El cumplimiento terapéutico en la hipertensión arterial en España, según la opinión de los médicos de familia. Proyecto Cumplex

ObjetivoEvaluar los conocimientos de los médicos sobre el cumplimiento farmacológico en general, su actitud ante éste y sus necesidades de formación.DiseñoEstudio descriptivo, transversal, mediante una encuesta.EmplazamientoCentros de atención primaria de España.ParticipantesParticiparon 3.834 médicos.Mediciones principalesDefinición de incumplimiento, incumplimiento observado en su consulta y el resto de España, métodos de medición, causas, asociación con fracaso terapéutico, eficacia y uso de estrategias para mejorarlo, y necesidad de formación.ResultadosEl 95,9% cumplimentó la encuesta. El 92% (intervalo de confianza [IC] del 95%, 91,1-92,9) define como incumplimiento la omisión por el paciente de 5-20% de las tomas. Un 32,4% (IC del 95%, 30,9-33,9) opinó que menos del 10% sería incumplidor, mientras que un 6,8% (IC del 95%, 6,0-7,6) opinaba que la tasa de incumplimiento en España era inferior al 10%. Los métodos de medición más usados son la respuesta del paciente (77,0%; IC del 9%, 75,7-78,4) y la propia experiencia (76,0%; IC del 95%, 74,6-77,4). El 50,7% cree que el incumplimiento está asociado con el fracaso terapéutico en más del 50%.La presencia de efectos adversos fue considerada una causa muy importante en el mayor porcentaje (81,9%). Las estrategias consideradas más eficaces y utilizadas son: empleo de fármacos en monodosis (84,3%; IC del 95, 83,1-85,5) y consulta de enfermería (84,9%; IC del 95%, 83,8-86,0). El 65,2% (IC del 95%, 63,7-66,7) no ha recibido formación durante la carrera y un 42% (IC del 95%; 40,4-43,6) considera necesario realizar alguna actividad formativa.ConclusionesUn alto porcentaje de medicos utiliza una definición incorrecta de cumplimiento y cree que otros medicos tienen más pacientes incumplidores. Se utilizan preferentemente métodos de medición no validados y se observa un déficit de formación.ObjectivesTo evaluate physicians’ knowledge of therapy compliance, their attitudes towards it and their training needs in this field.DesignTransversal, descriptive study using a questionnaire.SettingPrimary care centres in Spain.ParticipantsThree thousand and trirty four general practitioners.Main measurementsDefinition of non-compliance, non-compliance in their own consultations and in the rest of Spain, methods of measurement, causes, association with therapy failure, efficacy and use of compliance-enhancing strategies, and need for training.ResultsMost participants (92%; 95% CI, 91.1-92.9) defined non-compliance as patients’ failure to take 5%-20% of their pills. A total of 32.4% (95% CI, 30.9%-33.9%) of the physicians estimated that less than 10% of their patients were non-compliers, whereas 6.8% (95% CI, 6.0-7.6) thought this was also the rate in the rest of Spain. The preferred methods of measurement were patient response (77.0%; 75.7-78.4) and their own clinical experience (76.0%; 74.6-77.4). About half (50.7%) believed that lack of compliance was associated with therapy failure in more than 50% of cases. The presence of adverse side-effects was considered a very important cause of poor compliance by 81.9%. The most common and effective strategies were: use of single-dose drugs (84.3%; 83.1-85.5) and nursing support (84.9%; 83.8-86.0).Moreover, 65.2% (63.7-66.7) of the surveyed physicians had not received any education about compliance as medical students and 42% (40.4-43.6) said further training in compliance was needed.ConclusionsA high percentage of physicians define compliance incorrectly and believe that other doctors have more non-complying patients than they do. They tend to favour non-validated measuring methods and they lack training

Evaluation of the relationship between effervescent paracetamol and blood pressure: clinical trial

Background: Paracetamol's solubility is achieved by adding to the excipient sodium salts, either as bicarbonate, carbonate or citrate. As the relationship between salt and hypertension is well known, due to the sodium content it has raised a hypothesis that may interfere with the control of that risk factor. Therefore, the objective of this study is to evaluate the effect on blood pressure of effervescent paracetamol compared to non-effervescent, in hypertensive patients. Methods/Design: This is the protocol of a phase IV multicenter clinical trial, randomized, controlled, crossover, open, which will compare the effect of two different formulations of paracetamol (effervescent or non-effervescent) in the blood pressure of hypertensive patients, with a seven weeks follow up. 49 controlled hypertensive patients will be included (clinical BP lower than 150 and 95 mmHg, and lower than 135 mmHg and 85 mmHg in patients with diabetes or a history of cardiovascular event, and daytime ambulatory measurements lower than 140 and 90 mmHg) and mild to moderate pain (Visual Analog Scale between 1 and 4). The study was approved by the ethics committee of the Fundació Jordi Gol i Gurina and following standards of good clinical practice. The primary endpoint will be the variations in systolic BP in 24 h Ambulatory Blood Pressure Monitoring, considering significant differences 2 or more mmHg among those treated with non-effervescent and effervescent formulations. Intention-to-treat and per-protocol analysis will be held. Discussion: Despite the broad recommendation not to use effervescent drugs in patients with hypertension, there are relatively little studies that show exac tly this pressor effect due to sodium in salt that gives the effervescence of the product. This is the first clinical trial designed to study the effect of effervescence compared to the non-effervescent, in well-controlled hypertensive patients with mild to moderate pain, performed in routine clinical practic

Guia de pràctica clínica per a l’abordatge de la hipertensió arterial

Hipertensió arterial; Diagnòstic; Tractament; Estudi inicialHipertensión arterial; Diagnóstico; Tratamiento; Estudio inicialHigh blood pressure; Diagnosis; Treatment; Initial studyAquest document aporta una revisió acurada del coneixement científic actualment disponible sobre la hipertensió arterial, que tradueix en recomanacions per a la pràctica diària. Pel seu contingut docent, la Guia constitueix també un valuós document per facilitar l’adquisició de competències clíniques que ha de caracteritzar el desenvolupament dels professionals de l’Institut Català de la Salut

Guia de pràctica clínica per a l’abordatge de la hipertensió arterial

Hipertensió arterial; Diagnòstic; Tractament; Estudi inicialHipertensión arterial; Diagnóstico; Tratamiento; Estudio inicialHigh blood pressure; Diagnosis; Treatment; Initial studyAquest document aporta una revisió acurada del coneixement científic actualment disponible sobre la hipertensió arterial, que tradueix en recomanacions per a la pràctica diària. Pel seu contingut docent, la Guia constitueix també un valuós document per facilitar l’adquisició de competències clíniques que ha de caracteritzar el desenvolupament dels professionals de l’Institut Català de la Salut