Scientometrics on interventions used for adherence of hypertension and diabetes therapies

Julio de Souza Sá Lucas França Garcia Marcelo Picinin Bernuci Mirian Ueda Yamaguchi About the authors

ABSTRACT

Objective

To identify interventions aimed to improve adherence to medical and non-medical antihypertensive and antidiabetic therapy.

Methods

Scientometric study conducted in February and March 2018, based on data collected on PubMed ® and SciELO databases, using the following search terms: “interventions to improve adherence to diabetes therapy”, “interventions to improve adherence to hypertension therapy” and “interventions to improve adherence to therapy for hypertension and diabetes”.

Results

A total of 95 articles were selected. Scientific production increased as of 2009, with a higher number of studies published between 2015 and 2017. Most interventions described in literature were aimed at diabetic patients (46.31%). Face-to-face interventions were more common (46.31%), followed by telephone-based (31.58%) and digital (26.31%) interventions. North America stood out as the continent with the highest number of publications (68.42%), followed by Europe (14.74%). Most studies (63.16%) were based on a single type of intervention.

Conclusion

Traditional intervention methods were more widely used to promote adherence to antihypertensive and antidiabetic therapy; digital technology emerged as a trend in interventions aimed to improve hypertension and diabetes-related health behaviors.

Health promotion; Drug therapy; Hypertension; Diabetes mellitus; Community health nursing; Ambulatory care; Patient care team; Biomedical technology; Bibliometrics

RESUMO

Objetivo

Identificar as intervenções utilizadas para melhorar a adesão de terapias medicamentosas e não medicamentosas de pacientes hipertensos e diabéticos.

Métodos

Estudo cienciométrico realizado nos meses de fevereiro e março de 2018, utilizando os termos “intervenções para melhorar a adesão à terapia do diabetes”, “intervenções para melhorar a adesão à terapia de hipertensão” e “intervenções para melhorar a adesão à terapia da hipertensão e diabetes”, nas bases de dados PubMed®e SciELO.

Resultados

Foram selecionados 95 artigos. A partir do ano 2009, observou-se crescimento da produção científica com maior volume entre os anos 2015 e 2017. O maior número de intervenções encontradas na literatura foi para pacientes com diabetes (46,31%). A intervenções mais utilizadas foram a face a face (46,31%), por chamada telefônica (31,58%) e a digital (26,31%). A América do Norte destacou-se no número de pesquisas, com 68,42% das publicações, seguida pela Europa, com 14,74%. Dentre os estudos, a maioria (63,16%) utilizou apenas um tipo de intervenção.

Conclusão

Métodos de intervenção tradicionais foram mais empregados para promover a adesão às terapias anti-hipertensão e antidiabetes, embora o uso de tecnologias digitais desponte como tendência para melhorar esses comportamentos de saúde.

Promoção da saúde; Tratamento farmacológico; Hipertensão; Diabetes mellitus; Enfermagem em saúde comunitária; Assistência ambulatorial; Equipe interdisciplinar de saúde; Tecnologia biomédica; Bibliometria

INTRODUCTION

Hypertension and diabetes mellitus are among the major causes of death due to non-communicable chronic diseases (NCDs) worldwide, with a global prevalence of 22% in hypertensive individuals, and approximately 9.4 million related deaths per year.11. World Health Organization (WHO). Global status report on noncommunicable diseases 2014 [Internet]. Genebra: WHO; 2014 [cited 2018 Oct 3]. Available from: http://www.who.int/nmh/publications/ncd-status-report-2014/en/
http://www.who.int/nmh/publications/ncd-...
Global prevalence in diabetic individuals is roughly 9%, with more than 1.5 million related deaths annually.22. American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care. 2018;41(5):917-28. In these settings, adherence to medical and non-medical treatment of hypertension and diabetes is a major challenge in health promotion.33. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Secretaria de Atenção à Saúde. Política Nacional de Promoção da Saúde (PNPS): Revisão da Portaria MS/GM no687, de 30 de março de 2006 [Internet]. Brasília (DF): Ministério da Saúde; 2015. 36 p. [citado 2018 Out 3]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/pnps_revisao_portaria_687.pdf
http://bvsms.saude.gov.br/bvs/publicacoe...

The rate of hypertension- and diabetes-related complications is constantly on the rise in middle- and low-income countries. This is partly due to population aging and the need to adopt a healthy lifestyle.11. World Health Organization (WHO). Global status report on noncommunicable diseases 2014 [Internet]. Genebra: WHO; 2014 [cited 2018 Oct 3]. Available from: http://www.who.int/nmh/publications/ncd-status-report-2014/en/
http://www.who.int/nmh/publications/ncd-...
Lack of adherence to treatment is a major public health concern, with half of patients failing to comply with medical prescriptions.44. Souza AC, Borges JW, Moreira TM. Quality of life and treatment adherence in hypertensive patients: systematic review with meta-analysis. Rev Saude Publica. 2016;50:71. Review. Antihypertensive and antidiabetic drugs are recommended only when non-medical interventions, such as dietary management, regular physical activity, and other practices associated with a healthy lifestyle have failed.55. Oliveira GM, Mendes M, Malachias MV, Morais J, Moreira O, Coelho AS, et al. 2017 Guidelines for Arterial Hypertension Management in Primary Health Care in Portuguese Language Countries. Arq Bras Cardiol. 2017;109(5):389-96.

Measures adopted to tackle NCDs have defined policies and actions worldwide.66. Malta DC, Oliveira TP, Santos MA, Andrade SS, Silva MM; Grupo Técnico de Monitoramento do Plano de DCNT. Progress with the Strategic Action Plan for Tackling Chronic Non-Communicable Diseases in Brazil, 2011-2015. Epidemiol Serv Saude. 2016;25(2):373-390. Studies investigating adherence to treatment have revealed pathways for the development of innovative strategies and behavioral interventions, aimed to support proper monitoring of prescribed therapies, with improved quality of life for patients.44. Souza AC, Borges JW, Moreira TM. Quality of life and treatment adherence in hypertensive patients: systematic review with meta-analysis. Rev Saude Publica. 2016;50:71. Review.

Interventions consist of health promotion actions leading to individual or collective behavior changes, according to the social context in which each individual is inserted, with a view to improving adherence to NCD therapy.77. Sheppard-Law S, Zablotska-Manos I, Kermeen M, Holdaway S, Lee A, George J, et al. Factors associated with non-adherence to HBV antiviral therapy. Antivir Ther. 2018;23(5):425-33. A wide array of interventions can assist healthcare managers and services in NCD control, ranging from traditional methods, such as home visits and individual or group counselling, to technology-based approaches employed to send reminders or deliver content associated with health promotion.88. Ryan R, Santesso N, Lowe D, Hill S, Grimshaw J, Prictor M, et al. Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database Syst Rev. 2014;(4):CD007768. Review.

OBJECTIVE

To describe the state-of-the-art of scientific publications related to the development of interventions aimed to improve adherence to antihypertensive and antidiabetic therapy.

METHODS

Scienciometric study based on data collected between February and March 2018 via search of PubMed® (https://www.ncbi.nlm.nih.gov/pubmed/) and Scientific Electronic Library Online (SciELO; https://www.scielo.org/) databases.

PubMed® database search was conducted using the following search terms: “interventions to improve adherence to diabetes therapy”, “interventions to improve adherence to hypertension therapy” and “interventions to improve adherence to therapy for hypertension and diabetes”. SciELO database was searched using the following search terms: “ intervenções para melhorar a adesão à terapia do diabetes ”, “ intervenções para melhorar a adesão à terapia de hipertensão ” and “ intervenções para melhorar a adesão à terapia da hipertensão e diabetes ”.

Literature review and systematic literature review articles were excluded, and only original articles were selected for increased precision. Titles and abstracts were analyzed, and the articles classified under seven headings according to intervention type, as follows: face-to-face intervention, telephone-based intervention, digital intervention, indirect intervention, health education intervention, postal intervention or financial incentive intervention.

Data were entered into spreadsheets (Excel 2016) and tabulated according to year of publication, type of disease or target-audience, type of intervention, number of publications per continent and number of interventions per study.

RESULTS

Database search using selected terms yielded 600 publications in PubMed® and none in SciELO, between 2000 and 2018. Of these, 95 articles were selected following title and abstract analysis ( Table 1 - Appendix 1). Articles failing to meet inclusion criteria (505) were excluded.

Table 1
Articles included in the study

Data analysis revealed scientific production growth as of 2009, with a higher volume of publications describing interventions aimed to improve adherence to antihypertensive and antidiabetic therapy, between 2015 and 2017 ( Figure 1 ).

Figure 1
Number of articles listed on PubMed® according to period of publication

Studies focusing on interventions aimed at diabetes patients were more abundant (46.3%; n=44), followed by articles describing interventions aimed at hypertension (37.9%; n=36). Only 15.8% (n=15) of articles described interventions aimed at both diseases ( Figure 2 ).

Figure 2
Number of scientific articles according to type of disease

Most articles (63.2%; n=60) described a single intervention, whereas remaining articles included two (30.5%; n=29) or more (6.3%; n=6) concurrent interventions. Classification according to type of intervention was as follows: face-to-face, 46.3% (n=44); telephone-based, 31.6% (n=30); digital, 26.3% (n=25); indirect, 16.9% (n=16); health education, 12.7% (n=12); postal, 6.3% (n=6); and financial incentive, 5.2% (n=5) ( Figure 3 ).

Figure 3
Thematic axis profile of scientific articles describing types of interventions aimed to improve adherence to antihypertensive and antidiabetic therapy

Interventions were defined as follows: (1) face-to-face - individual appointments in clinics and home visits by health professionals; (2) telephone-based - whenever conducted over the telephone; (3) digital - SMS text messages, Apps or software ( WhatsApp, etc.); (4) indirect - public policies, audits, guidelines and professional training; (5) health education - talks and orientations given to patients; (6) postal - letters sent by regular mail; and (7) financial incentive - payments made or discounts given for financial compensation of patients.

Article distribution according to continent of origin revealed larger numbers of studies conducted in North America (68.4%; n=65) or Europe (14.8%; n=14), with only a small proportion (3.1%; n=3) from South America.

DISCUSSION

In this study, the findings derived from the analysis of scientific publications emphasize the importance of the topic selected in the realm of public policies aimed at health promotion, as shown by adoption of control measures by several counties in the face of increased prevalence of hypertension and diabetes.99. Diretrizes da sociedade brasileira de diabetes 2017-2018 [Internet]. São Paulo: Clannad; 2017 [citado 2019 Nov 5]. Disponível em: https://www.diabetes.org.br/profissionais/images/2017/diretrizes/diretrizes-sbd-2017-2018.pdf
https://www.diabetes.org.br/profissionai...
This process has led to the application of different interventions resulting in clinical improvement of patients and lower health care costs.1010. Olney JJ, Braitstein P, Eaton JW, Sang E, Nyambura M, Kimaiyo S, et al. Evaluating strategies to improve HIV care outcomes in Kenya: a modelling study. Lancet HIV. 2016;3(12):e592-600.

The World Health Organization (WHO), driven by some countries, such as the United States, Canada, Australia and the United Kingdom, expected to reduce mortality rates associated with chronic diseases by 2% per year, up to 2015.1111. World Health Organization (WHO). WHO methods and data sources for country-level causes of death 2000-2015 [Internet]. Genebra: WHO; 2017 [cited 2018 Oct 3]. Available from: http://www.who.int/healthinfo/global_burden_disease/GlobalCOD_method_2000_2015.pdf?ua=1
http://www.who.int/healthinfo/global_bur...
With these estimates in mind, joint efforts by the WHO, governments, world organizations and the private sector approved the Global Action Plan for the Prevention and Control of NCDs 2013-2020. The WHO has also set voluntary targets for 2025, among which the reduction of premature mortality due to these diseases by 25%.11. World Health Organization (WHO). Global status report on noncommunicable diseases 2014 [Internet]. Genebra: WHO; 2014 [cited 2018 Oct 3]. Available from: http://www.who.int/nmh/publications/ncd-status-report-2014/en/
http://www.who.int/nmh/publications/ncd-...

The higher number of scientific publications on interventions in the last decade may reflect population aging, given physiological changes tend to increase with age, leading to higher prevalence of NCDs.1212. Miranda GM, Mendes AC, da Silva AL. Population aging in Brazil: current and future social challenges and consequences. Rev Bras Geriatr Gerontol. 2016;19(3):507-19. Improved basic health care, growing urbanization, global commercialization of health harming products, and adoption of unhealthy life styles may have boosted scientific production during this period.22. American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care. 2018;41(5):917-28.

Hypertension is a silent disease affecting individuals of all socioeconomic levels, with higher mortality and global prevalence rates compared to other NCDs;55. Oliveira GM, Mendes M, Malachias MV, Morais J, Moreira O, Coelho AS, et al. 2017 Guidelines for Arterial Hypertension Management in Primary Health Care in Portuguese Language Countries. Arq Bras Cardiol. 2017;109(5):389-96. still, studies investigating interventions aimed at diabetic patients are even more abundant. This may be explained by the diversity of acute and chronic complications associated with diabetes mellitus and the two- to three-fold increase in health costs over the years as compared to costs associated with non-diabetic patients.22. American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care. 2018;41(5):917-28. In 2017, estimated global costs of diabetes amounted to US$ 850 billion, with significant social and economic impacts on healthcare systems.22. American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care. 2018;41(5):917-28.

As regards different types of interventions promoting adherence to medical and non-medical antihypertensive and antidiabetic therapy, face-to-face interventions consisting of individual appointments and home visits were more commonly described in scientific literature.1313. Kravetz JD, Walsh RF. Team-Based Hypertension Management to Improve Blood Pressure Control. J Prim Care Community Health. 2016;7(4):272-5. Individual appointments are widely used in outpatient services, clinics, community pharmacies, multidisciplinary health teams1414. Pannick S, Davis R, Ashrafian H, Byrne BE, Beveridge I, Athanasiou T, et al. Effects of Interdisciplinary Team Care Interventions on General Medical Wards: A Systematic Review. JAMA Intern Med. 2015;175(8):1288-98. Review. and other health centers, since they represent traditional methods involving joint analysis of barriers to adherence to therapy, and solutions for improved health outcomes, by physicians, pharmacists, nurses, psychologists, dietitians, physical educators and patients.1515. Floyd BD, Block JM, Buckingham BB, Ly T, Foster N, Wright R, et al. Stabilization of glycemic control and improved quality of life using a shared medical appointment model in adolescents with type 1 diabetes in suboptimal control. Pediatr Diabetes. 2017;18(3):204-12.

Telephone-based interventions also proved to be efficient, since these encourage patients with several comorbidities to adopt best care practices via telephone call monitoring.1616. Abughosh SM, Wang X, Serna O, Henges C, Masilamani S, Essien EJ, et al. A Pharmacist Telephone Intervention to Identify Adherence Barriers and Improve Adherence Among Nonadherent Patients with Comorbid Hypertension and Diabetes in a Medicare Advantage Plan. J Manag Care Spec Pharm. 2016;22(1):63-73. This type of traditional intervention is widely used by pharmacists in community pharmacies and clinics; as drug managers, pharmacists provide guidance to patients regarding health behaviors, thereby contributing to improved adherence to medical and non-medical antihypertensive and antidiabetic therapy.1717. Shane-McWhorter L, McAdam-Marx C, Lenert L, Petersen M, Woolsey S, Coursey JM, et al. Pharmacist-provided diabetes management and education via a telemonitoring program. J Am Pharm Assoc (2003). 2015;55(5):516-26. Telephone-based services constitute more accessible alternatives, with reduced medical appointment load, lower transportation costs for low-income patients and the added benefit of proposing the insertion of personalized information.1818. Friedberg JP, Rodriguez MA, Watsula ME, Lin I, Wylie-Rosett J, Allegrante JP, et al. Effectiveness of a tailored behavioral intervention to improve hypertension control: primary outcomes of a randomized controlled trial. Hypertension. 2015;65(2):440-6.

Digital interventions consisting of SMS text messages, Web, apps and WhatsApp have been attracting increasing attention in studies investigating adherence to treatment over the last few years. Such technology tools facilitate access to health information aimed to improve patients’ quality of life.1919. Ruiz Morilla MD, Sans M, Casasa A, Giménez N. Implementing technology in healthcare: insights from physicians. BMC Med Inform Decis Mak. 2017;17(1):92. One study has shown that combined technologies may encourage health behavior changes and increase adherence to antihypertensive and antidiabetic therapy.2020. Frias J, Virdi N, Raja P, Kim Y, Savage G, Osterberg L. Effectiveness of Digital Medicines to Improve Clinical Outcomes in Patients with Uncontrolled Hypertension and Type 2 Diabetes: Prospective, Open-Label, Cluster-Randomized Pilot Clinical Trial. J Med Internet Res. 2017;19(7):e246.

Digital interventions were shown to be particularly effective in underdeveloped and developing countries, for ensuring access to health benefits from remote areas worldwide via widely available technology.2121. Howitt P, Darzi A, Yang GZ, Ashrafian H, Atun R, Barlow J, et al. Technologies for global health. Lancet. 2012;380(9840):507-35. Review. Mobile health tools, or m-Health, are a major trend in NCD control, given their low cost and ability to provide remote health care.2222. Piette JD, List J, Rana GK, Townsend W, Striplin D, Heisler M. Mobile Health Devices as Tools for Worldwide Cardiovascular Risk Reduction and Disease Management. Circulation. 2015;132(21):2012-27.

Other interventions designed to improve health behavior in hypertensive and diabetic patients described in literature include indirect interventions, comprising public policies, health guidelines, audits and professional training.2323. do Valle Nascimento TM, Resnicow K, Nery M, Brentani A, Kaselitz E, Agrawal P, et al. A pilot study of a Community Health Agent-led type 2 diabetes self-management program using Motivational Interviewing-based approaches in a public primary care center in São Paulo, Brazil. BMC Health Serv Res. 2017;17(1):32.

Health education interventions are often implemented by nurses and other health professionals by means of talks and group guidance sessions, particularly in communities where technological resources are limited or lacking.2424. Schoenthaler A, De La Calle F, Barrios-Barrios M, Garcia A, Pitaro M, Lum A, et al. A practice-based randomized controlled trial to improve medication adherence among Latinos with hypertension: study protocol for a randomized controlled trial. Trials. 2015;16(1):290. Studies describing postal interventions, consisting of letters containing health recommendations were scarce.2525. Jing S, Naliboff A, Kaufman MB, Choy M. Descriptive analysis of mail interventions with physicians and patients to improve adherence with antihypertensive and antidiabetic medications in a mixed-model managed care organization of commercial and Medicare members. J Manag Care Pharm. 2011;17(5):355-66. Finally, financial incentive interventions applied by some health services, particularly the private sector, to encourage patient adherence out of financial compensation, were seldom described.2626. Wong CA, Miller VA, Murphy K, Small D, Ford CA, Willi SM, et al. Effect of Financial Incentives on Glucose Monitoring Adherence and Glycemic Control Among Adolescents and Young Adults With Type 1 Diabetes: A Randomized Clinical Trial. JAMA Pediatr. 2017;171(12):1176-83.

As regards study origin, most scientific research related to interventions tailored to hypertensive and diabetic individuals were conducted in North America, followed by European countries. In the United States, for example, one in every three individuals, or 75.2 million American citizens suffer from hypertension, and almost half this population (35 million people) has blood pressure levels above recommendations.2727. Merai R, Siegel C, Rakotz M, Basch P, Wright J, Wong B; DHSc, Thorpe P. CDC Grand Rounds: A Public Health Approach to Detect and Control Hypertension. MMWR Morb Mortal Wkly Rep. 2016;65(45):1261-4. From 2011 to 2014, the US hypertension prevalence averaged 34% (34.5% and 33.4%, in men and women respectively); prevalence in the elderly population was 67.2%, with approximately 410,624 deaths due to primary or secondary causes, and a total cost of US$ 51.2 billion between 2012 and 2013.2828. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017;135(10):e146-e603. Review. Erratum in: Circulation. 2017;135(10):e646. Circulation. 2017;136(10):e196.

Diabetes affected approximately 30.3 million Americans in 2015, with 9.4% prevalence. Diabetes was the seventh cause of death in the country, with more than 252,806 deaths resulting directly or indirectly from the disease, annually.2929. Centers for Disease Control and Prevention. National Diabetes Statistics Report 2017: Estimates of Diabetes and Its Burden in the United States. Atlanta (GA): Centers for Disease Control and Prevention; 2017. In 2017, total diabetes costs amounted to US$ 327 billion, with individuals aged 65 years or older accounting for most of the financial burden, and driving rising healthcare budget requirements.22. American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care. 2018;41(5):917-28. The 2010 estimated prevalence of diagnosed and undiagnosed diabetes in the adult population of 14% is expected increase to 21% up to 2050.3030. Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010;8:29.

Obesity is a major factor in the growing prevalence of other NCDs and has been associated with rising numbers of premature deaths due to hypertension and diabetes, particularly in countries such as the United States, where consumption of industrialized foods is high. Poor dietary habits resulted in 17% prevalence of obesity among children, and approximately one-third of the adult population (36.5%) affected between 2011 and 2014, particularly middle-aged individuals (40 to 59 years).2929. Centers for Disease Control and Prevention. National Diabetes Statistics Report 2017: Estimates of Diabetes and Its Burden in the United States. Atlanta (GA): Centers for Disease Control and Prevention; 2017.

The number of studies on interventions conducted in European countries has also increased. Population aging in these countries has led to a constant rise in NCD prevalence and sparked interest in strategies aimed at reducing the burden of health care costs.3131. Kingston A, Robinson L, Booth H, Knapp M, Jagger C; MODEM project. Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model. Age Ageing. 2018;47(3):374-80.

In South America, a continent comprising developing countries, studies investigating interventions aimed to increase adherence to antihypertensive and antidiabetic therapy are quite recent, and in lesser numbers compared to North America. In Brazil, improved health status and increased life expectancy translated into 18% growth of the aging population over the last 5 years, from 25.4 million in 2012, to 30 million in 2017. These factors contributed to growing estimated NCD prevalence over the course of one decade, with 14.2% increase in hypertension prevalence (from 22.5% to 25.7%, between 2006 and 2016) and 61.8% increase in diabetes prevalence (from 5.5% to 8.9%, between 2006 and 2016).3232. Malta DC, Silva MM, Moura L, Morais OL. A implantação do Sistema de Vigilância de Doenças Crônicas Não Transmissíveis no Brasil, 2003 a 2015: alcances e desafios. Rev Bras Epidemiol. 2017;20(4):661-75.

High NCD prevalence in 2015 led to 424,058 deaths due to cardiovascular diseases, and 62,466 deaths due to diabetes,3333. Malta DC, França E, Abreu DM, Perillo RD, Salmen MC, Teixeira RA, et al. Mortality due to noncommunicable diseases in Brazil, 1990 to 2015, according to estimates from the Global Burden of Disease study. Sao Paulo Med J. 2017;135(3):213-21. with total costs amounting to US$ 4.18 and US$ 22 billion, respectively.66. Malta DC, Oliveira TP, Santos MA, Andrade SS, Silva MM; Grupo Técnico de Monitoramento do Plano de DCNT. Progress with the Strategic Action Plan for Tackling Chronic Non-Communicable Diseases in Brazil, 2011-2015. Epidemiol Serv Saude. 2016;25(2):373-390. , 99. Diretrizes da sociedade brasileira de diabetes 2017-2018 [Internet]. São Paulo: Clannad; 2017 [citado 2019 Nov 5]. Disponível em: https://www.diabetes.org.br/profissionais/images/2017/diretrizes/diretrizes-sbd-2017-2018.pdf
https://www.diabetes.org.br/profissionai...
Over the last few years, lifestyle changes among Brazilian citizens have had significant impacts on obesity-related comorbidity rates, another important risk-factor for hypertension and diabetes.55. Oliveira GM, Mendes M, Malachias MV, Morais J, Moreira O, Coelho AS, et al. 2017 Guidelines for Arterial Hypertension Management in Primary Health Care in Portuguese Language Countries. Arq Bras Cardiol. 2017;109(5):389-96. Obesity rates increased 60% in Brazil in 10 years, from 11.8% in 2006 to 18.9% in 2016, with higher prevalence (22.9%) among individuals aged 55 to 64 years.3232. Malta DC, Silva MM, Moura L, Morais OL. A implantação do Sistema de Vigilância de Doenças Crônicas Não Transmissíveis no Brasil, 2003 a 2015: alcances e desafios. Rev Bras Epidemiol. 2017;20(4):661-75.

Brazil has adopted important measures to tackle NCDs over the last few years, such as establishing the Sistema de Vigilância de Doenças Crônicas Não Transmissíveis (VIGITEL) [Surveillance System for Non-communicable Chronic Diseases], for permanent monitoring of chronic diseases and assessment of the best intervention strategies.3232. Malta DC, Silva MM, Moura L, Morais OL. A implantação do Sistema de Vigilância de Doenças Crônicas Não Transmissíveis no Brasil, 2003 a 2015: alcances e desafios. Rev Bras Epidemiol. 2017;20(4):661-75. Creation of Plano de Ações para o Enfrentamento de DCNT 2011-2022 [Action Plan to Tackle NCDs 2011-2022] was another important measure encouraging the development of public policies aimed at health promotion, with significant contributions to the achievement of goals, such as 2% annual reduction in premature deaths due to NCDs until 2022,66. Malta DC, Oliveira TP, Santos MA, Andrade SS, Silva MM; Grupo Técnico de Monitoramento do Plano de DCNT. Progress with the Strategic Action Plan for Tackling Chronic Non-Communicable Diseases in Brazil, 2011-2015. Epidemiol Serv Saude. 2016;25(2):373-390. so as to ensure sustainable health development for the 2030 Agenda.3434. World Health Organization (WHO). World Health Statistics 2016: Monitoring health for the SDGs. Genebra: WHO; 2016.

Studies based on a single type of intervention were more common. In many countries, healthcare provision to elderly patients with two or more comorbidities poses a greater challenge to managers and health professionals. Interventions aimed to increase adherence to treatment require guidelines focused on incentives for patients in this age group.3535. Applegate WB. Across the Pond. J Am Geriatr Soc. 2017;65(5):901-2. In the United States, delivery of multiple interventions to the same patient failed to improve health outcomes due to disease-specific requirements and higher costs. Therefore, comprehensive tools focused on patient quality of life rather than disease alone must be sought after.3535. Applegate WB. Across the Pond. J Am Geriatr Soc. 2017;65(5):901-2.

CONCLUSION

This scientometric study revealed significant gaps. The number of studies conducted in Latin America, particularly in Brazil, was small, in contrast with the growing prevalence of hypertension and diabetes in the country and the Latin American continent overall. Financial incentive interventions were limited to some developed countries; still, despite limited evidence, this type of intervention may be a promising strategy for behavior change promotion. Studies investigating interventions designed to improve adherence to treatment by patients with comorbidities, such as hypertension and diabetes, were scarce.

Finally, traditional interventions such as face-to-face interviews or telephone calls were more commonly used to encourage adherence to antihypertensive and antidiabetic therapy, in spite of the current trend of digital technology application to leverage health behavior changes.

ACKNOWLEDGEMENTS

To Instituto Cesumar de Ciência, Tecnologia e Inovação - ICETI for the scholarship; and to Fundação Araucária - PR/SESA-PR/CNPq/MS/PPSUS for funding the research.

REFERENCES

  • 1
    World Health Organization (WHO). Global status report on noncommunicable diseases 2014 [Internet]. Genebra: WHO; 2014 [cited 2018 Oct 3]. Available from: http://www.who.int/nmh/publications/ncd-status-report-2014/en/
    » http://www.who.int/nmh/publications/ncd-status-report-2014/en/
  • 2
    American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care. 2018;41(5):917-28.
  • 3
    Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Secretaria de Atenção à Saúde. Política Nacional de Promoção da Saúde (PNPS): Revisão da Portaria MS/GM no687, de 30 de março de 2006 [Internet]. Brasília (DF): Ministério da Saúde; 2015. 36 p. [citado 2018 Out 3]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/pnps_revisao_portaria_687.pdf
    » http://bvsms.saude.gov.br/bvs/publicacoes/pnps_revisao_portaria_687.pdf
  • 4
    Souza AC, Borges JW, Moreira TM. Quality of life and treatment adherence in hypertensive patients: systematic review with meta-analysis. Rev Saude Publica. 2016;50:71. Review.
  • 5
    Oliveira GM, Mendes M, Malachias MV, Morais J, Moreira O, Coelho AS, et al. 2017 Guidelines for Arterial Hypertension Management in Primary Health Care in Portuguese Language Countries. Arq Bras Cardiol. 2017;109(5):389-96.
  • 6
    Malta DC, Oliveira TP, Santos MA, Andrade SS, Silva MM; Grupo Técnico de Monitoramento do Plano de DCNT. Progress with the Strategic Action Plan for Tackling Chronic Non-Communicable Diseases in Brazil, 2011-2015. Epidemiol Serv Saude. 2016;25(2):373-390.
  • 7
    Sheppard-Law S, Zablotska-Manos I, Kermeen M, Holdaway S, Lee A, George J, et al. Factors associated with non-adherence to HBV antiviral therapy. Antivir Ther. 2018;23(5):425-33.
  • 8
    Ryan R, Santesso N, Lowe D, Hill S, Grimshaw J, Prictor M, et al. Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database Syst Rev. 2014;(4):CD007768. Review.
  • 9
    Diretrizes da sociedade brasileira de diabetes 2017-2018 [Internet]. São Paulo: Clannad; 2017 [citado 2019 Nov 5]. Disponível em: https://www.diabetes.org.br/profissionais/images/2017/diretrizes/diretrizes-sbd-2017-2018.pdf
    » https://www.diabetes.org.br/profissionais/images/2017/diretrizes/diretrizes-sbd-2017-2018.pdf
  • 10
    Olney JJ, Braitstein P, Eaton JW, Sang E, Nyambura M, Kimaiyo S, et al. Evaluating strategies to improve HIV care outcomes in Kenya: a modelling study. Lancet HIV. 2016;3(12):e592-600.
  • 11
    World Health Organization (WHO). WHO methods and data sources for country-level causes of death 2000-2015 [Internet]. Genebra: WHO; 2017 [cited 2018 Oct 3]. Available from: http://www.who.int/healthinfo/global_burden_disease/GlobalCOD_method_2000_2015.pdf?ua=1
    » http://www.who.int/healthinfo/global_burden_disease/GlobalCOD_method_2000_2015.pdf?ua=1
  • 12
    Miranda GM, Mendes AC, da Silva AL. Population aging in Brazil: current and future social challenges and consequences. Rev Bras Geriatr Gerontol. 2016;19(3):507-19.
  • 13
    Kravetz JD, Walsh RF. Team-Based Hypertension Management to Improve Blood Pressure Control. J Prim Care Community Health. 2016;7(4):272-5.
  • 14
    Pannick S, Davis R, Ashrafian H, Byrne BE, Beveridge I, Athanasiou T, et al. Effects of Interdisciplinary Team Care Interventions on General Medical Wards: A Systematic Review. JAMA Intern Med. 2015;175(8):1288-98. Review.
  • 15
    Floyd BD, Block JM, Buckingham BB, Ly T, Foster N, Wright R, et al. Stabilization of glycemic control and improved quality of life using a shared medical appointment model in adolescents with type 1 diabetes in suboptimal control. Pediatr Diabetes. 2017;18(3):204-12.
  • 16
    Abughosh SM, Wang X, Serna O, Henges C, Masilamani S, Essien EJ, et al. A Pharmacist Telephone Intervention to Identify Adherence Barriers and Improve Adherence Among Nonadherent Patients with Comorbid Hypertension and Diabetes in a Medicare Advantage Plan. J Manag Care Spec Pharm. 2016;22(1):63-73.
  • 17
    Shane-McWhorter L, McAdam-Marx C, Lenert L, Petersen M, Woolsey S, Coursey JM, et al. Pharmacist-provided diabetes management and education via a telemonitoring program. J Am Pharm Assoc (2003). 2015;55(5):516-26.
  • 18
    Friedberg JP, Rodriguez MA, Watsula ME, Lin I, Wylie-Rosett J, Allegrante JP, et al. Effectiveness of a tailored behavioral intervention to improve hypertension control: primary outcomes of a randomized controlled trial. Hypertension. 2015;65(2):440-6.
  • 19
    Ruiz Morilla MD, Sans M, Casasa A, Giménez N. Implementing technology in healthcare: insights from physicians. BMC Med Inform Decis Mak. 2017;17(1):92.
  • 20
    Frias J, Virdi N, Raja P, Kim Y, Savage G, Osterberg L. Effectiveness of Digital Medicines to Improve Clinical Outcomes in Patients with Uncontrolled Hypertension and Type 2 Diabetes: Prospective, Open-Label, Cluster-Randomized Pilot Clinical Trial. J Med Internet Res. 2017;19(7):e246.
  • 21
    Howitt P, Darzi A, Yang GZ, Ashrafian H, Atun R, Barlow J, et al. Technologies for global health. Lancet. 2012;380(9840):507-35. Review.
  • 22
    Piette JD, List J, Rana GK, Townsend W, Striplin D, Heisler M. Mobile Health Devices as Tools for Worldwide Cardiovascular Risk Reduction and Disease Management. Circulation. 2015;132(21):2012-27.
  • 23
    do Valle Nascimento TM, Resnicow K, Nery M, Brentani A, Kaselitz E, Agrawal P, et al. A pilot study of a Community Health Agent-led type 2 diabetes self-management program using Motivational Interviewing-based approaches in a public primary care center in São Paulo, Brazil. BMC Health Serv Res. 2017;17(1):32.
  • 24
    Schoenthaler A, De La Calle F, Barrios-Barrios M, Garcia A, Pitaro M, Lum A, et al. A practice-based randomized controlled trial to improve medication adherence among Latinos with hypertension: study protocol for a randomized controlled trial. Trials. 2015;16(1):290.
  • 25
    Jing S, Naliboff A, Kaufman MB, Choy M. Descriptive analysis of mail interventions with physicians and patients to improve adherence with antihypertensive and antidiabetic medications in a mixed-model managed care organization of commercial and Medicare members. J Manag Care Pharm. 2011;17(5):355-66.
  • 26
    Wong CA, Miller VA, Murphy K, Small D, Ford CA, Willi SM, et al. Effect of Financial Incentives on Glucose Monitoring Adherence and Glycemic Control Among Adolescents and Young Adults With Type 1 Diabetes: A Randomized Clinical Trial. JAMA Pediatr. 2017;171(12):1176-83.
  • 27
    Merai R, Siegel C, Rakotz M, Basch P, Wright J, Wong B; DHSc, Thorpe P. CDC Grand Rounds: A Public Health Approach to Detect and Control Hypertension. MMWR Morb Mortal Wkly Rep. 2016;65(45):1261-4.
  • 28
    Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017;135(10):e146-e603. Review. Erratum in: Circulation. 2017;135(10):e646. Circulation. 2017;136(10):e196.
  • 29
    Centers for Disease Control and Prevention. National Diabetes Statistics Report 2017: Estimates of Diabetes and Its Burden in the United States. Atlanta (GA): Centers for Disease Control and Prevention; 2017.
  • 30
    Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010;8:29.
  • 31
    Kingston A, Robinson L, Booth H, Knapp M, Jagger C; MODEM project. Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model. Age Ageing. 2018;47(3):374-80.
  • 32
    Malta DC, Silva MM, Moura L, Morais OL. A implantação do Sistema de Vigilância de Doenças Crônicas Não Transmissíveis no Brasil, 2003 a 2015: alcances e desafios. Rev Bras Epidemiol. 2017;20(4):661-75.
  • 33
    Malta DC, França E, Abreu DM, Perillo RD, Salmen MC, Teixeira RA, et al. Mortality due to noncommunicable diseases in Brazil, 1990 to 2015, according to estimates from the Global Burden of Disease study. Sao Paulo Med J. 2017;135(3):213-21.
  • 34
    World Health Organization (WHO). World Health Statistics 2016: Monitoring health for the SDGs. Genebra: WHO; 2016.
  • 35
    Applegate WB. Across the Pond. J Am Geriatr Soc. 2017;65(5):901-2.

Publication Dates

  • Publication in this collection
    13 Dec 2019
  • Date of issue
    2020

History

  • Received
    8 Aug 2018
  • Accepted
    18 June 2019
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