[Antihypertensive and/or lipid-lowering treatments pattern of compliance in hypertense and/or dyslipemic patients in Primary Care].
OBJECTIVE
Lack of compliance is a major factor responsible for the differences between clinical trial results and real effectiveness in daily medical practice, contributing to an insufficient control of the cardiovascular risk factors (CVRF). Knowledge of the factors contributing to lack of compliance is limited, and in Spain data are scarce. The objectives of this study are: a) to indirectly determine the level of compliance among patients with hypertension and/or dyslipidemia; and b) to determine factors associated with compliance.


METHODS
9,001 hypertensive and/or dyslipidemic patients from four primary care centres in Catalonia were enrolled in Disease Management programmes during the previous four years. Compliance was estimated by the relationship between the amount of dispensed and prescribed pills: a) the levels of compliance of dyslipidemic patients without hypertension (DL-non HT), hypertensive patients with dyslipidemia (HT+DL) and hypertensives without dyslipidemia (HT-non DL) were compared; and b) an stepwise, multivariate, descriptive; multiple regression model was designed in order to explain compliance.


RESULTS
1. Compliance was 79% in DL-non HT, significantly lower than in HT+DL (81.2%, p=0.000) and in HT-non DL (82.4%, p=0.000). There were also statistically significant differences between these last two groups (p=0.001). 2. Explanatory variables of a better compliance in the multivariate analysis were: a) patient related factors: labour inactivity (p = 0.000); b) management related factors: specific doctor (p = 0.000) and intensity of follow-up (p = 0.04); and c) drug related factors: the drug group (p < 0.0001); the drug price (the higher price determines higher compliance, p = 0.006) and the number of active principles used (the higher number determines lower compliance, p = 0.019).


CONCLUSIONS
1. Dyslipidemic patients show a worse compliance than hypertensive patients, and dyslipidemia worsened global compliance in hypertensive patients. 2. Patient characteristics, doctor attitude, follow-up intensity, drug group and simplicity of treatment are related to compliance in daily medical practice.
Sicras Mainar
A
A
Servicios Asistenciales, Badalona.
Fernández de Bobadilla
J
J
Rejas Gutiérrez
J
J
García Vargas
M
M
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy*; D006973:Hypertension / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D010349:Patient Compliance; D011320:Primary Health Care; D012189:Retrospective Studies
D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents