Shin Jinho, Chia Yook-Chin, Heo Ran, Kario Kazuomi, Turana Yuda, Chen Chen-Huan, Hoshide Satoshi, Fujiwara Takeshi, Nagai Michiaki, Siddique Saulat, Sison Jorge, Tay Jam Chin, Wang Tzung-Dau, Park Sungha, Sogunuru Guru Prasad, Minh Huynh Van, Li Yan
Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, South Korea.
Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia.
J Clin Hypertens (Greenwich). 2020 Dec 17;23(3):584-94. doi: 10.1111/jch.14104.
Adherence continues to be the major hurdle in hypertension management. Since the early 2000s, systematic approaches have been emphasized to tackle multi-dimensional issues specific for each regional setting. However, there is little data regarding implementation of adherence interventions in Asian countries. Eleven hypertension experts from eight Asian countries answered questionnaires regarding the use of adherence interventions according to 11 theoretical domain frameworks by Allemann et al. A four-point Likert scale: Often, Sometimes, Seldom, and Never used was administered. Responses to 97 items from 11 domains excluding three irrelevant items were collected. "Often-used" interventions accounted for 5/9 for education, 1/8 for skills, 1/2 for social/professional role and identity, 1/1 for belief about capabilities, 0/3 for belief about consequences, 2/4 for intentions, 2/9 for memory, attention, and decision process, 11/20 for environmental context and resources, 0/2 for social influences, 0/2 for emotion, and 2/2 for behavioral regulation. Most of them are dependent on conventional resources. Most of "Never used" intervention were the adherence interventions related to multidisciplinary subspecialties or formal training for behavioral therapy. For adherence interventions recommended by 2018 ESC/ESH hypertension guidelines, only 1 in 7 patient level interventions was "Often used." In conclusion, conventional or physician level interventions such as education, counseling, and prescription have been well implemented but multidisciplinary interventions and patient or health system level interventions are in need of better implementation in Asian countries.
依从性仍然是高血压管理中的主要障碍。自21世纪初以来，人们一直强调采用系统方法来解决每个地区特有的多维度问题。然而，关于亚洲国家实施依从性干预措施的数据很少。来自八个亚洲国家的11位高血压专家根据阿勒曼等人的11个理论领域框架回答了关于依从性干预措施使用情况的问卷。采用了四点李克特量表：经常使用、有时使用、很少使用和从未使用。收集了对11个领域中97个项目（不包括三个无关项目）的回答。“经常使用”的干预措施在教育方面占5/9，在技能方面占1/8，在社会/职业角色和身份方面占1/2，在能力信念方面占1/1，在后果信念方面占0/3，在意向方面占2/4，在记忆、注意力和决策过程方面占2/9，在环境背景和资源方面占11/20，在社会影响方面占0/2，在情感方面占0/2，在行为调节方面占2/2。其中大多数依赖传统资源。大多数“从未使用”的干预措施是与多学科亚专业或行为治疗正式培训相关的依从性干预措施。对于2018年欧洲心脏病学会/欧洲高血压学会高血压指南推荐的依从性干预措施，患者层面的干预措施中只有1/7是“经常使用”的。总之，传统的或医生层面的干预措施，如教育、咨询和处方，已经得到很好的实施，但多学科干预措施以及患者或卫生系统层面的干预措施在亚洲国家需要更好地实施。
