Adherence to Pharmacotherapy in Post-Menopausal Women with Hypertension or Metabolic Syndrome: Real World Experience

Abstract

Background: Adherence to medications is dependent upon a variety of factors, including individual characteristics of the patient, interactions with health care providers, and medication complexity. Even though several studies were conducted to test intervention strategies, results are uncertain. Aim: The aim of the study is to assess if a tailored combined intervention strategy improves medication adherence in a large population of post-menopausal women affected by hypertension or metabolic syndrome. Methods: We enrolled 6833 patients aged 50 to 69 years, 85.7% with hypertension, and 14.3% with metabolic syndrome. A network between patients, general practitioners, and cardiologists was established. Interventions included education, adequate information to patients, a simplified scheme of treatment, and periodic adherence assessment. These were either delivered as healthcare provider supports or using modern technology. Medication adherence was estimated by the proportion of days covered for all classes of drugs after the index date. Results: Non-adherent hypertensive women were 297 (5%), and those with metabolic syndrome were 73 (7.4%) (p < 0.02). Considering only patients with cardiomyopathy non-adherent were 234 (5.4%), while without cardiomyopathy 136 (5.3%); non-adherent hypertensive postmenopausal women with cardiomyopathy were 194 (5.2%), non-adherent postmenopausal women with metabolic syndrome and cardiomyopathy were 40 (7.2%) (p < 0.04). Non-adherent hypertensive postmenopausal women without cardiomyopathy were 103 (4.9%), and non-adherent postmenopausal women with metabolic syndrome and without cardiomyopathy were 33 (7.7%) (p < 0.01). Conclusions: The rate of non-adherence in both settings of postmenopausal women was 7.7%, much lower than that described in the literature. This rate was increased in patients with metabolic syndrome; probably it is related to the complexity of the therapeutic scheme or to a poor consciousness of the disease. Therefore, implementing a tailored combined intervention can improve significantly patients’ adherence to medical therapy.