Identificador: TDX:617
Autors: Reig Puigbertran, Rosaura
Resum:
Background. Awareness of patients' adherence is generally low among primary healthcare physicians when they are given a drug. If drugs are not used appropriately their benefits disappear. Aim. To determine the compliance rate of patients diagnosed of hypercholesterolemia at the end of the first month of a statin therapy and validate several indirect methods of drug-compliance in order to know which of them fit more closely with the actual compliance of the patient. Design. Observational prospective survey.Setting of the study. Primary health care.Subjects. 271 patients belonging to 14 practices of four primary health care centres who were diagnosed of hypercholesterolemia and were susceptible to drug therapy with a statin. Informed consent were asked for even though the true aim of the survey was not accurately explained to them. Measurements and interventions. Visits at home one to three days before ending up the statin were performed in which counting of pills was assessed. Patients who had between 80 and 110% compliance were defined as compliant. The following parameters were analysed: age, gender, high blood pressure, diabetes, cardiovascular risk, polipharmacy (more than five different drugs taken simultaneously), analysis before and after the first month of drug therapy (total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, and hepatic enzymes). 4 physicians gave simultaneously an explanatory sheet about how to take the statin and the other 10, did not. Furthermore, patients were asked about communication of self-compliance, modified Morisky-Green test and a test of knowledge with 3 questions. Chi-square, Student t, variance analysis, correlations, and validation parameters were used, considering p-values < 0.05 as statistically significant. Results. 7 subjects were rejected because of no possibility to go to their homes, considering a total number of 264, with a mean age of 63.4 ± 10,7 yr. and 56.8% of women. 111 patients had a pill counting less than < 80% (42% of non-compliance). Compliance rate was better among those individuals who were given the explanatory sheet (80.8%), those who had a reduction of LDL-cholesterol more than 24% (74.1%) and those who had active cardiovascular disease (71.4%). The indirect method that best predicted the non-compliance status was the modified Morisky-Green test. The utilization of two questions of this test (1. We all forget to take the pills, have you forgotten to take any cholesterol-decreasing pill?, and 2. If you were once upset, have you given up taking a pill?) predicted very well the non-compliance status of the patient (sensitivity 94.6%, specificity 96.1%), that improved when a question of knowledge was added: 'The aim of the treatment rather than decrease the level of cholesterol is reduce the cardiovascular risk'. In case of a wrong answer to any of these questions, the sensitivity to predict non-compliance status was 97.3% and specificity 96.1%.Conclusions. The use of simple methods in the practice in order to predict if our patients adhere to our recommendations is really important. On the basis of the results of this survey, in case of a statin therapy, the wrong answer to any of a 3-question questionnaire predicts very well patient's non-compliance; so its introduction in the practice could be useful. Key words: Compliance, adherence, statin, hypercholesterolemia, Morisky-Green test
Repositori URV