Registro del historial farmacoterapéutico de la historia clínica informatizada en pacientes con hipertensión arterial: un nuevo instrumento para valorar la adherencia terapéutica / A prescription register incorporated into computerized medical records for patients with hypertension: a new instrument to evaluate medication adherence

Objetivo. Estudiar la validez del registro del historial farmacoterapéutico (HF) de la historia clínica electrónica (HCE) comparado con el test de Morisky-Green en pacientes con tratamiento farmacológico de la hipertensión arterial.DiseñoEstudio descriptivo transversal. Emplazamiento. Atención Primaria. Participantes. Doscientos cincuenta y dos pacientes con hipertensión arterial en tratamiento farmacológico, sin cambios de fármacos o dosis, seleccionados aleatoriamente. Mediciones principales. Se estudiaron variables descriptivas, presión arterial, proporción de comprimidos retirados de las farmacias según el HF durante 12 meses respecto a los prescritos en la HCE (mala adherencia terapéutica [AT] si era < 80%) y test de Morisky-Green. La validez del HF se estudió mediante el índice Kappa, comparándolo con el test de Morisky-Green (referencia) y el control de la presión arterial. Resultados. La edad media fue de 68 años (50% de mujeres). Completaron el estudio el 77,4%. La mala AT fue del 51,3% por HF (IC 95% 44,3-58,3%) y del 15,4% (IC 95% 10,3-20,4%) con el test de Morisky-Green. El índice Kappa fue -0,068. Los pacientes con mala AT según el HF presentaron cifras más elevadas de presión arterial sistólica y diastólica (4,3 y 2,9 mmHg, respectivamente, p<0,05), sin diferencias en los pacientes con mala AT según el test de Morisky-Green (0,1 y 1 mmHg, respectivamente, p>0,05).Conclusiones. La mala AT según el HF es elevada y asociada al mal control de la hipertensión arterial, de manera contraria al test de Morisky-Green. Estos resultados sugieren que el HF podría ser útil para valorar la AT y que el test de Morisky-Green infraestima la mala AT(AU)

Objective. To study the validity of a prescription register (PR) incorporated into computerized medical records (CMR) compared with the Morisky-Green test in patients with high blood pressure using anti-hypertensive medication.DesignCross-sectional study. Setting. Primary Care. Participants. A total of 252 patients with hypertension using drug therapy with no changes in drugs or dosage were randomly selected. Main measurements. Descriptive variables, blood pressure, proportion of drug therapy collected from pharmacies according to the PR over 12 months compared with drug therapy prescribed in CMR (poor medication adherence [MA] if <80%), and Morisky-Green test. Validity of the PR was analysed using the Kappa index to compare PR with the Morisky-Green test (reference) and blood pressure levels. Results. Mean age was 68 years, 50% were women, and 77% completed the study. Poor MA was 51.3% according to the PR (95% CI 44.3%-58.3%) and 15.4% (95% CI; 10.3%-20.4%) when using the Morisky-Green test. The Kappa index was -0.068. Patients with poor MA according to the PR had higher levels of systolic and diastolic blood pressure (4.3 and 2.9 mmHg, respectively, P<0.05). No differences in blood pressure were observed in patients with poor MA if the Morisky-Green test was used (0.1 and 1 mmHg, respectively, P>0.05).Conclusions. Poor MA according to the PR is high and is associated with poorer control of blood pressure; the Morisky-Green test does not pick up on these differences. These results suggest that the PR could be useful for evaluating MA and that the Morisky-Green test underestimates poor MA(AU)

[A prescription register incorporated into computerized medical records for patients with hypertension: a new instrument to evaluate medication adherence]. / Registro del historial farmacoterapéutico de la historia clínica informatizada en pacientes con hipertensión arterial: un nuevo instrumento para valorar la adherencia terapéutica.

OBJECTIVE: To study the validity of a prescription register (PR) incorporated into computerized medical records (CMR) compared with the Morisky-Green test in patients with high blood pressure using anti-hypertensive medication. DESIGN: Cross-sectional study. SETTING: Primary Care. PARTICIPANTS: A total of 252 patients with hypertension using drug therapy with no changes in drugs or dosage were randomly selected. MAIN MEASUREMENTS: Descriptive variables, blood pressure, proportion of drug therapy collected from pharmacies according to the PR over 12 months compared with drug therapy prescribed in CMR (poor medication adherence [MA] if <80%), and Morisky-Green test. Validity of the PR was analysed using the Kappa index to compare PR with the Morisky-Green test (reference) and blood pressure levels. RESULTS: Mean age was 68 years, 50% were women, and 77% completed the study. Poor MA was 51.3% according to the PR (95% CI 44.3%-58.3%) and 15.4% (95% CI; 10.3%-20.4%) when using the Morisky-Green test. The Kappa index was -0.068. Patients with poor MA according to the PR had higher levels of systolic and diastolic blood pressure (4.3 and 2.9 mmHg, respectively, P<0.05). No differences in blood pressure were observed in patients with poor MA if the Morisky-Green test was used (0.1 and 1 mmHg, respectively, P>0.05). CONCLUSIONS: Poor MA according to the PR is high and is associated with poorer control of blood pressure; the Morisky-Green test does not pick up on these differences. These results suggest that the PR could be useful for evaluating MA and that the Morisky-Green test underestimates poor MA.