Internal picture of the disease as a factor of adherence to treatment after coronary bypass surgery

The research is devoted to the actual in clinical psychology problem of adherence to treatment, which manifests in the fact that about half of patients with chronic diseases including cardiovascular diseases do not comply with medical recommendations (CVD are considered to be the leading cause of death among noncommunicable diseases). However, despite the objective efficacy of surgical treatment of the coronary heart disease (CHD), the figures of patients’ health outcomes and quality of life often do not rise because of patients’ nonadherence to their rehabilitation. That is why patients’ nonadherence to medical prescriptions is considered to be a serious problem in clinical practice. The article describes the results of the study carried out with the objective of comparative analysis of the internal picture of the disease among 85 male patients suffering from CHD with different degrees of adherence to rehabilitation treatment after coronary bypass surgery. The study was performed in the Federal North-West Medical Research Centre (Saint-Petersburg) among two sample groups of patients after coronary bypass surgery: adherent to treatment (43 persons) and nonadherent patients (42 persons). The results of performing clinic-psychological method (study of medical history, special questionnaires) and psychometric method (technique for diagnosing the types of attitude towards the disease) in both groups of patients are presented in this article. Based on the obtained data, several conclusions were made. It was confirmed that a number of factors (adherence to the prescribed diet, rejection of harmful habits, increasing physical activity) must be taken into account to evaluate the adherence to treatment after bypass surgery. In both groups of patients prevalence of types of attitude towards illness, related to the “first block” in which mental and social adaptation is not significantly disturbed (‘harmonious’, ‘ergopathic’ and ‘anosognostic’ types) was identified. Bar-graph analysis of the 12 available types of attitude towards the disease revealed that adherent patients show higher values on the scale related to the ‘harmonious’ type versus nonadherent patients (p≤0,01); patients with poor adherence show higher values on the scale of the ‘apathetic’ (anergic) type (p≤0,01), as well as the ‘melancholic’ type of attitude towards illness (p≤0,05) in comparison with adherent patients. The data obtained in the future will help to identify patients with high risk of nonadherence to medical recommendations and identify the targets for psychocorrective and educational programs for patients with CHD, including the period after coronary bypass surgery. Thus, the results of this study have a great practical value and can be used by clinical psychologists and also by cardiologists and rehabilitation specialists.