Intervención no farmacológica como estrategia para favorecer el control de la hipertensión arterial y mejorar el cumplimiento antihipertensivo / Non-pharmacological intervention as a strategy to improve antihypertensive treatment compliance

Objetivo: Comprobar la eficacia de una intervención mediante una revista educacional en el cumplimiento antihipertensivo de la hipertensión arterial (HTA) no controlada.DiseñoEstudio clínico controlado, aleatorizado y multicéntrico.EmplazamientoOchenta y siete Centros de Salud de España.ParticipantesSe incluyeron 450 pacientes hipertensos diagnosticados de HTA no controlada.IntervenciónSe formaron 2 grupos con 225 individuos: a) grupo de intervención (GI), los que recibieron una revista educacional domiciliaria bimensual y b) grupo de control (GC), que tuvieron práctica clínica habitual.ResultadosConcluyeron 393 individuos (edad: 62,4 años [desviación estándar de 11,6 años]), 196 pacientes del GI y 197 pacientes del GC. Ciento ochenta y cuatro eran varones (46,8%).ResultadosFueron cumplidores del total de las dosis tomadas el 83,2% en el GI (del 78 al 88,4%) y el 49,2% del GC (IC del 95%: del 42,2 al 56,2%) (p=0,0001) y fueron cumplidores diarios el 74% del GI (IC del 95%: del 67,9 al 80,1%) y el 42,6% del GC (IC del 95%: del 35,7 al 49,5%) (p=0,0001).ResultadosEl control de la HTA fue del 81,6% en el GI (IC del 95%: del 76,2 al 86,5%) y del 56,3% en el GC (IC del 95%: del 49,4 al 63,2%). El NNT con la intervención fue de 3,3 pacientes.ConclusionesEl incumplimiento del tratamiento fue muy alto. La revista educacional es una estrategia eficaz para disminuir el incumplimiento y mejorar el grado de control de la HTA(AU)

Objetive: To evaluate the efficacy of an intervention by means of an educational magazine on treatment compliance in uncontrolled arterial hypertension (AHT).DesignControlled, randomised clinical trial.Setting87 primary care centres. Spain.ParticipantsA total of 450 patients with uncontrolled hypertension were included.InterventionTwo groups of 225 patients were formed: 1) Control group (CG): standard health intervention; 2) Intervention Group (IG): received a twice monthly educational magazine at home.Main measurementsCompliance was measured using the Medication Event Monitoring System (MEMS-Aardex). Compliance rate (CR) was recorded. Compliers were defined as individuals with a treatment compliance of 80–110%. The percentage of compliers, the mean percentage of doses taken and the percentage of patients taking the medication at the correct times were estimated. The mean blood pressures (BPs) and the percentage of controlled patientswere calculated. The number needed to treat (NNT) was calculated.ResultsA total of 393 individuals were evaluable (Age: 62.4 years), 196 in the IG and 197 in the CG. There were 83.2% (95% CI 78–88.4) and 49.2% (95% CI 42.2–56.2) (P=0.0001) of overall compliers in the IG and CG, respectively and 74% (95% CI: 67.9–80.1) and 42.6% (95% CI=35.7–49.5) (P=0.0001) of correct times compliers. A total of 81.6% (95% CI=76.2–86.5%)) were controlled in the IG and 56.3% (95% CI=49.4–63.2) in the CG. The NNT was 3.3 patients.ConclusionsTherapeutic non-compliance was very high. The educational magazine is an effective strategy to improve the compliance and degree of control of the AHT(AU)

[Non-pharmacological intervention as a strategy to improve antihypertensive treatment compliance]. / Intervención no farmacológica como estrategia para favorecer el control de la hipertensión arterial y mejorar el cumplimiento antihipertensivo.

OBJECTIVE: To evaluate the efficacy of an intervention by means of an educational magazine on treatment compliance in uncontrolled arterial hypertension (AHT). DESIGN: Controlled, randomised clinical trial. SETTING: 87 primary care centres. Spain. PARTICIPANTS: A total of 450 patients with uncontrolled hypertension were included. INTERVENTION: Two groups of 225 patients were formed: 1) Control group (CG): standard health intervention; 2) Intervention Group (IG): received a twice monthly educational magazine at home. MAIN MEASUREMENTS: Compliance was measured using the Medication Event Monitoring System (MEMS-Aardex). Compliance rate (CR) was recorded. Compliers were defined as individuals with a treatment compliance of 80-110%. The percentage of compliers, the mean percentage of doses taken and the percentage of patients taking the medication at the correct times were estimated. The mean blood pressures (BPs) and the percentage of controlled patientswere calculated. The number needed to treat (NNT) was calculated. RESULTS: A total of 393 individuals were evaluable (Age: 62.4 years), 196 in the IG and 197 in the CG. There were 83.2% (95% CI 78-88.4) and 49.2% (95% CI 42.2-56.2) (P=0.0001) of overall compliers in the IG and CG, respectively and 74% (95% CI: 67.9-80.1) and 42.6% (95% CI=35.7-49.5) (P=0.0001) of correct times compliers. A total of 81.6% (95% CI=76.2-86.5%)) were controlled in the IG and 56.3% (95% CI=49.4-63.2) in the CG. The NNT was 3.3 patients. CONCLUSIONS: Therapeutic non-compliance was very high. The educational magazine is an effective strategy to improve the compliance and degree of control of the AHT.

[Therapy compliance in cases of hyperlipaemia, as measured through electronic monitors. Is a reminder calendar to avoid forgetfulness effective?]. / El cumplimiento terapéutico en las dislipemias medido mediante monitores electrónicos. Es eficaz un calendario recordatorio para evitar los olvidos?

OBJECTIVE: To analyse the efficacy of the intervention with a calendar reminder of the medication taking in the treatment of the hyperlipidemias. DESIGN: Controlled, randomised clinical trial. SETTING: Twelve clinics at 5 primary care centres, Spain. PARTICIPANTS: Two hundred and twenty people diagnosed with hypercholesterolaemia according to Spanish Consensus criteria were chosen. INTERVENTION: Two groups were formed. The control group (CG) of 110 patients, who received the doctor's normal treatment; and the Intervention group (IG) of 110 patients, who received in addition a calendar remider of medication taking. MAIN MEASUREMENTS: Meausured of compliance was performed by moniotrs electronic (MEMS) and cholesterol, triglycerides, HDL-C, and LDL-C determined at the start, and at the third and sixth months. Percentages of patients complying (80%-110%), the mean compliance percentage and the degree of control were compared. The reduction of absolute and relative risk (RAR and RRR) and the mean number of people that required an intervention in order to avoid non-compliance (NI) were calculated. RESULTS: One hundred and eighty eight people (85.45%) completed the survey, 96 in the IG and 92 in the CG; 26.55% were non compliers with the therapy (CI, +/-6.3%) (IG, 10.5%, CI, +/-4.6%; CG, 42.6%, CI, +/-10.1% [P<.0001]). Mean compliance ran at 88,1% (IC, +/-4.6%) overall, at 92% (CI, +/-5.4%) in the IG and at 84% (CI, +/-7.4%) in the IG (P<.05). The RAR was 32.1%, the RRR 75.35%, and the NI was 3.1 patients. The patients with cholesterol controlled ran at 66.7% (CI, +/-9.4%) in the IG and 41.2% in the CG (P<.001). CONCLUSIONS: The calendar reminder intervention is an efficacious way of improving the percentage of patients complying with lipaemia treatment.

El cumplimiento terapéutico en las dislipemias medido mediante monitores electrónicos. ¿Es eficaz un calendario recordatorio para evitar los olvidos? / Therapy compliance in cases of hyperlipaemia, as measured through electronic monitors. Is a reminder calendar to avoid forget fulness effective?

Objetivo. Analizar la eficacia de la intervención mediante un calendario recordatorio de la toma de medicación en el cumplimiento terapéutico de las dislipemias. Diseño. Ensayo clínico controlado, aleatorizado. Emplazamiento. Doce consultas de 5 centros de atención primaria. Participantes. Se seleccionó a 220 pacientes con hipercolesterolemia diagnosticados según criterios del National Cholesterol Education Program (NCEP). Intervención. Se formaron 2 grupos: a) grupo control (GC), con 110 pacientes, que recibieron la intervención habitual, y b) grupo intervención (GI), con 110 pacientes que recibieron además un calendario recordatorio de la toma de medicación. Mediciones principales. Se estudió el cumplimiento mediante monitores electrónicos de control de medicación (MEMS) y se determinó el colesterol, los triglicéridos, el colesterol de las lipoproteínas de alta densidad (cHDL) y el de las de baja densidad (cLDL) al inicio, al tercero y al sexto mes. Se compararon los porcentajes de cumplidores (80-110%), el porcentaje medio de cumplimiento y el grado de control. Se calculó la reducción del riesgo absoluto (RRA) y el relativo (RRR) y el número de individuos que se necesita tratar para evitar un incumplimiento (NNT). Resultados. Finalizaron 188 sujetos (el 85,45% de la muestra); el GI lo componían 96 individuos, y el GC, 92. Hubo un 26,55% (intervalo de confianza [IC], ±6,3%) de incumplidores, el 10,5% (IC, ±6,1%) en el GI y el 42,6% (IC, ±10,1%) en el GC (p < 0,001). La media del porcentaje de cumplimiento fue del 88,1% (IC, ±4,6%), el 92% (IC, ±5,4%) en el GI y el 84% (IC, ±7,4%) en el GC (p < 0,05). Se observaron descensos significativos en el GI para el colesterol total y el cLDL. El porcentaje de pacientes con colesterol controlado fue del 66,7% (IC, ±9,4%) en el GI y el 41,2% (IC, ±10%) en el GC (p < 0,01), y el cLDL en el 41,2% del GI y el 35,8% en el GC (p = NS). La RRA fue del 32,1%, la RRR del 75,35% y el NNT de 3,1 pacientes. Conclusiones. La intervención con un calendario recordatorio es una medida eficaz para mejorar el porcentaje de cumplidores en el tratamiento de las dislipemias

Objective. To analyse the efficacy of the intervention with a calendar reminder of the medication taking in the treatment of the hyperlipidemias. Design. Controlled, randomised clinical trial. Setting. Twelve clinics at 5 primary care centres, Spain. Participants. Two hundred and twenty people diagnosed with hypercholesterolaemia according to Spanish Consensus criteria were chosen. Intervention. Two groups were formed. The control group (CG) of 110 patients, who received the doctor's normal treatment; and the Intervention group (IG) of 110 patients, who received in addition a calendar remider of medication taking. Main measurements. Meausured of compliance was performed by moniotrs electronic (MEMS) and cholesterol, triglycerides, HDL-C, and LDL-C determined at the start, and at the third and sixth months. Percentages of patients complying (80%-110%), the mean compliance percentage and the degree of control were compared. The reduction of absolute and relative risk (RAR and RRR) and the mean number of people that required an intervention in order to avoid non-compliance (NI) were calculated. Results. One hundred and eighty eight people (85.45%) completed the survey, 96 in the IG and 92 in the CG; 26.55% were non compliers with the therapy (CI, ±6.3%) (IG, 10.5%, CI, ±4.6%; CG, 42.6%, CI, ±10.1% [P<.0001]). Mean compliance ran at 88,1% (IC, ±4.6%) overall, at 92% (CI, ±5.4%) in the IG and at 84% (CI, ±7.4%) in the IG (P<.05). The RAR was 32.1%, the RRR 75.35%, and the NI was 3.1 patients. The patients with cholesterol controlled ran at 66.7% (CI, ±9.4%) in the IG and 41.2% in the CG (P<.001). Conclusions. The calendar reminder intervention is an efficacious way of improving the percentage of patients complying with lipaemia treatment