[Compliance with hypertension therapy in Spain, according to the views of family doctors. Complex project]. / El cumplimiento terapéutico en la hipertensión arterial en España, según la opinión de los médicos de familia. Proyecto Cumplex.

OBJECTIVES: To evaluate physicians' knowledge of therapy compliance, their attitudes towards it and their training needs in this field. DESIGN: Transversal, descriptive study using a questionnaire. SETTING: Primary care centres in Spain. PARTICIPANTS: Three thousand and thirty-four general practitioners. MAIN MEASUREMENTS: Definition of non-compliance, non-compliance in their own consultations and in the rest of Spain, methods of measurement, causes, association with therapy failure, efficacy and use of compliance-enhancing strategies, and need for training. RESULTS: Most participants (92%; 95% CI, 91.1-92.9) defined non-compliance as patients' failure to take 5%-20% of their pills. A total of 32.4% (95% CI, 30.9%-33.9%) of the physicians estimated that less than 10% of their patients were non-compliers, whereas 6.8% (95% CI, 6.0-7.6) thought this was also the rate in the rest of Spain. The preferred methods of measurement were patient response (77.0%; 75.7-78.4) and their own clinical experience (76.0%; 74.6-77.4). About half (50.7%) believed that lack of compliance was associated with therapy failure in more than 50% of cases. The presence of adverse side-effects was considered a very important cause of poor compliance by 81.9%. The most common and effective strategies were: use of single-dose drugs (84.3%; 83.1-85.5) and nursing support (84.9%; 83.8-86.0). Moreover, 65.2% (63.7-66.7) of the surveyed physicians had not received any education about compliance as medical students and 42% (40.4-43.6) said further training in compliance was needed. CONCLUSIONS: A high percentage of physicians define compliance incorrectly and believe that other doctors have more non-complying patients than they do. They tend to favour non-validated measuring methods and they lack training.

El cumplimiento terapéutico en la hipertensión arterial en España, según la opinión de los médicos de familia. Proyecto Cumples / Compliance with hypertension therapy in Spain, according to the views of family

Objetivo. Evaluar los conocimientos de los médicos sobre el cumplimiento farmacológico en general, su actitud ante éste y sus necesidades de formación. Diseño. Estudio descriptivo, transversal, mediante una encuesta. Emplazamiento. Centros de atención primaria de España. Participantes. Participaron 3.834 médicos. Mediciones principales. Definición de incumplimiento, incumplimiento observado en su consulta y el resto de España, métodos de medición, causas, asociación con fracaso terapéutico, eficacia y uso de estrategias para mejorarlo, y necesidad de formación. Resultados. El 95,9% cumplimentó la encuesta. El 92% (intervalo de confianza [IC] del 95%, 91,1-92,9) define como incumplimiento la omisión por el paciente de 5-20% de las tomas. Un 32,4% (IC del 95%, 30,9-33,9) opinó que menos del 10% sería incumplidor, mientras que un 6,8% (IC del 95%, 6,0-7,6) opinaba que la tasa de incumplimiento en España era inferior al 10%. Los métodos de medición más usados son la respuesta del paciente (77,0%; IC del 9%, 75,7-78,4) y la propia experiencia (76,0%; IC del 95%, 74,6-77,4). El 50,7% cree que el incumplimiento está asociado con el fracaso terapéutico en más del 50%. La presencia de efectos adversos fue considerada una causa muy importante en el mayor porcentaje (81,9%). Las estrategias consideradas más eficaces y utilizadas son: empleo de fármacos en monodosis (84,3%; IC del 95, 83,1-85,5) y consulta de enfermería (84,9%; IC del 95%, 83,8-86,0). El 65,2% (IC del 95%, 63,7-66,7) no ha recibido formación durante la carrera y un 42% (IC del 95%; 40,4-43,6) considera necesario realizar alguna actividad formativa. Conclusiones. Un alto porcentaje de médicos utiliza una definición incorrecta de cumplimiento y cree que otros médicos tienen más pacientes incumplidores. Se utilizan preferentemente métodos de medición no validados y se observa un déficit de formación

Objectives. To evaluate physicians' knowledge of therapy compliance, their attitudes towards it and their training needs in this field. Design. Transversal, descriptive study using a questionnaire. Setting. Primary care centres in Spain. Participants. Three thousand and trirty four general practitioners. Main measurements. Definition of non-compliance, non-compliance in their own consultations and in the rest of Spain, methods of measurement, causes, association with therapy failure, efficacy and use of compliance-enhancing strategies, and need for training. Results. Most participants (92%; 95% CI, 91.1-92.9) defined non-compliance as patients' failure to take 5%-20% of their pills. A total of 32.4% (95% CI, 30.9%-33.9%) of the physicians estimated that less than 10% of their patients were non-compliers, whereas 6.8% (95% CI, 6.0-7.6) thought this was also the rate in the rest of Spain. The preferred methods of measurement were patient response (77.0%; 75.7-78.4) and their own clinical experience (76.0%; 74.6-77.4). About half (50.7%) believed that lack of compliance was associated with therapy failure in more than 50% of cases. The presence of adverse side-effects was considered a very important cause of poor compliance by 81.9%. The most common and effective strategies were: use of single-dose drugs (84.3%; 83.1-85.5) and nursing support (84.9%; 83.8-86.0). Moreover, 65.2% (63.7-66.7) of the surveyed physicians had not received any education about compliance as medical students and 42% (40.4-43.6) said further training in compliance was needed. Conclusions. A high percentage of physicians define compliance incorrectly and believe that other doctors have more non-complying patients than they do. They tend to favour non-validated measuring methods and they lack training