BackgroundLow adherence to pharmacological treatments is one of the factors associated with poor blood pressure control. Questionnaires are an indirect measurement method that is both economic and easy to use. However, questionnaires should meet specific criteria, to minimize error and ensure reproducibility of results. Numerous studies have been conducted to design questionnaires that quantify adherence to pharmacological antihypertensive treatments. Nevertheless, it is unknown whether questionnaires fulfil the minimum requirements of validity and reliability. The aim of this study was to compile validated questionnaires measuring adherence to pharmacological antihypertensive treatments that had at least one measure of validity and one measure of reliability.MethodsA literature search was undertaken in PubMed, the Excerpta Medica Database (EMBASE), and the Latin American and Caribbean Health Sciences Literature database (Literatura Latino-Americana e do Caribe em Ciências da Saúde [LILACS]). References from included articles were hand-searched. The included papers were all that were published in English, French, Portuguese, and Spanish from the beginning of the database’s indexing until July 8, 2013, where a validation of a questionnaire (at least one demonstration of the validity and at least one of reliability) was performed to measure adherence to antihypertensive pharmacological treatments.ResultsA total of 234 potential papers were identified in the electronic database search; of these, 12 met the eligibility criteria. Within these 12 papers, six questionnaires were validated: the Morisky–Green–Levine; Brief Medication Questionnaire; Hill-Bone Compliance to High Blood Pressure Therapy Scale; Morisky Medication Adherence Scale; Treatment Adherence Questionnaire for Patients with Hypertension (TAQPH); and Martín–Bayarre–Grau. Questionnaire length ranged from four to 28 items. Internal consistency, assessed by Cronbach’s α, varied from 0.43 to 0.889. Additional statistical techniques utilized to assess the psychometric properties of the questionnaires varied greatly across studies.ConclusionAt this stage, none of the six questionnaires included could be considered a gold standard. However, this revision will assist health professionals in the selection of the most appropriate tool for their individual circumstances.
Two tools for measuring implementation fidelity, an adherence index and a patient responsiveness scale, have been developed and tested. Future assessment, in particular to establish criterion validity, is recommended.
When home blood pressure (HBP) measurements are taken, the readings can be registered manually by the patient and/or stored in the device's memory. The instructions provided by healthcare professionals would be particularly relevant to guarantee the reliability of manual blood pressure (BP) figures and enhance clinical decision making. The aim of this study is assess the agreement between HBP measurements manually registered by patients and those stored in the device's memory after an educational session provided by community pharmacists. Secondary data of the MEPAFAR and the Palmera studies have been used in this analysis. All the (treated hypertensive) patients attended an individual educational session in which they were instructed on how to use the measurement device and properly measure and manually register HBP. The same device and HBP monitoring protocol were used in both studies: 4 consecutive days (three morning measurements and three in the evening). HBP measurements were both manually registered by patients and stored in the device's memory. To evaluate the agreement between BP figures, Lin's correlation-concordance coefficient and κ coefficient were used for quantitative and qualitative agreement, respectively. One hundred and sixty-sixty patients were included in this analysis. The agreement between the average manual and the stored HBP was very good [systolic=0.99, 95% confidence interval (CI): 0.99-0.99; diastolic=0.99, 95% CI: 0.99-1.00]. 99.4% of patients were classified in the same category by both alternatives [κ index=0.99 (95% CI: 0.98-1.00)]. In this sample of treated hypertensive patients, the agreement between manually registered and stored BP figures was very good. This high concordance may be explained by the pharmacist's intervention.
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