT patients searched the main Russian and international electronic databases eLIBRARY.ru, Russian Medicine, Embase, MEDLINE for full-text reports published in the Russian language between 2000 and 2017. The last search was on November 28, 2017. Among 520 reports identified, 31 were included in the review.
Results - Eighteen studies assessed adherence using the 4-item Morisky Medication Adherence Scale (MMAS-4); others used bespoke questionnaires or pill counts. 25 studies assessed levels of adherence, 11 examined its determinants, and 18 examined intervention strategies. The proportion of “adherent” patients varied from 11 to 44% using the MMAS-4, from 23 to 74% when using bespoke questionnaires, and from 5 to 43% when using pill counts. Adherence was associated with sociodemographic factors, access to free drugs provided through the Medicine Assistance Scheme (MAS), use of home blood pressure (BP) monitoring, anxiety, and comorbidity. There was no evidence that adherence was associated with income or physical activity. Evidence of an association between MAS, grade of HT, or experience of hypertensive crisis was inconclusive. Various methods to improve adherence were studied including patient education (improved from 1.8 to 3.9 points, p = 0.0002 or 2.80 to 3.79 points, p < 0.0001 measured by the MMAS-4), telephone reminders (p < 0.0001), training in home BP monitoring (p < 0.05), and use of fixed-dose combinations (p < 0.05).
Conclusions - The main determinants of adherence to AHT are sociodemographic characteristics, the severity of HT, and presence of comorbidity. Patient education and use of fixed-dose combinations of drugs were identified as most important for improving adherence. Most studies assessing adherence use self-reported methods so there is a need for greater use of objective methods.