A prescription register incorporated into computerized medical records for patients with hypertension: a new instrument to evaluate medication adherence

作者：Miguel Baena Diez Jose; Gomez Fernandez Claudia; Vilato Garcia Monica; Javier Vasquez Lazo Ernesto; Olivia Byram Alice; Vidal Solsona Marc

来源：Atencion Primaria, 2011, 43(7): 336-342.

DOI：10.1016/j.aprim.2010.04.018

• Patient compliance
• Medication adherence
• Drug therapy
• Hypertension

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.

• 出版日期2011-7