Gil V, Pineda M, Martínez J L, Belda J, Santos M L, Merino J
Departamento de Medicina, Universidad de Alicante.
Med Clin (Barc). 1994 Apr 16;102(14):532-6.
For adequate control of high blood pressure (HBP) the therapy indicated must be correct, with effective medication which must be taken as required. At a collective level methods to evaluate patients' compliance of the above are necessary since without the same the efficacy of the drugs cannot be determined. In this study methods allowing the clinic to easily quantify patient fulfillment were sought.
Six indirect methods were used to evaluate therapeutic compliance: 1) self communicated compliance (SC), 2) appointment attendance (AA), 3) degree el control obtained in the blood pressure (DC), 4) Morinsky and Green tests (M-G), 5) patient's knowledge of the disease (PK) and 6) doctor's judgement on patient's compliance (DJ). All the above were applied to 152 hypertense patients randomly selected from the Health Centers of Alfaz and Alicante (Spain). Concordance with the compliance obtained from the "counting of tablets" in the patient's home and by surprise were evaluated by double entry tables.
The SC is the method which obtains greatest specificity (96.7%), exactness (73%), probability of low compliance (88%) and percent of probability of low compliance (11.3%). The PK had greatest sensitivity (83.3%) and greater probability of high compliance (83.6%) and percentage of probability of high compliance (0.3%). The SC (23.1%), AA (1.3%) and the DJ (7.5%), overestimate good compliance. The M-G test (7.9%) and the PK (20.4%) overestimate had compliance.
In this study self communicated compliance and patient's knowledge of disease were the methods which provided the best indicators of validity to measure therapeutic compliance in high blood pressure in outpatients, although there is the inconvenience of significantly over and under estimating good and bad compliance.
为了充分控制高血压（HBP），所选用的治疗方法必须正确，使用的药物要有效且需按要求服用。在群体层面，有必要采用方法来评估患者对上述要求的依从性，因为若没有依从性，就无法确定药物的疗效。本研究旨在寻找能让诊所轻松量化患者依从情况的方法。
采用六种间接方法评估治疗依从性：1）自我报告的依从性（SC），2）预约就诊情况（AA），3）血压控制程度（DC），4）莫林斯基和格林测试（M-G），5）患者对疾病的了解程度（PK），6）医生对患者依从性的判断（DJ）。将上述所有方法应用于从西班牙阿尔法兹和阿利坎特健康中心随机选取的152名高血压患者。通过双向表格评估与患者家中“药片计数”以及突击检查所获得的依从性的一致性。
自我报告的依从性是特异性最高（96.7%）、准确性（73%）、低依从性概率（88%）和低依从性概率百分比（11.3%）最高的方法。患者对疾病的了解程度敏感性最高（83.3%），高依从性概率（83.6%）和高依从性概率百分比（0.3%）也更高。自我报告的依从性（23.1%）、预约就诊情况（1.3%）和医生的判断（7.5%）高估了良好依从性。莫林斯基和格林测试（7.9%）以及患者对疾病的了解程度（20.4%）高估了不良依从性。
在本研究中，自我报告的依从性和患者对疾病的了解程度是为门诊高血压患者测量治疗依从性提供最佳有效性指标的方法，尽管存在显著高估和低估良好与不良依从性的不便之处。
