Piñeiro Chousa F, Gil Guillén V F, Pastor López R, Merino Sánchez J
Departamento de Medicina, Universidad Miguel Hernández, Alicante.
Rev Clin Esp. 1998 Oct;198(10):669-72.
To know the non-compliance of hypertensive patients with scheduled visits, to define the patient profile, and to study the best method which identifies such patients.
A total of 174 hypertensive patients under pharmacological therapy in the Primary Care setting. Non-compliance with scheduled visits was assessed by review of the appointment book. The characteristics of patients, of the disease, and therapy associated with non-compliance were studied and six indirect methods were validates.
The profile of the non-compliant patient corresponded to a housewife or with working activity (p = 0.01), obesity (p = 0.01), anxiety (p = 0.008), moderate-severe cardiovascular risk (p = 0.02), bad control of blood pressure values (p = 0.03), and physician's dependence (p = 0.001). Of the investigated methods, education level (EL) had the highest sensitivity (77.8%) (CI: 65.7%-89.9%) and medical judgement (MJ) the highest specificity (87.6; CI: 81.9%-93.3%), negative predictive value 80.1%, positive predictive value 51.5%, odds ratio of low compliance 3.1 and best Kappa index 0.28.
Factors predicting non-compliance are few but delineate a possible profile. Only MJ is valid to detect non-compliance with scheduled visits.
了解高血压患者未按预约就诊的情况，确定患者特征，并研究识别此类患者的最佳方法。
共纳入174例在基层医疗环境中接受药物治疗的高血压患者。通过查阅预约簿评估未按预约就诊的情况。研究了患者、疾病及与未按时就诊相关治疗的特征，并验证了六种间接方法。
未按时就诊患者的特征包括家庭主妇或有工作（p = 0.01）、肥胖（p = 0.01）、焦虑（p = 0.008）、中度至重度心血管风险（p = 0.02）、血压值控制不佳（p = 0.03）以及对医生的依赖（p = 0.001）。在所研究的方法中，教育水平（EL）敏感性最高（77.8%）（95%置信区间：65.7%-89.9%），医学判断（MJ）特异性最高（87.6%；95%置信区间：81.9%-93.3%），阴性预测值80.1%，阳性预测值51.5%，低依从性比值比3.1，最佳Kappa指数0.28。
预测未按时就诊的因素较少，但勾勒出了一个可能的患者特征。只有医学判断对检测未按预约就诊有效。
