[Validity of 6 indirect methods to assess treatment compliance in arterial hypertension].

BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.