Validación de la llamada telefónica como método de medida del cumplimiento terapéutico de la HTA en Extremadura VALCUMPLEX-HTA

Abstract

INTRODUCTION AND OBJETIVES: Pharmacological non-compliance or non-therapeutic adherence supposes a big problem which can affect the patients health; being one of the causes of therapy failure. Finding an indirect method that is both valid and realiable for determining if the patients have taking the correct number of pills; would result in our patients´ health improvement. The main goal of this investigation is to validate the phone call to the patient´s home as a self-method as to the amount of tablets that the patient took, as an alternative method to a tablet count at the medical office ( gold standard); as a measure of the therapeutic compliance of the treatment of arterial hypertension. MATERIAL AND METHODS: We carried out a study of research in health´s results, observational, multicentric, prospective, longitudinal, developed in medical clinics in 25 basic assistant units from different health centres of Extremadura, including 125 patients diagnosed of non controlled arterial hypertension, with a follow-up during a period of two months with the participation of 25 researchers who chose 5 patients each. Three visits were done a) inclusion visit; b) a control visit in the next 4 weeks; and, c) the final visit in the next 8 weeks. Prior to the visits 1 and 2, a phone call was made to remind patients of the visit and collect information on the number of pills remaining in his possession. RESULTS: In the final visit the phone-call method of compliance showed: 100% of sensitivity, 86% of specificity, 86.8% of overall accuracy, 30.4% of PPV, 100% of NPV, CP + 7.13, CP- 0.0 and kappa index 0.415 (p < 0,0001). The area under the ROC curve was 0,995 (IC95% 0,985-1), indicating that there exists a possibility of 99,5% that the diagnosis realized, to be a patient of non-compliance is more correct than a patient in compliance; chosen at random. CONCLUSIONES: The most important findings from this research gives us a maximum sensitivity with a high specificity to the overall accuracy of the phone call as a compliance measure. It meets the necessary condition of validating an indirect method having specificity and sensitivity higher than the 80%. We concluded that the phone call as a therapeutic compliance method, can be a good alternative because of its near universality, its easy use, its reduced cost and without the need of patient going to the medical centres, or the health professionals going to the patients homes in order to take a tablet count; and all supported in the validity of the test.