Kakumani Kiranmayi Venkata, Waingankar Prasad
Intern.
Associate Professor, Community Medicine, MGM Medical College, Navi Mumbai, Maharashtra.
J Assoc Physicians India. 2016 Dec;64(12):36-40.
Substantial burden of diabetes and hypertension is on rise in India, leading to a twin epidemic. India, being a rural country, has unique problems regarding the treatment compliance which is a serious risk for morbidity and mortality.
To assess the compliance to treatment of hypertension and diabetes amongst the diagnosed patients from rural area and to study reasons of non-compliance and knowledge and attitude.
Community based, cross sectional, observational study conducted in the rural communities of Tara and Barapada villages of Raigad district of Maharashtra. Survey was conducted covering population of 2115 across 360 families, 250 at Barapada and 110 at Tara. All the cases of diabetes and hypertension diagnosed for more than one year were included. A structured and pre-tested questionnaire was administered including details on demography, medical documentation, treatment details and factors assessing the compliance, knowledge and attitude towards the diseases.
When reviewed the treatment adherence pattern based on documentary evidence and interview of the patient, on history of taking medication strictly since the detection illness, it was found that more than 70% of the Diabetics and more than 75% of the Hypertensive have discontinued the treatment in between. The most common reasons of non-compliance is the lack of sufficient motivation for treatment adherence as many mentioned (61.4% diabetics, 55.8% hypertensives) difficulty to remember to take daily medication due to work or forgetfulness. This is followed by lack of money (50%diabetics, 55.8% hypertensives) and living far away from doctor in city (43% diabetics and 46% hypertensives).
The study findings are only tip of iceberg and the non-adherence to the treatment of diabetes and hypertension in rural population is at alarmingly high. Illiteracy, lack of faith in treatment and motivation, unawareness and self-neglect as well as financial constraints and lack of specialist care in rural area is playing important role.
在印度，糖尿病和高血压的沉重负担正在上升，导致了双重流行。印度作为一个农村国家，在治疗依从性方面存在独特问题，这对发病率和死亡率构成严重风险。
评估农村地区确诊患者对高血压和糖尿病治疗的依从性，并研究不依从的原因以及知识和态度。
在马哈拉施特拉邦赖加德区塔拉和巴拉帕达村的农村社区进行基于社区的横断面观察性研究。调查涵盖了360个家庭的2115人，巴拉帕达村250人，塔拉村110人。纳入所有确诊糖尿病和高血压一年以上的病例。采用一份结构化且经过预测试的问卷，内容包括人口统计学、医疗记录、治疗细节以及评估依从性、对疾病的知识和态度的因素。
根据文件证据和患者访谈回顾治疗依从模式，即自疾病确诊以来严格服药的历史，发现超过70%的糖尿病患者和超过75%的高血压患者在治疗期间中断了治疗。最常见的不依从原因是缺乏足够的治疗依从动力，许多人提到（61.4%的糖尿病患者，55.8%的高血压患者）由于工作或健忘难以记住每日服药。其次是缺钱（50%的糖尿病患者，55.8%的高血压患者）以及居住在离城市医生较远的地方（43%的糖尿病患者和46%的高血压患者）。
研究结果只是冰山一角，农村人口中糖尿病和高血压治疗的不依从率高得惊人。文盲、对治疗缺乏信心和动力、意识不足和自我忽视以及经济限制和农村地区缺乏专科护理都起着重要作用。
