ABSTRACT
OBJECTIVES: To find the non-compliance of patients with Lipaemia with scheduled appointments, to define the profile of non-attending patients and to study the best way of identifying them. DESIGN: Prospective study. SETTING: Primary Care Centres in the province of Alicante. PATIENTS: 107 patients with Lipaemia from five General Medical clinics who received treatment with lipid-lowering drugs. MEASUREMENTS AND MAIN RESULTS: Non-compliance was assessed by reviewing the appointment books. Non-compliant patients were defined as those who had not attended 80-100% of the appointments made in the six months since the beginning of the study. Non-compliance with appointments was 16.8% (CI: 9.7-23.9). In the profile study none of the variables analysed showed significant differences. Of the methods validated, level of knowledge had the highest sensitivity (88.9%: CI 81.9-94.1); and medical judgement the greatest specificity (86.5%: CI 79.5-92.5), with the coefficient for probability of low compliance 2.9 and best Kappa index 0.25. CONCLUSIONS: One out of every six patients with Lipaemia does not attend follow-up appointments. There is no profile of the non-compliant patient. Only medical judgement can be valid for suspecting non-compliance with scheduled appointments.
Subject(s)
Appointments and Schedules , Hyperlipidemias/drug therapy , Patient Compliance/statistics & numerical data , Aged , Female , Humans , Male , Middle Aged , Socioeconomic FactorsABSTRACT
OBJECTIVE: 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. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: Factors predicting non-compliance are few but delineate a possible profile. Only MJ is valid to detect non-compliance with scheduled visits.
Subject(s)
Appointments and Schedules , Hypertension , Treatment Refusal , Female , Humans , Hypertension/psychology , Male , Middle Aged , Prospective Studies , Sensitivity and SpecificityABSTRACT
OBJECTIVES: To validate six indirect methods for evaluation of therapy compliance with oral hypoglycemic agents: self-reported compliance, attendance to scheduled visits, Morisky-Green test, degree of disease control, medical judgement and level of knowledge on the disease. PATIENTS AND METHODS: The certainty method used was pill counts at patient's home by surprise with a sample of 107 randomly selected patients from three Primary Care Centers in the province of Alicante. RESULTS: SV was the method with the highest specificity (94.2%), likelihood of low compliance (84.2%) and percentage of likelihood of low compliance (5.1). DC assessed by basal blood glucose had the highest sensitivity (81.8%) and DC assessed by glycoxylated hemoglobin the highest likelihood of high compliance (61.1%). CONCLUSIONS: In this study, SV and DC with basal blood glucose were the highest validity indicators and could be used combined in clinical practice to evaluate compliance with oral hypoglycemic agents.
