La Orden Clinical Management Unit, Huelva, Spain.
Adoratrices Clinical Management Unit, Huelva, Spain.
Patient Educ Couns. 2018 Sep;101(9):1654-1660. doi: 10.1016/j.pec.2018.04.009. Epub 2018 Apr 23.
To validate electronic prescriptions (e-prescriptions) as a method for measuring treatment adherence in patients with hypertension.
This prospective study initially included 120 patients treated for hypertension in primary care centers. Adherence was measured using the gold standard, the medication event monitoring system (MEMS), versus the index test, the e-prescription program, at baseline and at 6, 12, 18 and 24 months. We calculated the adherence rate using the MEMS and the medication possession ratio (MPR) for the e-prescriptions. We considered patients adherent if they had an adherence rate of 80% to 100%. To validate the e-prescription, we obtained measures of diagnostic accuracy, the Kappa concordance index, and the area under the ROC curve (AUC).
We included 102 patients. Overall adherence was 77.4% by MEMS (95%CI: 66.8-88) and 80.4% (95%CI: 70.3-90.5) by MPR. At 24 months, sensitivity was 87% and specificity, 93.7%. The AUC was 0.903 (95%CI: 0.817-0.989).
Measures of treatment adherence were not significantly different between e-prescription and gold standard at most visits, and the e-prescription showed good discriminatory diagnostic capacity.
If patients are included in an e-prescription program for at least 2 years, e-prescription is an inexpensive method to measure adherence in hypertension.
验证电子处方（e-prescriptions）作为测量高血压患者治疗依从性的方法。
本前瞻性研究最初纳入了 120 名在基层医疗中心接受高血压治疗的患者。使用金标准——药物事件监测系统（MEMS）和指标测试——电子处方程序，在基线以及 6、12、18 和 24 个月时测量依从性。我们使用 MEMS 和电子处方的药物持有率（MPR）计算了依从率。如果患者的依从率为 80%至 100%，则认为他们是依从的。为了验证电子处方，我们获得了诊断准确性的度量标准、Kappa 一致性指数和 ROC 曲线下的面积（AUC）。
我们纳入了 102 名患者。通过 MEMS（95%置信区间：66.8-88）和 MPR（95%置信区间：70.3-90.5），总体依从率分别为 77.4%和 80.4%。在 24 个月时，敏感性为 87%，特异性为 93.7%。AUC 为 0.903（95%置信区间：0.817-0.989）。
在大多数就诊时，电子处方和金标准的治疗依从性测量值没有显著差异，电子处方具有良好的鉴别诊断能力。
如果患者至少参加 2 年的电子处方计划，电子处方是一种测量高血压患者依从性的廉价方法。
