Villa Lorenzo, Sun Diana, Denhaerynck Kris, Vancayzeele Stefaan, Brié Heidi, Hermans Christine, Aerts Ann, Levengood Michael, MacDonald Karen, Abraham Ivo
Faculty of Pharmacy, University of Concepción, Concepción, Chile.
Center for Health Outcomes & PharmacoEconomic Research, College of Pharmacy, The University of Arizona, Tucson, AZ, US.
Br J Gen Pract. 2015 Jan;65(630):e9-15. doi: 10.3399/bjgp15X683101.
Patient adherence is often not monitored because existing methods of evaluating adherence are either burdensome or do not accurately predict treatment outcomes.
To examine whether two simple, single-item physician-administered measures of patient adherence to antihypertensive medication are predictive of blood pressure outcomes.
Retrospective database analysis of patients with hypertension treated in Belgian primary care.
Using pooled data from five observational studies, a sample was identified of 9725 patients who were assessed using two single-item physician-administered measures of adherence to antihypertensive medication: the first item of the Basel Assessment of Adherence Scale (BAAS) and the Visual Analogue Scale (VAS). These two assessment tools were administered by GPs during regular appointments with patients. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and combined SBP/DBP were measured at baseline and at 90 days.
BAAS-identified adherent patients achieved lower mean SBP and DBP compared with non-adherent patients at 90 days (P<0.001), and had odds ratios of achieving blood pressure control of 0.66 (95% confidence intervals (CI) = 0.61 to 0.73, P<0.001) for SBP, 0.69 (95% CI = 0.62 to 0.76, P<0.001) for DBP, and 0.65 (95% CI = 0.59 to 0.72, P<0.001) for combined SBP/DBP. For VAS-identified adherent patients, the odds ratios of achieving blood pressure control were 0.93 (95% CI = 0.86 to 1.00, P<0.001) for SBP, 0.79 (95% CI = 0.73 to 0.85, P<0.001) for DBP, and 0.91 (95% CI = 0.84 to 0.99, P<0.001) for combined SBP/DBP.
The first item of the BAAS and the VAS are independent predictors of blood pressure control. These methods can be integrated seamlessly into routine clinical practice by allowing GPs to quickly evaluate a patient's adherence and tailor treatment recommendations accordingly.
患者依从性通常未得到监测，因为现有的评估依从性的方法要么繁琐，要么无法准确预测治疗结果。
研究两种由医生进行的简单单项患者抗高血压药物依从性测量方法是否能预测血压结果。
对比利时初级保健中治疗的高血压患者进行回顾性数据库分析。
使用来自五项观察性研究的汇总数据，确定了9725例患者的样本，这些患者使用两种由医生进行的单项抗高血压药物依从性测量方法进行评估：巴塞尔依从性评估量表（BAAS）的第一项和视觉模拟量表（VAS）。这两种评估工具由全科医生在与患者的定期预约中使用。在基线和90天时测量收缩压（SBP）、舒张压（DBP）以及综合SBP/DBP。
在90天时，与非依从患者相比，经BAAS确定为依从的患者平均SBP和DBP更低（P<0.001），SBP达到血压控制的比值比为0.66（95%置信区间（CI）=0.61至0.73，P<0.001），DBP为0.69（95%CI = 0.62至0.76，P<0.001），综合SBP/DBP为0.65（95%CI = 0.59至0.72，P<0.001）。对于经VAS确定为依从的患者，SBP达到血压控制的比值比为0.93（95%CI = 0.86至1.00，P<0.001），DBP为0.79（95%CI = 0.73至0.85，P<0.001），综合SBP/DBP为0.91（95%CI = 0.84至0.99，P<0.001）。
BAAS的第一项和VAS是血压控制的独立预测因素。通过让全科医生快速评估患者的依从性并据此调整治疗建议，这些方法可以无缝整合到常规临床实践中。
