Influencia de factores psicológicos, sociales y familiares sobre el control, la demanda asistencial y la adherencia terapéutica en pacientes con alto riesgo cardiovascular

Abstract

Background Chronic diseases constitute a major public health problem due to their prevalence, morbidity, mortality and healthcare costs. Cardiovascular diseases play a relevant role among chronic conditions, since they are one of the main causes of health care by themselves and due to the activities involved in the control of their risk factors such as hypertension, hyperlipidemia, tobacco addiction, etc. Aim To establish the relationship between cognitive, behavioral, psychological, social history and family background in patients with high cardiovascular risk and the control of their disease, their therapeutic adherence and their demand for healthcare. Material Sample: 211 individuals among a population of 3750 people with high cardiovascular risk assigned to an urban Primary Health Care Center Studied variables o Demographics: Age, gender, marital status and educational level o Resources: Drug use and demand for healthcare o Clinical variables: Blood pressure and glycosylated hemoglobin o Psychometric tools: ■ Revised Eysenck Personality Questionnaire, EPQ-R ■ Goldberg General Health Questionnaire, GHQ-28 ■ COPE inventory B Social Support Questionnaire, SSQ H Family Function APGAR Questionnaire ■ Beliefs about Medicines Questionnaire, BMQ ■ Morisky-Green Medication Adherence Questionnaire Methods Sample selection according to random number table Clinical interview to the selected individuals Signed informed consent Review of clinical records Statistical study including descriptive and inferential statistics by means of bivariate and multivariate analysis. Study approval by the Ethical Committee of Huelva Results The following items: “acceptance”, “restraint cop ng” and “concentrating efforts to reach solutions” in the COPE inventory and “doctors use too many medicines” in the BMQ questionnaire were found significant in the multivariate analysis related to global control. The variables “number of drugs” and “social dysfunction” in the GHQ-28 questionnaire were found significant in the multivariate analysis related to frequent attendance. The score of BQM questionnaire was the most powerful predictor in the multivariate analysis related to therapeutic adherence, with an impact magnitude of 2,628 (ANOVA: F= 237,474; p<0.0001) Conclusions Mood changes and passive styles of coping with stress are associated with poorer control of cardiovascular risk factors whereas active styles of coping with stress coping do better. Education and polymedication influence the demand for health care in the studied population. Therapeutic adherence is strongly associated with the beliefs about medicines.