Facteurs de Non Observance au Traitement Anti Hypertenseur chez les Adultes à Douala

Noel Emmanuel Essomba, Ba Hamadou, Danielle Christiane Kedy Koum, Armelle Atemkeng, Yves Coppieters

Abstract


RÉSUMÉ
Introduction. De nombreux patients hypertendus ont une pression artérielle non contrôlée du fait d’une mauvaise adhésion aux traitements. L’objectif de cette étude était d’évaluer l'observance du traitement antihypertenseur et de décrire quelques facteurs associés à la non observance chez les adultes. Méthodes. Il s`agit d`une étude transversale et analytique à recueil prospectif, effectuée de janvier à mai 2015. Les données ont été récoltées à partir d`un questionnaire validé relatif à l’observance. L’analyse bivariée et le modèle de régression logistique ont été utilisés pour la détermination des facteurs associés à la non observance. Résultats. 404 sujets hypertendus vus en milieu hospitalier (âge moyen 58±13 ans, sex ratio H/F 0,54) ont été étudiés. Parmi eux, 106 (26,2%) sujets avaient une bonne observance, 194(48%) avaient un minime problème d’observance et 104 (25,7%) étaient mauvais observants. Les principales raisons de la non observance étaient : l’oubli, le coût et l`absence de connaissance sur la maladie. En analyse univariée, la mauvaise observance était associée à un âge avancé, à l’ancienneté de la maladie, au sexe masculin, à l'absence d'assurance-maladie et à la présence de complications cardiovasculaires. En analyse multivariée, une forte corrélation entre diabète et hypertension artérielle [IC 95% OR= 1,10 – 4,46 p= 0,03] a été observée. Conclusion. L'observance thérapeutique est médiocre ou mauvaise dans notre population d'hypertendus, particulièrement chez ceux qui ont des comorbidités et des complications associées. Il est nécessaire d'insister sur l'éducation thérapeutique et de subventionner les médicaments dans nos hôpitaux.

ABSTRACT
Introduction: Many hypertensive patients have uncontrolled blood pressure due to poor adherence to treatment. The objective of this study was to evaluate adherence to antihypertensive treatment and to identify some factors associated with non observance in adults. Methods: This was a cross-sectional and analytical study, conducted from January to May 2015 in a hospital setting. The data were collected using a validated questionnaire on adherence. Bivariate analysis and logistic regression model were used to determine factors associated with non adherence. Results: 404 hypertensive patients (mean age 58 ± 13 years, sex ratio 0.54) were recruited. Among them, 106 (26.2%) were good observants, 194(48%) had minimal observance problems and 104 (25.7%) were bad observants. The main reasons of non compliance were: forgetfulness, medication cost and poor knowledge of the disease. In univariate analysis, poor adherence was associated with advanced age, disease duration, male sex, lack of health insurance and presence of cardiovascular complications. In multivariate analysis, a strong correlation between diabetes and hypertension [95% CI OR = 1.10 to 4.46 p = 0.03] was determined. Conclusion. Observance problems are common in our hypertensive population, and this is particularly true for those who have comorbidities or associated complications. Ways of solution include patient education and subsidizing medicines in our hospitals.


Keywords


hypertension artérielle, traitement, non observance, Douala-Cameroun.

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References


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