[Adherence, the Achilles heel of cardiovascular disease]

Validez y confiabilidad del cuestionario para medir la adherencia al tratamiento de pacientes con enfermedad cardiovascular

Objetivo: elaborar y validar un instrumento para medir la adherencia al tratamiento farmacológico y no farmacológico de pacientes con diagnóstico de enfermedad cardiovascular, a partir de un referente teórico sustentado en las conductas de adherencia al tratamiento y la autoeficacia. Materiales y métodos: se detalla el proceso de validez facial, de contenido y de constructo realizado al instrumento, así como las pruebas de confiabilidad. El instrumento fue sometido a evaluación por parte de 6 expertos, 380 adultos de diferentes características sociodemográficas y posteriormente aplicado a 145 pacientes con diagnóstico de enfermedad cardiovascular isquémica. Resultados: se obtuvo un cuestionario con 29 ítems, 6 dimensiones, un alfa de Cronbach de 0,837 y un puntaje entre 29-174, lo que indica que a mayor puntaje mejor adherencia. Conclusiones: se considera un instrumento útil para determinar conductas terapéuticas de adherencia al tratamiento en pacientes con enfermedad cardiovascular isquémica, pues está sustentado en un constructo teórico que se fundamenta, por una parte, en las conductas de adherencia y, por otra, en la autoeficacia como predictor de esta, lo que amplía el abordaje de medición del fenómeno incluida la determinación de las capacidades que perciben los pacientes para poder llevar a cabo un tratamiento.

[Relationship between process indicators measured using electronic records and intermediate health outcomes in patients with diabetes]

OBJECTIVE

To study relationship between institutional process indicators (measured using electronic records) and intermediate outcomes of patients with diabetes.

METHOD

Cross-sectional epidemiological study. Setting Primary care health district 1. Madrid. 2010.

PATIENTS

all patients with diabetes; n = 16.652. Main measures variables. Independent. Institutional process indicators. Dependent. Intermediate outcomes: GHb, BP, LDL, tobacco and weight within target limits and detected complications. Confounding. Age, gender, type and years for DM, co-morbidity, drugs and professional variables.

RESULTS

GHb of 55.9% (SE 0,4) of patients was within target limits. Bivariate analysis and multivariate logistic regression showed that the recording of some process indicators was associated with an increase in the probability to achieve targets in intermediate outcomes: reviewing personal and family history, lifestyle and drug therapy, creatinine, GHb, BP and weight measurement, smoking advice, EKG, ankle-arm index, and eye examination. OR were from 1,15 (CI 95%: 1.01-1.32) to 2.05 (CI 95%: 1.76-2.39). Relationship among other indicators and higher probability to achieve targets was not found: classification, reviewing care plan, glucose, BMI, LDL and microalbuminury measurement.

CONCLUSIONS

In diabetes, a lot of institutional process indicators measured on electronic records was associated with increase of probability to achieve targets in intermediate outcomes. It suggests to maintain process and outcome measurement, to include other outcomes, to include other interventions, to prioritize improvements in process indicators that show low performance and high impact and to keep out or to change process indicators that relationship was not found.