Validation of the electronic prescription as a method of measurement of treatment adherence in hypertension
- Published
- Accepted
- Subject Areas
- Cardiology, Health Policy, Pharmacology, Legal Issues, Human-Computer Interaction
- Keywords
- hypertension, medication adherence, Primary Health Care, Patient Compliance, measurement method
- Copyright
- © 2015 Marquez-Contreras et al.
- Licence
- This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. For attribution, the original author(s), title, publication source (PeerJ PrePrints) and either DOI or URL of the article must be cited.
- Cite this article
- 2015. Validation of the electronic prescription as a method of measurement of treatment adherence in hypertension. PeerJ PrePrints 3:e1538v1 https://doi.org/10.7287/peerj.preprints.1538v1
Abstract
Background. The diagnosis of non-adherence is complex and there are no completely reliable methods that can be used widely in daily practice. The aim of this study was to validate electronic prescriptions as a method of measuring treatment adherence in patients with mild-moderate hypertension.
Methods. We conducted a prospective, longitudinal, multicenter study in primary care centers. The study involved 120 patients treated for hypertension and included in the electronic prescription program of the centers. Five visits were made: initial, 6, 12, 18 and 24 months. Adherence was measured using an electronic monitor [medication event monitoring system (MEMS)] and through the electronic prescription program. We calculated the adherence rate (AR) using the MEMS and the electronic prescriptions, with the Medication Possession Ratio (MPR). Adherent patients were considered to be those whose AR was 80-100%. To validate the electronic prescription, its data were compared to the pill count by MEMS (Method of certainty). Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and positive (LR+) and negative (LR-) likelihood ratios were calculated. The Kappa concordance index and the area under the ROC curve were also determined.
Results. The study was completed by 108 patients (mean age 61.06 years, SD 9.08). Adherence was 77.4% by MEMS (95% CI: 66.8-88%) and 80.4% (95% CI=70.3-90.5) by MPR. At 24 months the sensitivity was 87%, specificity 93.7%, PPV 80%, NPV 96.1%, LR+ 13.8 and LR- 0.1. The K was 0.782 and the AUC was 0.903 (95% CI: 0.817-0.989). Therapeutic complexity was associated with pharmacological non-adherence (OR=1.35, p<0.01).
Discussion. The electronic prescription was an excellent method to measure non-adherence in hypertensive patients included in this program for over two years. Therapeutic simplicity improved treatment adherence.
Author Comment
This is a submission to PeerJ for review.