Adherence to treatment of hypertension, hypercholesterolaemia and diabetes in an elderly population of a Spanish cohort

array:23 ["pii" => "S2387020619302724" "issn" => "23870206" "doi" => "10.1016/j.medcle.2018.10.026" "estado" => "S300" "fechaPublicacion" => "2019-07-05" "aid" => "7010" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Clin. 2019;153:1-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775318306547" "issn" => "00257753" "doi" => "10.1016/j.medcli.2018.10.023" "estado" => "S300" "fechaPublicacion" => "2019-07-05" "aid" => "4684" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Clin. 2019;153:1-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 38 "formatos" => array:2 [ "HTML" => 28 "PDF" => 10 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Adherencia al tratamiento de hipertensión arterial, hipercolesterolemia y diabetes en población anciana de una cohorte española" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1" "paginaFinal" => "5" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Adherence to treatment of hypertension, hypercholesterolaemia and diabetes in an elderly population of a Spanish cohort" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Aida Moreno Juste, Antonio Gimeno Miguel, Beatriz Poblador Plou, Francisca González Rubio, María Mercedes Aza Pascual-Salcedo, Enrica Menditto, Alexandra Prados Torres" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Aida" "apellidos" => "Moreno Juste" ] 1 => array:2 [ "nombre" => "Antonio" "apellidos" => "Gimeno Miguel" ] 2 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Poblador Plou" ] 3 => array:2 [ "nombre" => "Francisca" "apellidos" => "González Rubio" ] 4 => array:2 [ "nombre" => "María Mercedes" "apellidos" => "Aza Pascual-Salcedo" ] 5 => array:2 [ "nombre" => "Enrica" "apellidos" => "Menditto" ] 6 => array:2 [ "nombre" => "Alexandra" "apellidos" => "Prados Torres" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020619302724" "doi" => "10.1016/j.medcle.2018.10.026" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020619302724?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775318306547?idApp=UINPBA00004N" "url" => "/00257753/0000015300000001/v1_201906160629/S0025775318306547/v1_201906160629/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020619302013" "issn" => "23870206" "doi" => "10.1016/j.medcle.2018.12.015" "estado" => "S300" "fechaPublicacion" => "2019-07-05" "aid" => "4744" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Clin. 2019;153:6-12" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Zika virus disease in Spain. Surveillance results and epidemiology on reported cases, 2015–2017" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "6" "paginaFinal" => "12" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La enfermedad por virus Zika en España. Resultados de la vigilancia y epidemiología de los casos notificados en 2015-2017" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1625 "Ancho" => 2547 "Tamanyo" => 193072 ] ] "descripcion" => array:1 [ "en" => "Autonomous Regions (AR) colonised by Aedes albopictus (in at least one municipality) according to year and distribution of reported Zika virus disease (ZVD) cases according to AR. Spain, 2015–2017." ] ] ] "autores" => array:2 [ 0 => array:2 [ "autoresLista" => "Beatriz Fernández Martínez, Elena V. Martínez Sánchez, Oliva Díaz García, Diana Gómez Barroso, M. José Sierra Moros, Rosa Cano Portero" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Fernández Martínez" ] 1 => array:2 [ "nombre" => "Elena V." "apellidos" => "Martínez Sánchez" ] 2 => array:2 [ "nombre" => "Oliva" "apellidos" => "Díaz García" ] 3 => array:2 [ "nombre" => "Diana" "apellidos" => "Gómez Barroso" ] 4 => array:2 [ "nombre" => "M. José" "apellidos" => "Sierra Moros" ] 5 => array:2 [ "nombre" => "Rosa" "apellidos" => "Cano Portero" ] 6 => array:1 [ "colaborador" => "on behalf of the National Network of Epidemiological Surveillance (RENAVE)" ] ] ] 1 => array:2 [ "autoresLista" => "" "autores" => array:1 [ 0 => array:1 [ "colaborador" => "Components of the RENAVE group (in alphabetical order of CC.AA.)" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775319300260" "doi" => "10.1016/j.medcli.2018.12.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775319300260?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020619302013?idApp=UINPBA00004N" "url" => "/23870206/0000015300000001/v1_201906260821/S2387020619302013/v1_201906260821/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Adherence to treatment of hypertension, hypercholesterolaemia and diabetes in an elderly population of a Spanish cohort" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1" "paginaFinal" => "5" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Aida Moreno Juste, Antonio Gimeno Miguel, Beatriz Poblador Plou, Francisca González Rubio, María Mercedes Aza Pascual-Salcedo, Enrica Menditto, Alexandra Prados Torres" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Aida" "apellidos" => "Moreno Juste" "email" => array:1 [ 0 => "aidamorenoj@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Antonio" "apellidos" => "Gimeno Miguel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Beatriz" "apellidos" => "Poblador Plou" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Francisca" "apellidos" => "González Rubio" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "María Mercedes" "apellidos" => "Aza Pascual-Salcedo" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Enrica" "apellidos" => "Menditto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 6 => array:3 [ "nombre" => "Alexandra" "apellidos" => "Prados Torres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio Aragonés de Salud (SALUD), Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Grupo de Trabajo de Utilización de Fármacos de la semFYC, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "CIRFF, Centro de Farmacoeconomía, Universidad de Nápoles Federico II, Naples, Italy" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Adherencia al tratamiento de hipertensión arterial, hipercolesterolemia y diabetes en población anciana de una cohorte española" ] ] "textoCompleto" => "IntroductionThe World Health Organisation (WHO) defines multimorbidity as the presence of two or more chronic diseases in the same person.<a class="elsevierStyleCrossRef" href="#bib0155">1</a> This phenomenon is very common in most countries and its impact is greater in the elderly population, in which health problems accumulate due to the improvement of socioeconomic conditions and advances in the field of health, allowing a significant proportion of the population to survive previously fatal diseases.<a class="elsevierStyleCrossRef" href="#bib0160">2</a> According to the National Health Survey, the so-called young elderly population aged 65–74 in Spain has an average of 2.8 chronic health problems, while those over 75 have an average of 3.2 diseases.<a class="elsevierStyleCrossRef" href="#bib0165">3</a> Multimorbidity is associated with polypharmacy or simultaneous and prolonged prescription of multiple medications, which implies a series of undesirable consequences, such as increased risk of inappropriate drug use, appearance of secondary symptoms from non-compliance, underuse of effective drugs, pharmacological interactions and adverse reactions.<a class="elsevierStyleCrossRefs" href="#bib0165">3,4</a> Adherence, in terms of taking medications, following diets or making lifestyle changes, can also be affected by the simultaneous administration of several drugs.<a class="elsevierStyleCrossRef" href="#bib0175">5</a> One of the ways to determine the extent to which patients follow the instructions accompanying their prescribed treatments is to measure adherence to medication.<a class="elsevierStyleCrossRef" href="#bib0180">6</a> Chronic diseases are the most affected by low adherence: it is estimated that approximately 50% of the population that has a chronic disease does not take their medication in the manner prescribed to them. The study of factors related to low adherence is essential to designing prevention strategies that can increase treatment effectiveness, reduce morbidity and mortality and improve patients’ quality of life.<a class="elsevierStyleCrossRef" href="#bib0185">7</a>The objective of this study was to determine therapeutic adherence to the most commonly used drugs for type 2 diabetes mellitus, hypercholesterolemia and hypertension in new users of these drugs aged 65 or older, and to study their effect on sex, age, number of drugs and presence of other chronic ailments and mental illness.Materials and methodsDesign and study populationRetrospective cross-sectional observational study conducted in the EpiChron Cohort that anonymously comprised the following user data, collected through the Aragonese Health System clinical records and clinical-administrative databases: demographic, clinical, drug dispensing, use of services and health outcomes.<a class="elsevierStyleCrossRef" href="#bib0190">8</a> This study was approved by the Community of Aragon Research Ethics Committee (PI16/088).The drugs dispensed were coded according to the Anatomical Therapeutic Chemical (ATC) Classification System.<a class="elsevierStyleCrossRef" href="#bib0195">9</a> From this cohort, we selected the patients aged over 65 who had initiated a prescribed oral monotherapy between July 1 and December 31, 2010 with any of the following: a) an oral antidiabetic (biguanides, A10BA, sulfonylureas, A10BB, alpha-glucosidase inhibitors, A10BF, thiazolidinediones, A10BG, inhibitors of dipeptidyl peptidase 4, A10BH, or other oral antidiabetics, A0BX); b) a hypolipidemic agent (inhibitors of HMG-CoA reductase, C10AA, fibrates, C10AB, bile acid sequestrants, C10AC, or other lipid modifiers, C10AX) or c) a renin–angiotensin system antihypertensive drug (convertase enzyme inhibitor angiotensin, C09AA, or angiotensin II antagonists, C09CA). The patients excluded were those: (a) who were undergoing treatment with a drug from the same group under study prescribed within the six months prior to their inclusion in the study; (b) who did not maintain monotherapy, either by pharmacological combination or separately; (c) whose drug prescription had not been validated for one year; (d) who had only one dispensation of the drug being studied.With these criteria, a final sample of 16,208 patients was obtained, which were classified in each of the pharmacological groups under study according to the new drug prescribed within the study dates and monitored for a period of 12 months.VariablesThe age of each patient was recorded at the time they were included in the study and the sample was classified into three groups (65–74, 75–84 and ≥85). The patients’ sex was also registered. Other explanatory variables were collected in the six months prior to inclusion in the study, such as the number of co-prescribed drugs, the number of chronic diseases and a presence of mental illness. All Anatomical Therapeutic Chemical (ATC) codes were included as the number of co-prescribed drugs, except for ATC J (anti-infectives for systemic use) and ATC V (several), since only drugs used chronically were considered for the study. Chronic diagnoses were coded according to the International Classification of Primary Care and the International Classification of Diseases classifications and, subsequently, they were unified in the Expanded Diagnostic Clusters (EDC) using the Johns Hopkins ACG® System software (version 11.0, The Johns Hopkins University, Baltimore, MD, USA). The presence of mental illness was considered to be the presence of any of the following diagnostic codes: PSY01 (anxiety, neurosis), PYS02 (substance abuse), PSY04 (behavioural problems), PSY05 (attention deficit disorder), PSY07 (schizophrenia and affective psychosis), PSY08 (personality disorders), PSY09 (depression), or NUR11 (dementia and delusions).As an outcome variable, adherence was quantified by measuring the medication possession ratio (MPR) for each of the pharmacological study groups. The MPR is calculated using a standard method for the assessment of adherence: the number of pharmacological units dispensed divided by the number of units expected to be administered during the observation period.<a class="elsevierStyleCrossRef" href="#bib0200">10</a> It is calculated as the proportion of the number of days with treatment administered during the intended treatment period, i.e., 100×∑(days administered)/365. The number of days in which treatment was administered was estimated according to the number of tablets dispensed during the follow-up year, assuming in our case that the treatment dose was one tablet per day. After calculating the MPR, we created the dichotomous variable ‘Adherence to treatment (yes/no)’; a patient was considered to have been adherent if MPR ≥80%.<a class="elsevierStyleCrossRef" href="#bib0205">11</a>Statistical analysisA descriptive study of the population and therapeutic adherence was made for each pharmacological group under study. Once new users’ adherence for each group of drugs was measured, a binary logistic regression model was performed to assess the relationship between adherence (dependent variable) and the independent variables: sex, age (stratified within the aforementioned three age groups), number of coprescribed drugs, number of chronic comorbidities and presence of mental illness. 95% confidence intervals were calculated for each mean, and a statistical significance level of 0.05 was considered in the logistic regression. The set of calculations was carried out using the Stata software (version 12.0, StataCorp LLC, College Sation, TX, USA).ResultsThe study population consisted of 2950 new users of antidiabetics, 7076 new users of hypolipidemic agents and 6182 new users of antihypertensive drugs. Most of the new users of these drugs were patients aged between 65 and 74 in the case of hypolipidemic agents, and between 75 and 84 in the case of antidiabetics and antihypertensive drugs. There was a greater proportion of females than males in all pharmacological groups. The MPR calculation showed treatment adhesions that ranged between 44% and 72% of new users of hypolipidemic agents and antidiabetics, respectively (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The logistic regression model applied to the new users of antidiabetics group showed that adherence to treatment decreases by 4.1% for each drug coprescribed to antidiabetics, while for each concomitant chronic comorbidity, the probability of adherence increases by 7.9% (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Conversely, sex, age and the presence of mental illness did not modify adherence rates for this pharmacological group. In the new users of hypolipidemic agents group, we observed that being female decreases the probability of adhering by 18.8%, compared to being male. Patients aged between 75 and 84 had a 14.2% lower probability of adhering than the 65–74 reference group, while in the case of those older than 85, this probability was 32.5% lower. Each additional chronic comorbidity presented by patients using hypolipidemic agents increased the probability of being adherent by 6.7%, and with each co-prescribed drug it was increased by 2.2%. Finally, the logistic regression models revealed a 12.3% lower probability of females being adherent to antihypertensive drugs. The probability of being adherent increased by 3.5% with each chronic comorbidity added, while no association was observed with age, number of drugs co-prescribed or presence of mental illness.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>DiscussionThis work explored therapeutic adherence to treatment of the three the most prevalent chronic diseases in the Aragonese population aged over 65, i.e. arterial hypertension, hypercholesterolaemia and type 2 diabetes mellitus, as well as the factors that condition it.Despite the importance of good therapeutic compliance in the treatment of these chronic diseases, our study found a generally low adherence to treatment, especially in the case of hypolipidemic agents and antihypertensive drugs, to which approximately only one of every two patients is adherent. This fact can be translated into an increase in long-term complications of the disease and an increase in morbidity and mortality.<a class="elsevierStyleCrossRef" href="#bib0210">12</a> Other studies have found higher levels of adherence to hypolipidemic agents, such as one conducted in patients with coronary disease, where adherence was 79.8% of cases at 400 days of follow-up.<a class="elsevierStyleCrossRef" href="#bib0215">13</a> In another study conducted in 2010, adherence to treatment with antihypertensive drugs was reported to be 79.8%, but this was measured with defined daily dose method.<a class="elsevierStyleCrossRef" href="#bib0220">14</a> This, together with possible differences in the patients inclusion criteria, could partially explain the differences observed with our study.Conversely, results showed that almost three out of every four diabetic patients adhered to their antidiabetic treatment. Similar results were found in a 2011 study that showed adherence to antidiabetics was higher than adherence to hypolipidemic agents (68.6 vs. 57.5%).<a class="elsevierStyleCrossRef" href="#bib0225">15</a>Regarding the factors that influence adherence, we observed that in the group of new users of antihypertensive drugs and hypolipidemic agents, adherence was greater in males than in females. Some authors believe that a lower adherence in females is due to the fact that they are the primary caregiver of the family, and they thus have less time and energy for their own personal care.<a class="elsevierStyleCrossRef" href="#bib0230">16</a> Age was only significantly associated with the likelihood of adherence in the group of hypolipidemic agents, which saw a drastic decrease in adherence at a higher age. In this sense, there is no consensus on the role of age in adherence, since some studies observed an increase in adherence as age increased, while others found the opposite.<a class="elsevierStyleCrossRef" href="#bib0235">17</a> Conversely, there are no studies investigating the causes of lack of adherence to hypolipidemic agents in primary prevention. Some hypotheses recently put forward about this suggest that a lack of adherence to these drugs could be due to adverse effects; these secondary effects are not recognised by health professionals, and patients abandon their treatments as they do not feel well when taking them.In addition to sex and age, other factors that have been associated with adhesion include: number of drugs; concomitant comorbidities, the presence of symptoms; whether the treatment is curative or preventive; knowledge of the disease and the presence of mental illness, among others. A lack of motivation and decrease in attention and memory have also been put forward as a cause of poor adherence by certain studies,<a class="elsevierStyleCrossRef" href="#bib0220">14</a> although our study did not analyse these factors, as there is no information on them available. In our study, adherence rates when other drugs were administered simultaneously were not consistent. The literature has highlighted how the complexity of treatment is inversely proportional to adherence.<a class="elsevierStyleCrossRef" href="#bib0220">14</a> A study into adherence to antihypertensive drugs in New Jersey found that a prescription of more than eight drugs decreased the likelihood of adherence.<a class="elsevierStyleCrossRef" href="#bib0240">18</a> Similarly, a 2010 study in the Autonomous Community of Aragon also concluded that polypharmacy is associated with low adherence to treatment. Other factors that have been associated with a decrease in adherence are: the prescription of a large quantity of drugs; dispensation of medication in an unsynchronised manner; frequency of administration; variability in the doses and the specific instructions given at the time of taking the medication.<a class="elsevierStyleCrossRef" href="#bib0220">14</a>Contrary to the effect of the number of coprescribed drugs, which was not consistent, this study did find an increase in therapeutic adherence as the number of chronic diseases increased, regardless of the pharmacological group studied. Adherence to treatment increased on average between 3 and 8% for each additional chronic comorbidity. How the presence of multiple chronic diseases or multimorbidity influences therapeutic adherence has been widely studied, and positive associations between diseases and adherence to antihypertensive medication has been observed.<a class="elsevierStyleCrossRef" href="#bib0245">19</a> In a study into hypolipidemic agents, adhesion increased from 56% in patients with one chronic comorbidity to 72% in patients with three or more comorbidities.<a class="elsevierStyleCrossRef" href="#bib0250">20</a> Conversely, other studies have shown that the presence of more comorbidities is associated with a decrease in adherence.<a class="elsevierStyleCrossRefs" href="#bib0255">21,22</a> While yet another study found that comorbidities requiring regular administration of medications did not affect patients’ compliance with antihypertensive drugs.<a class="elsevierStyleCrossRef" href="#bib0260">22</a> It has also been noted that symptomatology positively influences therapeutic compliance; this is intuitive given that when patients present symptoms, they are more aware of their disease, and as such adhere more to the established treatment in order to treat it. This is why it is easy to understand that there are high rates of non-compliance in asymptomatic diseases such as dyslipidemia.<a class="elsevierStyleCrossRef" href="#bib0265">23</a> Another cause of good adherence could be that this type of drug is for secondary prevention. Several studies have shown that there is a higher rate of non-compliance in primary prevention than in secondary prevention, and that the presence of cardiovascular comorbidities or complications derived from cardiovascular disease improve adherence.<a class="elsevierStyleCrossRefs" href="#bib0270">24,25</a> A greater adherence to arterial hypertension treatment has been observed in patients with higher cardiovascular risk, probably because both the patient and their primary care doctor are more aware of the importance of treatment and are thus more motivated to follow their set regime.<a class="elsevierStyleCrossRef" href="#bib0220">14</a>The heterogeneity in the results and conclusions drawn from different studies may be related to the fact that adherence to medication is a complex phenomenon influenced by several factors, including: knowledge of the disease; patients’ attitudes; the socioeconomic environment; health system issues; doctor–patient relationships and the role of pharmacists.<a class="elsevierStyleCrossRefs" href="#bib0260">22,26</a> This has been corroborated in an interview-based study carried out with type 2 diabetes mellitus patients. It reported that most of the sample understood the importance of taking medication and were aware of the importance of being adequately informed about their disease, comorbidities and the benefits of medication.<a class="elsevierStyleCrossRef" href="#bib0285">27</a>Strengths and limitationsThe main strength of this study is that it is a large-scale population-based study conducted in a cohort validated for research into chronic diseases and drug-epidemiology, in which the data is treated through continuous quality control. In addition, the inclusion of only new prescription patients for each of the drugs studied minimises the risk of confounding biases.Its main limitations include, that in order to measure adherence to treatment, it is assumed each patient consumes one tablet of the drug per day. A higher daily dosage for some cases could produce an overestimation of the adherence, since patients with more than one might stop taking the medication or consume it incorrectly and be considered adherent. The opposite might also be true: cases where the daily dose is less than one tablet, resulting in the dispensed prescription lasting more days than expected, could lead to an underestimation of the adherence. Furthermore, it is assumed that the dispensation for the same disease is the same for all patients, which does not correspond to the actual clinical practice of personalising prescriptions according to the tolerability of each patient, the evolution of the disease or interactions with other drugs.<a class="elsevierStyleCrossRef" href="#bib0290">28</a> The method of calculating the MPR to assess adherence is to assume that the tablets dispensed are the quantity consumed by the patient; this method is accepted as standard for measuring adherence because measuring the actual consumption of the medication is difficult.<a class="elsevierStyleCrossRef" href="#bib0295">29</a> Both the causes of discontinuation, which could be due to adverse effects or patients perceiving a low efficacy,<a class="elsevierStyleCrossRefs" href="#bib0250">20,30</a> and indications of treatment to assess adhesion more thoroughly, remain unknown. Finally, this study does not include information on other variables that might also influence adherence to treatment, such as physical function, frailty or disability.ConclusionsThe results obtained show a suboptimal adherence to treatment of the three chronic diseases studied. Regarding the factors that modulate adherence, it has been observed that adherence increases with the number of chronic diseases, while sex, age, mental illness and the number of drugs do not have a consistent effect on it. This study is exploratory and opens the door to further research to assess therapeutic adherence in cases that include combinations of drugs and, more exhaustively, the role played by factors such as adverse effects; patient's awareness of the importance of correct treatment; chronic diseases; patients’ social environment and whether it is primary or secondary prevention. These results could guide the implementation of actions aimed at improving patients’ therapeutic adherence to chronic diseases and thus prevent the negative consequences of non-compliance since, as stated by WHO, improving therapeutic adherence may have a greater impact on health than advances in treatments.FundingThe authors have not received specific grants from public, private or non-profit organisations for this study.Conflict of interestsThere is no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1211914" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1127985" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1211915" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1127986" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design and study population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Variables" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:3 [ "identificador" => "sec0035" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Strengths and limitations" ] ] ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interests" ] 11 => array:2 [ "identificador" => "xack414269" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-07-10" "fechaAceptado" => "2018-10-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1127985" "palabras" => array:5 [ 0 => "Adherence" 1 => "Medication" 2 => "Polypharmacy" 3 => "Multimorbidity" 4 => "Chronic diseases" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1127986" "palabras" => array:5 [ 0 => "Adherencia" 1 => "Medicación" 2 => "Polifarmacia" 3 => "Multimorbilidad" 4 => "Enfermedades crónicas" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Background and objectiveSub-optimal adherence to treatment in the general population has been highlighted in several studies, especially in the elderly and/or chronic patients. This study aims to describe the adherence to treatment of diabetes mellitus, dyslipidaemia and hypertension, and to identify the factors that influence adherence. Material and methodRetrospective, cross-sectional observational study on 16,208 patients aged ≥65 years from the EpiChron Cohort who initiated monotherapy treatment of an antidiabetic, a lipid-lowering or an antihypertensive medication in 2010. Adherence was measured by calculating the medication possession ratio during one year, considering those cases with medication possession ratio ≥80% to be adherent. We performed a descriptive study, and a logistic regression model was used to identify the predictors of low adherence. ResultsAdherence to antidiabetics, antihypertensive and lipid-lowering drugs was 72.4%, 50.7% and 44.3%, respectively. An increase in adherence of 3–8% was observed for each additional chronic disease suffered by the patient. The presence of mental illness did not affect adherence, and sex, age and number of prescribed drugs did not present consistent effects. ConclusionThe results obtained show a sub-optimal adherence to treatment for the 3 chronic diseases studied. Adherence increased with the number of chronic diseases, while sex, age and number of drugs did not show a consistent effect. It is necessary to investigate if there are other factors that may influence therapeutic adherence, since improving adherence may have a greater impact on health than any progress in therapies." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Antecedentes y objetivoVarios estudios han puesto de manifiesto un cumplimiento terapéutico subóptimo en la población general, sobre todo en ancianos y en enfermos crónicos. El objetivo de este estudio es describir la adherencia al tratamiento de diabetes mellitus, dislipidemia e hipertensión arterial, e identificar los factores que la influencian. Material y métodosEstudio observacional transversal retrospectivo sobre 16.208 pacientes mayores de 65 años de la Cohorte EpiChron, que iniciaron tratamiento en monoterapia de un antidiabético, un hipolipidemiante o un antihipertensivo en 2010. La adherencia se midió mediante el cálculo de la relación de posesión de medicación durante un año de seguimiento, considerándose adherentes los casos con posesión de medicación ≥80%. Se realizó un estudio descriptivo y un modelo de regresión logística para identificar los factores predictores de baja adherencia. ResultadosLa adherencia a los antidiabéticos, antihipertensivos e hipolipidemiantes fue del 72,4; 50,7 y 44,3%, respectivamente. Se observó un aumento en la adherencia del 3-8% por cada enfermedad crónica adicional del paciente. La presencia de enfermedad mental no afectó a la adherencia, y el sexo, edad y número de fármacos prescritos no presentaron efectos consistentes. ConclusionesLos resultados obtenidos ponen de manifiesto una adherencia al tratamiento subóptima en las enfermedades crónicas estudiadas. La adherencia aumentó con el número de enfermedades crónicas, mientras que sexo, edad y número de fármacos no presentaron un efecto consistente. Es necesario investigar si existen otros factores que puedan influir en la adherencia terapéutica, ya que su mejora puede tener mayor impacto en la salud que cualquier avance en las terapias." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Moreno Juste A, Gimeno Miguel A, Poblador Plou B, González Rubio F, Aza Pascual-Salcedo MM, Menditto E, et al. Adherencia al tratamiento de hipertensión arterial, hipercolesterolemia y diabetes en población anciana de una cohorte española. Med Clin (Barc). 2019;153:1–5." ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Antidiabetic \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hypolipidemic agents \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Antihypertensive drugs \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex (n, %)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1555 (52.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4220 (59.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3449 (55.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1395 (47.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2856 (40.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2733 (44.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (n, %)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65–74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1213 (41.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3497 (49.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2422 (39.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75–84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1301 (44.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2826 (39.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2731 (44.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">436 (14.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">753 (10.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1029 (16.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adherence to treatment<a class="elsevierStyleCrossRef" href="#tblfn1005">a</a>(%)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2068969.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn1005" "etiqueta" => "a" "nota" => "Measured as medication possession ratio (MPR). A patient was considered adherent if MPR ≥80%." ] ] ] "descripcion" => array:1 [ "en" => "Incidence of new users undergoing oral monotherapy with antidiabetics, hypolipidemic agents or antihypertensive drugs in patients aged 65 and over from the EpiChron Cohort during the July 1 and December 31, 2010 period, according to age and sex, and therapeutic adherence to each one of those pharmacological groups." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR (95% CI)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antidiabetic</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex (female vs. male) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.01 (0.862–1.19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.883 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75–84 vs. 65–74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.960 (0.812–1.13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.630 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥85 vs. 65–74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.832 (0.655–1.06) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.133 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No. of coprescribed drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.959 (0.942–0.977) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No. of chronic diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.079 (1.05–1.11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Presence of mental illness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.864 (0.712–1.05) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.137 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypolipidemic agents</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex (female vs. male) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.812 (0.731–0.902) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75–84 vs. 65–74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.858 (0.770–0.957) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥85 vs. 65–74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.675 (0.563–0.809) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No. of coprescribed drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.02 (1.01–1.03) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No. of chronic diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.07 (1.05–1.09) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Presence of mental illness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.924 (0.813–1.05) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.221 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antihypertensive drugs</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex (female vs. male) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.877 (0.785–0.980) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.021 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75–84 vs. 65–74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.01 (0.897–1.13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.878 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥85 vs. 65–74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.949 (0.808–1.12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.529 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No. of coprescribed drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.01 (0.999–1.03) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.072 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No. of chronic diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.03 (1.01–1.05) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Presence of mental illness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.01 (0.881–1.16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.893 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2068970.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "The odds ratio (OR) of being adherent is provided for each explanatory variable, accompanied by its 95% confidence interval." ] ] ] "descripcion" => array:1 [ "en" => "Effect of sex, age, number of prescribed drugs, number of chronic diseases and the presence of mental illness on adherence to treatment by new users undergoing oral monotherapy with antidiabetics, hypolipidemic agents or antihypertensive drugs." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0155" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The World Health Report 2008 – primary healthcare: how wide is the gap between its agenda and implementation in 12 high-income health systems?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Gauld" 1 => "R. Blank" 2 => "J. Burgers" 3 => "A.B. Cohen" 4 => "M.K. Dobrow" 5 => "N.K. Ikegami" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Health Policy" "fecha" => "2012" "volumen" => "7" "paginaInicial" => "38" "paginaFinal" => "58" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0160" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multimorbidity patterns in primary care: interactions among chronic diseases using factor analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Prados-Torres" 1 => "B. Poblador-Plou" 2 => "A. Calderón-Larrañaga" 3 => "L.A. Gimeno-Feliu" 4 => "F. González-Rubio" 5 => "A. Poncel-Falcó" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0032190" "Revista" => array:5 [ "tituloSerie" => "PLoS ONE" "fecha" => "2012" "volumen" => "7" "paginaInicial" => "e32190" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22393389" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0165" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy: study protocol of a cluster randomized clinical trial (Multi-PAP project)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Prados-Torres" 1 => "I. del Cura-González" 2 => "D. Prados-Torres" 3 => "J.A. López-Rodríguez" 4 => "F. Leiva-Fernández" 5 => "A. Calderón-Larrañaga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13012-017-0584-x" "Revista" => array:5 [ "tituloSerie" => "Implement Sci" "fecha" => "2017" "volumen" => "12" "paginaInicial" => "54" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28449721" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0170" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polypharmacy patterns: unravelling systematic associations between prescribed medications" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Calderón-Larrañaga" 1 => "L.A. Gimeno-Feliu" 2 => "F. González-Rubio" 3 => "B. Poblador-Plou" 4 => "M. Lairla-San José" 5 => "J.M. Abad-Díez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0084967" "Revista" => array:5 [ "tituloSerie" => "PLOS ONE" "fecha" => "2013" "volumen" => "8" "paginaInicial" => "e84967" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24376858" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0175" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patient adherence to treatment: three decades of research: a comprehensive review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Vermiere" 1 => "H. Hearnshaw" 2 => "P.D. Van Royen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Pharm Ther" "fecha" => "2001" "volumen" => "26" "paginaInicial" => "331" "paginaFinal" => "342" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11679023" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0180" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multimorbidity, polypharmacy, referrals, and adverse drug events: are we doing things well?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Calderón-Larrañaga" 1 => "B. Poblador-Plou" 2 => "F. González-Rubio" 3 => "L.A. Gimeno-Feliu" 4 => "J.M. Abad-Díez" 5 => "A. Prados-Torres" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3399/bjgp12X659295" "Revista" => array:6 [ "tituloSerie" => "Br J Gen Pract" "fecha" => "2012" "volumen" => "62" "paginaInicial" => "e821" "paginaFinal" => "e826" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23211262" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0185" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adherence to long-term therapies: evidence for action" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "World Health Organization" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2015" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0190" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cohort profile: the epidemiology of chronic diseases and multimorbidity. The EpiChron Cohort Study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Prados-Torres" 1 => "B. Poblador-Plou" 2 => "A. Gimeno-Miguel" 3 => "A. Calderón-Larrañaga" 4 => "A. Poncel-Falcó" 5 => "L.A. Gimeno-Feliú" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Int J Epidemiol" "fecha" => "2018" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0195" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "World Health Organization. Collaborating Centre for Drugs Statistics Methodology – ATC/DDD Index. Available from: <a href="https://www.whocc.no/atc_ddd_index/">https://www.whocc.no/atc_ddd_index/</a> [Internet; accessed 19.03.18]." ] ] ] 9 => array:3 [ "identificador" => "bib0200" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Measuring medication adherence in health-related databases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Menditto" 1 => "V. Orlando" 2 => "S. Malo-Fumanal" 3 => "A. Prados-Torres" 4 => "C. Cahir" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "editores" => "E.Costa" "titulo" => "Adherence to medical plans for active and healthy ageing" "paginaInicial" => "189" "paginaFinal" => "206" "serieFecha" => "2017" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0205" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An observational study examining the effect of comorbidity on the rates of persistence and adherence to newly initiated oral anti-hyperglycaemic agents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.P. O'Shea" 1 => "M. Teeling" 2 => "Bennet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/pds.3535" "Revista" => array:6 [ "tituloSerie" => "Pharmacoepidemiol Drug Saf" "fecha" => "2013" "volumen" => "22" "paginaInicial" => "1336" "paginaFinal" => "1344" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24142802" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0210" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Self-reported adherence among individuals at high risk of metabolic syndrome: effect of knowledge and attitude" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E.A. Alefishat" 1 => "R.K. Abu Farha" 2 => "M.M. Al-Debei" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000453037" "Revista" => array:6 [ "tituloSerie" => "Med Princ Pract" "fecha" => "2017" "volumen" => "26" "paginaInicial" => "157" "paginaFinal" => "163" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27816978" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0215" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adherence to statins and LDL-cholesterol goal attainment" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.D. Chi" 1 => "S.S. Vansomphone" 2 => "I.L.A. Liu" 3 => "T.C. Cheetham" 4 => "K.R. Green" 5 => "R.D. Scott" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Manag Care" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "e105" "paginaFinal" => "e112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24884955" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0220" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-adherence to antihypertensive medication: the role of mental and physical comorbidity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Calderón-Larrañaga" 1 => "E. Diaz" 2 => "B. Poblador-Plou" 3 => "L.A. Gimeno-Feliu" 4 => "J.M. Abad-Díez" 5 => "A. Prados-Torres" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2016.01.069" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2016" "volumen" => "207" "paginaInicial" => "310" "paginaFinal" => "316" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26814635" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0225" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Compliance and persistence with concomitant statin and oral antihyperglycemic therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Q. Zhang" 1 => "C. Zhao" 2 => "M.J. Davies" 3 => "L. Radican" 4 => "T. Seck" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Manag Care" "fecha" => "2011" "volumen" => "17" "paginaInicial" => "746" "paginaFinal" => "752" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22084894" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0230" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patient characteristics associated with medication adherence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.J. Rolnick" 1 => "P.A. Pawloski" 2 => "B.D. Hedblom" 3 => "S.E. Asche" 4 => "R.J. Bruzek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3121/cmr.2013.1113" "Revista" => array:6 [ "tituloSerie" => "Clin Med Res" "fecha" => "2013" "volumen" => "11" "paginaInicial" => "54" "paginaFinal" => "65" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23580788" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0235" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Analysis of factors associated with statin adherence in a hierarchical model considering physician, pharmacy, patient, and prescription characteristics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Pedan" 1 => "L. Varasteh" 2 => "S. Schneeweiss" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.18553/jmcp.2007.13.6.487" "Revista" => array:7 [ "tituloSerie" => "J Manag Care Pharm" "fecha" => "2007" "volumen" => "13" "paginaInicial" => "487" "paginaFinal" => "496" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17672810" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673617322900" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0240" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of initial drug choice and comorbidity on antihypertensive therapy compliance. Results from a population-based study in the elderly" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Monane" 1 => "R.L. Bohn" 2 => "J.H. Gurwitz" 3 => "R.J. Glynn" 4 => "R. Levin" 5 => "J. Avorn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0895-7061(97)00056-3" "Revista" => array:6 [ "tituloSerie" => "Am J Hypertens" "fecha" => "1997" "volumen" => "10" "paginaInicial" => "697" "paginaFinal" => "704" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9234822" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0245" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factors influencing antihypertensive medication compliance in Taiwan: a nationwide population-based study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.-Y. Lee" 1 => "C.-C. Huang" 2 => "H.-C. Shih" 3 => "K.-H. Huang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/2047487312451252" "Revista" => array:6 [ "tituloSerie" => "Eur J Prev Cardiol" "fecha" => "2013" "volumen" => "20" "paginaInicial" => "930" "paginaFinal" => "937" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22689418" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0250" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adherence with statins in a real-life setting is better when associated cardiovascular risk factors increase: a cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Latry" 1 => "M. Molimard" 2 => "B. Dedieu" 3 => "T. Couffinhal" 4 => "B. Bégaud" 5 => "K. Martin-Latry" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2261-11-46" "Revista" => array:6 [ "tituloSerie" => "BMC Cardiovasc Disord" "fecha" => "2011" "volumen" => "11" "paginaInicial" => "46" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21791073" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673613612490" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0255" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A class comparison of medication persistence in people with type 2 diabetes: a retrospective observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. McGovern" 1 => "W. Hinton" 2 => "S. Calderara" 3 => "N. Munro" 4 => "M. Whyte" 5 => "S. de Lusignan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s13300-017-0361-5" "Revista" => array:6 [ "tituloSerie" => "Diabetes Ther" "fecha" => "2018" "volumen" => "9" "paginaInicial" => "229" "paginaFinal" => "242" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29302934" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0260" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adherence to antihypertensives in patients with comorbid condition" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z. Saadat" 1 => "F. Nikdoust" 2 => "H. Aerab-Sheibani" 3 => "M. Bahremand" 4 => "E. Shobeiri" 5 => "H. Saadat" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5812/numonthly.29863" "Revista" => array:5 [ "tituloSerie" => "Nephrourol Mon" "fecha" => "2015" "volumen" => "7" "paginaInicial" => "e29863" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26539419" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0265" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Actualización en Medicina de Familia: Cumplimiento terapéutico" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Orueta" 1 => "P. Toledano" 2 => "R.M. Gómez-Calcerrada" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Fam Semer" "fecha" => "2008" "volumen" => "34" "paginaInicial" => "235" "paginaFinal" => "243" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0270" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between adherence, treatment satisfaction and illness perception in hypertensive patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Saarti" 1 => "A. Hajj" 2 => "L. Karam" 3 => "H. Jabbour" 4 => "A. Sarkis" 5 => "N. El Osta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/jhh.2015.86" "Revista" => array:6 [ "tituloSerie" => "J Hum Hypertens" "fecha" => "2016" "volumen" => "30" "paginaInicial" => "341" "paginaFinal" => "345" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26310182" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0275" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adherence to evidence-based therapies after acute coronary syndrome: a retrospective population-based cohort study linking hospital, outpatient, and pharmacy health information systems in Valencia, Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Sanfélix-Gimeno" 1 => "S. Peiró" 2 => "I. Ferreros" 3 => "R. Pérez-Vicente" 4 => "J. Librero" 5 => "F. Catalá-López" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.18553/jmcp.2013.19.3.247" "Revista" => array:6 [ "tituloSerie" => "J Manag Care Pharm" "fecha" => "2013" "volumen" => "19" "paginaInicial" => "247" "paginaFinal" => "257" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23537459" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0280" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adherence to chronic medication in older populations: application of a common protocol among three European cohorts" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Menditto" 1 => "C. Cahir" 2 => "M. AzaPascual-Salcedo" 3 => "D. Bruzzese" 4 => "B. Poblador-Plou" 5 => "S. Malo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/PPA.S164819" "Revista" => array:6 [ "tituloSerie" => "Patient Prefer Adherence" "fecha" => "2018" "volumen" => "12" "paginaInicial" => "1975" "paginaFinal" => "1987" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30323567" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0285" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medication adherence and persistence in type 2 diabetes mellitus: perspectives of patients, physicians and pharmacists on the Spanish health care system" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Labrador Barba" 1 => "M. Rodriguez de Miguel" 2 => "A. Hernández Mijares" 3 => "F.J. Alonso-Moreno" 4 => "M.L. Orera Peña" 5 => "S. Aceituno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/PPA.S122556" "Revista" => array:6 [ "tituloSerie" => "Patient Prefer Adherence" "fecha" => "2017" "volumen" => "11" "paginaInicial" => "707" "paginaFinal" => "718" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28435229" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0290" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "8. Pharmacologic approaches to glycemic treatment: standards of medical care in diabetes – 2018" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "American Diabetes Association" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Diabetes Care" "fecha" => "2017" "volumen" => "41" "numero" => "Suppl. 1" "paginaInicial" => "S64" "paginaFinal" => "S74" "itemHostRev" => array:3 [ "pii" => "S0021915014016189" "estado" => "S300" "issn" => "00219150" ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0295" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommendations for evaluating compliance and persistence with hypertension therapy using retrospective data" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.T. Halpern" 1 => "Z.M. Khan" 2 => "J.K. Schmier" 3 => "M. Burnier" 4 => "J.J. Caro" 5 => "J. Cramer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.HYP.0000222373.59104.3d" "Revista" => array:6 [ "tituloSerie" => "Hypertension" "fecha" => "2006" "volumen" => "47" "paginaInicial" => "1039" "paginaFinal" => "1048" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16651464" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0300" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Persistence with antihypertensive medications in uncomplicated treatment-naïve patients: effects of initial therapeutic classes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y.M. Ah" 1 => "J.Y. Lee" 2 => "Y.J. Choi" 3 => "B. Kim" 4 => "K.H. Choi" 5 => "J. Kong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3346/jkms.2015.30.12.1800" "Revista" => array:6 [ "tituloSerie" => "J Korean Med Sci" "fecha" => "2015" "volumen" => "30" "paginaInicial" => "1800" "paginaFinal" => "1806" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26713055" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack414269" "titulo" => "Acknowledgements" "texto" => "The authors would like to thank the members of the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA) Action Group A1 for their collaboration." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015300000001/v1_201906260821/S2387020619302724/v1_201906260821/en/main.assets" "Apartado" => array:4 [ "identificador" => "43310" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015300000001/v1_201906260821/S2387020619302724/v1_201906260821/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020619302724?idApp=UINPBA00004N"]

Statistics

Original article

Adherence to treatment of hypertension, hypercholesterolaemia and diabetes in an elderly population of a Spanish cohort

Adherencia al tratamiento de hipertensión arterial, hipercolesterolemia y diabetes en población anciana de una cohorte española

Aida Moreno Justea,b,

Corresponding author

aidamorenoj@gmail.com

Corresponding author.

, Antonio Gimeno Miguela, Beatriz Poblador Ploua, Francisca González Rubioa,b,c, María Mercedes Aza Pascual-Salcedoa,b, Enrica Mendittod, Alexandra Prados Torresa

a Grupo EpiChron de Investigación en Enfermedades Crónicas, Instituto Aragonés de Ciencias de la Salud (IACS), IIS Aragón, REDISSEC ISCIII, Zaragoza, Spain

b Servicio Aragonés de Salud (SALUD), Zaragoza, Spain

c Grupo de Trabajo de Utilización de Fármacos de la semFYC, Spain

d CIRFF, Centro de Farmacoeconomía, Universidad de Nápoles Federico II, Naples, Italy

Read

Times
was read the article

Total PDF

Total HTML

Share statistics

 array:23 [
  "pii" => "S2387020619302724"
  "issn" => "23870206"
  "doi" => "10.1016/j.medcle.2018.10.026"
  "estado" => "S300"
  "fechaPublicacion" => "2019-07-05"
  "aid" => "7010"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;. All rights reserved"
  "copyrightAnyo" => "2018"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Med Clin. 2019;153:1-5"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0025775318306547"
      "issn" => "00257753"
      "doi" => "10.1016/j.medcli.2018.10.023"
      "estado" => "S300"
      "fechaPublicacion" => "2019-07-05"
      "aid" => "4684"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Med Clin. 2019;153:1-5"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 38
        "formatos" => array:2 [
          "HTML" => 28
          "PDF" => 10
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "Adherencia al tratamiento de hipertensi&#243;n arterial&#44; hipercolesterolemia y diabetes en poblaci&#243;n anciana de una cohorte espa&#241;ola"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "1"
            "paginaFinal" => "5"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Adherence to treatment of hypertension&#44; hypercholesterolaemia and diabetes in an elderly population of a Spanish cohort"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Aida Moreno Juste, Antonio Gimeno Miguel, Beatriz Poblador Plou, Francisca Gonz&#225;lez Rubio, Mar&#237;a Mercedes Aza Pascual-Salcedo, Enrica Menditto, Alexandra Prados Torres"
            "autores" => array:7 [
              0 => array:2 [
                "nombre" => "Aida"
                "apellidos" => "Moreno Juste"
              ]
              1 => array:2 [
                "nombre" => "Antonio"
                "apellidos" => "Gimeno Miguel"
              ]
              2 => array:2 [
                "nombre" => "Beatriz"
                "apellidos" => "Poblador Plou"
              ]
              3 => array:2 [
                "nombre" => "Francisca"
                "apellidos" => "Gonz&#225;lez Rubio"
              ]
              4 => array:2 [
                "nombre" => "Mar&#237;a Mercedes"
                "apellidos" => "Aza Pascual-Salcedo"
              ]
              5 => array:2 [
                "nombre" => "Enrica"
                "apellidos" => "Menditto"
              ]
              6 => array:2 [
                "nombre" => "Alexandra"
                "apellidos" => "Prados Torres"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2387020619302724"
          "doi" => "10.1016/j.medcle.2018.10.026"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020619302724?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775318306547?idApp=UINPBA00004N"
      "url" => "/00257753/0000015300000001/v1_201906160629/S0025775318306547/v1_201906160629/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2387020619302013"
    "issn" => "23870206"
    "doi" => "10.1016/j.medcle.2018.12.015"
    "estado" => "S300"
    "fechaPublicacion" => "2019-07-05"
    "aid" => "4744"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Med Clin. 2019;153:6-12"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Zika virus disease in Spain&#46; Surveillance results and epidemiology on reported cases&#44; 2015&#8211;2017"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "6"
          "paginaFinal" => "12"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "La enfermedad por virus Zika en Espa&#241;a&#46; Resultados de la vigilancia y epidemiolog&#237;a de los casos notificados en 2015-2017"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Fig&#46; 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1625
              "Ancho" => 2547
              "Tamanyo" => 193072
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Autonomous Regions &#40;AR&#41; colonised by <span class="elsevierStyleItalic">Aedes albopictus</span> &#40;in at least one municipality&#41; according to year and distribution of reported Zika virus disease &#40;ZVD&#41; cases according to AR&#46; Spain&#44; 2015&#8211;2017&#46;</p>"
          ]
        ]
      ]
      "autores" => array:2 [
        0 => array:2 [
          "autoresLista" => "Beatriz Fern&#225;ndez Mart&#237;nez, Elena V&#46; Mart&#237;nez S&#225;nchez, Oliva D&#237;az Garc&#237;a, Diana G&#243;mez Barroso, M&#46; Jos&#233; Sierra Moros, Rosa Cano Portero"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "Beatriz"
              "apellidos" => "Fern&#225;ndez Mart&#237;nez"
            ]
            1 => array:2 [
              "nombre" => "Elena V&#46;"
              "apellidos" => "Mart&#237;nez S&#225;nchez"
            ]
            2 => array:2 [
              "nombre" => "Oliva"
              "apellidos" => "D&#237;az Garc&#237;a"
            ]
            3 => array:2 [
              "nombre" => "Diana"
              "apellidos" => "G&#243;mez Barroso"
            ]
            4 => array:2 [
              "nombre" => "M&#46; Jos&#233;"
              "apellidos" => "Sierra Moros"
            ]
            5 => array:2 [
              "nombre" => "Rosa"
              "apellidos" => "Cano Portero"
            ]
            6 => array:1 [
              "colaborador" => "on behalf of the National Network of Epidemiological Surveillance &#40;RENAVE&#41;"
            ]
          ]
        ]
        1 => array:2 [
          "autoresLista" => ""
          "autores" => array:1 [
            0 => array:1 [
              "colaborador" => "Components of the RENAVE group &#40;in alphabetical order of CC&#46;AA&#46;&#41;"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0025775319300260"
        "doi" => "10.1016/j.medcli.2018.12.014"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775319300260?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020619302013?idApp=UINPBA00004N"
    "url" => "/23870206/0000015300000001/v1_201906260821/S2387020619302013/v1_201906260821/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Adherence to treatment of hypertension&#44; hypercholesterolaemia and diabetes in an elderly population of a Spanish cohort"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "1"
        "paginaFinal" => "5"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Aida Moreno Juste, Antonio Gimeno Miguel, Beatriz Poblador Plou, Francisca Gonz&#225;lez Rubio, Mar&#237;a Mercedes Aza Pascual-Salcedo, Enrica Menditto, Alexandra Prados Torres"
        "autores" => array:7 [
          0 => array:4 [
            "nombre" => "Aida"
            "apellidos" => "Moreno Juste"
            "email" => array:1 [
              0 => "aidamorenoj@gmail.com"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Antonio"
            "apellidos" => "Gimeno Miguel"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Beatriz"
            "apellidos" => "Poblador Plou"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Francisca"
            "apellidos" => "Gonz&#225;lez Rubio"
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Mar&#237;a Mercedes"
            "apellidos" => "Aza Pascual-Salcedo"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Enrica"
            "apellidos" => "Menditto"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Alexandra"
            "apellidos" => "Prados Torres"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Grupo EpiChron de Investigaci&#243;n en Enfermedades Cr&#243;nicas&#44; Instituto Aragon&#233;s de Ciencias de la Salud &#40;IACS&#41;&#44; IIS Arag&#243;n&#44; REDISSEC ISCIII&#44; Zaragoza&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio Aragon&#233;s de Salud &#40;SALUD&#41;&#44; Zaragoza&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Grupo de Trabajo de Utilizaci&#243;n de F&#225;rmacos de la semFYC&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "CIRFF&#44; Centro de Farmacoeconom&#237;a&#44; Universidad de N&#225;poles Federico II&#44; Naples&#44; Italy"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Adherencia al tratamiento de hipertensi&#243;n arterial&#44; hipercolesterolemia y diabetes en poblaci&#243;n anciana de una cohorte espa&#241;ola"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The World Health Organisation &#40;WHO&#41; defines multimorbidity as the presence of two or more chronic diseases in the same person&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> This phenomenon is very common in most countries and its impact is greater in the elderly population&#44; in which health problems accumulate due to the improvement of socioeconomic conditions and advances in the field of health&#44; allowing a significant proportion of the population to survive previously fatal diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> According to the National Health Survey&#44; the so-called young elderly population aged 65&#8211;74 in Spain has an average of 2&#46;8 chronic health problems&#44; while those over 75 have an average of 3&#46;2 diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> Multimorbidity is associated with polypharmacy or simultaneous and prolonged prescription of multiple medications&#44; which implies a series of undesirable consequences&#44; such as increased risk of inappropriate drug use&#44; appearance of secondary symptoms from non-compliance&#44; underuse of effective drugs&#44; pharmacological interactions and adverse reactions&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;4</span></a> Adherence&#44; in terms of taking medications&#44; following diets or making lifestyle changes&#44; can also be affected by the simultaneous administration of several drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> One of the ways to determine the extent to which patients follow the instructions accompanying their prescribed treatments is to measure adherence to medication&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> Chronic diseases are the most affected by low adherence&#58; it is estimated that approximately 50&#37; of the population that has a chronic disease does not take their medication in the manner prescribed to them&#46; The study of factors related to low adherence is essential to designing prevention strategies that can increase treatment effectiveness&#44; reduce morbidity and mortality and improve patients&#8217; quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The objective of this study was to determine therapeutic adherence to the most commonly used drugs for type 2 diabetes mellitus&#44; hypercholesterolemia and hypertension in new users of these drugs aged 65 or older&#44; and to study their effect on sex&#44; age&#44; number of drugs and presence of other chronic ailments and mental illness&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Design and study population</span><p id="par0015" class="elsevierStylePara elsevierViewall">Retrospective cross-sectional observational study conducted in the EpiChron Cohort that anonymously comprised the following user data&#44; collected through the Aragonese Health System clinical records and clinical-administrative databases&#58; demographic&#44; clinical&#44; drug dispensing&#44; use of services and health outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> This study was approved by the Community of Aragon Research Ethics Committee &#40;PI16&#47;088&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The drugs dispensed were coded according to the Anatomical Therapeutic Chemical &#40;ATC&#41; Classification System&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> From this cohort&#44; we selected the patients aged over 65 who had initiated a prescribed oral monotherapy between July 1 and December 31&#44; 2010 with any of the following&#58; a&#41; an oral antidiabetic &#40;biguanides&#44; A10BA&#44; sulfonylureas&#44; A10BB&#44; alpha-glucosidase inhibitors&#44; A10BF&#44; thiazolidinediones&#44; A10BG&#44; inhibitors of dipeptidyl peptidase 4&#44; A10BH&#44; or other oral antidiabetics&#44; A0BX&#41;&#59; b&#41; a hypolipidemic agent &#40;inhibitors of HMG-CoA reductase&#44; C10AA&#44; fibrates&#44; C10AB&#44; bile acid sequestrants&#44; C10AC&#44; or other lipid modifiers&#44; C10AX&#41; or c&#41; a renin&#8211;angiotensin system antihypertensive drug &#40;convertase enzyme inhibitor angiotensin&#44; C09AA&#44; or angiotensin II antagonists&#44; C09CA&#41;&#46; The patients excluded were those&#58; &#40;a&#41; who were undergoing treatment with a drug from the same group under study prescribed within the six months prior to their inclusion in the study&#59; &#40;b&#41; who did not maintain monotherapy&#44; either by pharmacological combination or separately&#59; &#40;c&#41; whose drug prescription had not been validated for one year&#59; &#40;d&#41; who had only one dispensation of the drug being studied&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">With these criteria&#44; a final sample of 16&#44;208 patients was obtained&#44; which were classified in each of the pharmacological groups under study according to the new drug prescribed within the study dates and monitored for a period of 12 months&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables</span><p id="par0030" class="elsevierStylePara elsevierViewall">The age of each patient was recorded at the time they were included in the study and the sample was classified into three groups &#40;65&#8211;74&#44; 75&#8211;84 and &#8805;85&#41;&#46; The patients&#8217; sex was also registered&#46; Other explanatory variables were collected in the six months prior to inclusion in the study&#44; such as the number of co-prescribed drugs&#44; the number of chronic diseases and a presence of mental illness&#46; All Anatomical Therapeutic Chemical &#40;ATC&#41; codes were included as the number of co-prescribed drugs&#44; except for ATC J &#40;anti-infectives for systemic use&#41; and ATC V &#40;several&#41;&#44; since only drugs used chronically were considered for the study&#46; Chronic diagnoses were coded according to the International Classification of Primary Care and the International Classification of Diseases classifications and&#44; subsequently&#44; they were unified in the <span class="elsevierStyleItalic">Expanded Diagnostic Clusters</span> &#40;EDC&#41; using the Johns Hopkins ACG<span class="elsevierStyleSup">&#174;</span> System <span class="elsevierStyleItalic">software</span> &#40;version 11&#46;0&#44; The Johns Hopkins University&#44; Baltimore&#44; MD&#44; USA&#41;&#46; The presence of mental illness was considered to be the presence of any of the following diagnostic codes&#58; PSY01 &#40;anxiety&#44; neurosis&#41;&#44; PYS02 &#40;substance abuse&#41;&#44; PSY04 &#40;behavioural problems&#41;&#44; PSY05 &#40;attention deficit disorder&#41;&#44; PSY07 &#40;schizophrenia and affective psychosis&#41;&#44; PSY08 &#40;personality disorders&#41;&#44; PSY09 &#40;depression&#41;&#44; or NUR11 &#40;dementia and delusions&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">As an outcome variable&#44; adherence was quantified by measuring the medication possession ratio &#40;MPR&#41; for each of the pharmacological study groups&#46; The MPR is calculated using a standard method for the assessment of adherence&#58; the number of pharmacological units dispensed divided by the number of units expected to be administered during the observation period&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> It is calculated as the proportion of the number of days with treatment administered during the intended treatment period&#44; i&#46;e&#46;&#44; 100&#215;&#8721;&#40;days administered&#41;&#47;365&#46; The number of days in which treatment was administered was estimated according to the number of tablets dispensed during the follow-up year&#44; assuming in our case that the treatment dose was one tablet per day&#46; After calculating the MPR&#44; we created the dichotomous variable &#8216;Adherence to treatment &#40;yes&#47;no&#41;&#8217;&#59; a patient was considered to have been adherent if MPR &#8805;80&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">A descriptive study of the population and therapeutic adherence was made for each pharmacological group under study&#46; Once new users&#8217; adherence for each group of drugs was measured&#44; a binary logistic regression model was performed to assess the relationship between adherence &#40;dependent variable&#41; and the independent variables&#58; sex&#44; age &#40;stratified within the aforementioned three age groups&#41;&#44; number of coprescribed drugs&#44; number of chronic comorbidities and presence of mental illness&#46; 95&#37; confidence intervals were calculated for each mean&#44; and a statistical significance level of 0&#46;05 was considered in the logistic regression&#46; The set of calculations was carried out using the Stata <span class="elsevierStyleItalic">software</span> &#40;version 12&#46;0&#44; StataCorp LLC&#44; College Sation&#44; TX&#44; USA&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">The study population consisted of 2950 new users of antidiabetics&#44; 7076 new users of hypolipidemic agents and 6182 new users of antihypertensive drugs&#46; Most of the new users of these drugs were patients aged between 65 and 74 in the case of hypolipidemic agents&#44; and between 75 and 84 in the case of antidiabetics and antihypertensive drugs&#46; There was a greater proportion of females than males in all pharmacological groups&#46; The MPR calculation showed treatment adhesions that ranged between 44&#37; and 72&#37; of new users of hypolipidemic agents and antidiabetics&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The logistic regression model applied to the new users of antidiabetics group showed that adherence to treatment decreases by 4&#46;1&#37; for each drug coprescribed to antidiabetics&#44; while for each concomitant chronic comorbidity&#44; the probability of adherence increases by 7&#46;9&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Conversely&#44; sex&#44; age and the presence of mental illness did not modify adherence rates for this pharmacological group&#46; In the new users of hypolipidemic agents group&#44; we observed that being female decreases the probability of adhering by 18&#46;8&#37;&#44; compared to being male&#46; Patients aged between 75 and 84 had a 14&#46;2&#37; lower probability of adhering than the 65&#8211;74 reference group&#44; while in the case of those older than 85&#44; this probability was 32&#46;5&#37; lower&#46; Each additional chronic comorbidity presented by patients using hypolipidemic agents increased the probability of being adherent by 6&#46;7&#37;&#44; and with each co-prescribed drug it was increased by 2&#46;2&#37;&#46; Finally&#44; the logistic regression models revealed a 12&#46;3&#37; lower probability of females being adherent to antihypertensive drugs&#46; The probability of being adherent increased by 3&#46;5&#37; with each chronic comorbidity added&#44; while no association was observed with age&#44; number of drugs co-prescribed or presence of mental illness&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">This work explored therapeutic adherence to treatment of the three the most prevalent chronic diseases in the Aragonese population aged over 65&#44; i&#46;e&#46; arterial hypertension&#44; hypercholesterolaemia and type 2 diabetes mellitus&#44; as well as the factors that condition it&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Despite the importance of good therapeutic compliance in the treatment of these chronic diseases&#44; our study found a generally low adherence to treatment&#44; especially in the case of hypolipidemic agents and antihypertensive drugs&#44; to which approximately only one of every two patients is adherent&#46; This fact can be translated into an increase in long-term complications of the disease and an increase in morbidity and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> Other studies have found higher levels of adherence to hypolipidemic agents&#44; such as one conducted in patients with coronary disease&#44; where adherence was 79&#46;8&#37; of cases at 400 days of follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> In another study conducted in 2010&#44; adherence to treatment with antihypertensive drugs was reported to be 79&#46;8&#37;&#44; but this was measured with defined daily dose method&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> This&#44; together with possible differences in the patients inclusion criteria&#44; could partially explain the differences observed with our study&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Conversely&#44; results showed that almost three out of every four diabetic patients adhered to their antidiabetic treatment&#46; Similar results were found in a 2011 study that showed adherence to antidiabetics was higher than adherence to hypolipidemic agents &#40;68&#46;6 vs&#46; 57&#46;5&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Regarding the factors that influence adherence&#44; we observed that in the group of new users of antihypertensive drugs and hypolipidemic agents&#44; adherence was greater in males than in females&#46; Some authors believe that a lower adherence in females is due to the fact that they are the primary caregiver of the family&#44; and they thus have less time and energy for their own personal care&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> Age was only significantly associated with the likelihood of adherence in the group of hypolipidemic agents&#44; which saw a drastic decrease in adherence at a higher age&#46; In this sense&#44; there is no consensus on the role of age in adherence&#44; since some studies observed an increase in adherence as age increased&#44; while others found the opposite&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> Conversely&#44; there are no studies investigating the causes of lack of adherence to hypolipidemic agents in primary prevention&#46; Some hypotheses recently put forward about this suggest that a lack of adherence to these drugs could be due to adverse effects&#59; these secondary effects are not recognised by health professionals&#44; and patients abandon their treatments as they do not feel well when taking them&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In addition to sex and age&#44; other factors that have been associated with adhesion include&#58; number of drugs&#59; concomitant comorbidities&#44; the presence of symptoms&#59; whether the treatment is curative or preventive&#59; knowledge of the disease and the presence of mental illness&#44; among others&#46; A lack of motivation and decrease in attention and memory have also been put forward as a cause of poor adherence by certain studies&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> although our study did not analyse these factors&#44; as there is no information on them available&#46; In our study&#44; adherence rates when other drugs were administered simultaneously were not consistent&#46; The literature has highlighted how the complexity of treatment is inversely proportional to adherence&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> A study into adherence to antihypertensive drugs in New Jersey found that a prescription of more than eight drugs decreased the likelihood of adherence&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> Similarly&#44; a 2010 study in the Autonomous Community of Aragon also concluded that polypharmacy is associated with low adherence to treatment&#46; Other factors that have been associated with a decrease in adherence are&#58; the prescription of a large quantity of drugs&#59; dispensation of medication in an unsynchronised manner&#59; frequency of administration&#59; variability in the doses and the specific instructions given at the time of taking the medication&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Contrary to the effect of the number of coprescribed drugs&#44; which was not consistent&#44; this study did find an increase in therapeutic adherence as the number of chronic diseases increased&#44; regardless of the pharmacological group studied&#46; Adherence to treatment increased on average between 3 and 8&#37; for each additional chronic comorbidity&#46; How the presence of multiple chronic diseases or multimorbidity influences therapeutic adherence has been widely studied&#44; and positive associations between diseases and adherence to antihypertensive medication has been observed&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> In a study into hypolipidemic agents&#44; adhesion increased from 56&#37; in patients with one chronic comorbidity to 72&#37; in patients with three or more comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> Conversely&#44; other studies have shown that the presence of more comorbidities is associated with a decrease in adherence&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">21&#44;22</span></a> While yet another study found that comorbidities requiring regular administration of medications did not affect patients&#8217; compliance with antihypertensive drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> It has also been noted that symptomatology positively influences therapeutic compliance&#59; this is intuitive given that when patients present symptoms&#44; they are more aware of their disease&#44; and as such adhere more to the established treatment in order to treat it&#46; This is why it is easy to understand that there are high rates of non-compliance in asymptomatic diseases such as dyslipidemia&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> Another cause of good adherence could be that this type of drug is for secondary prevention&#46; Several studies have shown that there is a higher rate of non-compliance in primary prevention than in secondary prevention&#44; and that the presence of cardiovascular comorbidities or complications derived from cardiovascular disease improve adherence&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">24&#44;25</span></a> A greater adherence to arterial hypertension treatment has been observed in patients with higher cardiovascular risk&#44; probably because both the patient and their primary care doctor are more aware of the importance of treatment and are thus more motivated to follow their set regime&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The heterogeneity in the results and conclusions drawn from different studies may be related to the fact that adherence to medication is a complex phenomenon influenced by several factors&#44; including&#58; knowledge of the disease&#59; patients&#8217; attitudes&#59; the socioeconomic environment&#59; health system issues&#59; doctor&#8211;patient relationships and the role of pharmacists&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">22&#44;26</span></a> This has been corroborated in an interview-based study carried out with type 2 diabetes mellitus patients&#46; It reported that most of the sample understood the importance of taking medication and were aware of the importance of being adequately informed about their disease&#44; comorbidities and the benefits of medication&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a></p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Strengths and limitations</span><p id="par0090" class="elsevierStylePara elsevierViewall">The main strength of this study is that it is a large-scale population-based study conducted in a cohort validated for research into chronic diseases and drug-epidemiology&#44; in which the data is treated through continuous quality control&#46; In addition&#44; the inclusion of only new prescription patients for each of the drugs studied minimises the risk of confounding biases&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Its main limitations include&#44; that in order to measure adherence to treatment&#44; it is assumed each patient consumes one tablet of the drug per day&#46; A higher daily dosage for some cases could produce an overestimation of the adherence&#44; since patients with more than one might stop taking the medication or consume it incorrectly and be considered adherent&#46; The opposite might also be true&#58; cases where the daily dose is less than one tablet&#44; resulting in the dispensed prescription lasting more days than expected&#44; could lead to an underestimation of the adherence&#46; Furthermore&#44; it is assumed that the dispensation for the same disease is the same for all patients&#44; which does not correspond to the actual clinical practice of personalising prescriptions according to the tolerability of each patient&#44; the evolution of the disease or interactions with other drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> The method of calculating the MPR to assess adherence is to assume that the tablets dispensed are the quantity consumed by the patient&#59; this method is accepted as standard for measuring adherence because measuring the actual consumption of the medication is difficult&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> Both the causes of discontinuation&#44; which could be due to adverse effects or patients perceiving a low efficacy&#44;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">20&#44;30</span></a> and indications of treatment to assess adhesion more thoroughly&#44; remain unknown&#46; Finally&#44; this study does not include information on other variables that might also influence adherence to treatment&#44; such as physical function&#44; frailty or disability&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusions</span><p id="par0100" class="elsevierStylePara elsevierViewall">The results obtained show a suboptimal adherence to treatment of the three chronic diseases studied&#46; Regarding the factors that modulate adherence&#44; it has been observed that adherence increases with the number of chronic diseases&#44; while sex&#44; age&#44; mental illness and the number of drugs do not have a consistent effect on it&#46; This study is exploratory and opens the door to further research to assess therapeutic adherence in cases that include combinations of drugs and&#44; more exhaustively&#44; the role played by factors such as adverse effects&#59; patient&#39;s awareness of the importance of correct treatment&#59; chronic diseases&#59; patients&#8217; social environment and whether it is primary or secondary prevention&#46; These results could guide the implementation of actions aimed at improving patients&#8217; therapeutic adherence to chronic diseases and thus prevent the negative consequences of non-compliance since&#44; as stated by WHO&#44; improving therapeutic adherence may have a greater impact on health than advances in treatments&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Funding</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors have not received specific grants from public&#44; private or non-profit organisations for this study&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interests</span><p id="par0110" class="elsevierStylePara elsevierViewall">There is no conflict of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:3 [
          "identificador" => "xres1211914"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Background and objective"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Material and method"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1127985"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1211915"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Antecedentes y objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Material y m&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1127986"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Design and study population"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Variables"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Results"
        ]
        7 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "Discussion"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Strengths and limitations"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Funding"
        ]
        10 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflict of interests"
        ]
        11 => array:2 [
          "identificador" => "xack414269"
          "titulo" => "Acknowledgements"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-07-10"
    "fechaAceptado" => "2018-10-18"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1127985"
          "palabras" => array:5 [
            0 => "Adherence"
            1 => "Medication"
            2 => "Polypharmacy"
            3 => "Multimorbidity"
            4 => "Chronic diseases"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1127986"
          "palabras" => array:5 [
            0 => "Adherencia"
            1 => "Medicaci&#243;n"
            2 => "Polifarmacia"
            3 => "Multimorbilidad"
            4 => "Enfermedades cr&#243;nicas"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sub-optimal adherence to treatment in the general population has been highlighted in several studies&#44; especially in the elderly and&#47;or chronic patients&#46; This study aims to describe the adherence to treatment of diabetes mellitus&#44; dyslipidaemia and hypertension&#44; and to identify the factors that influence adherence&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective&#44; cross-sectional observational study on 16&#44;208 patients aged &#8805;65 years from the EpiChron Cohort who initiated monotherapy treatment of an antidiabetic&#44; a lipid-lowering or an antihypertensive medication in 2010&#46; Adherence was measured by calculating the medication possession ratio during one year&#44; considering those cases with medication possession ratio &#8805;80&#37; to be adherent&#46; We performed a descriptive study&#44; and a logistic regression model was used to identify the predictors of low adherence&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Adherence to antidiabetics&#44; antihypertensive and lipid-lowering drugs was 72&#46;4&#37;&#44; 50&#46;7&#37; and 44&#46;3&#37;&#44; respectively&#46; An increase in adherence of 3&#8211;8&#37; was observed for each additional chronic disease suffered by the patient&#46; The presence of mental illness did not affect adherence&#44; and sex&#44; age and number of prescribed drugs did not present consistent effects&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The results obtained show a sub-optimal adherence to treatment for the 3 chronic diseases studied&#46; Adherence increased with the number of chronic diseases&#44; while sex&#44; age and number of drugs did not show a consistent effect&#46; It is necessary to investigate if there are other factors that may influence therapeutic adherence&#44; since improving adherence may have a greater impact on health than any progress in therapies&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and method"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Varios estudios han puesto de manifiesto un cumplimiento terap&#233;utico sub&#243;ptimo en la poblaci&#243;n general&#44; sobre todo en ancianos y en enfermos cr&#243;nicos&#46; El objetivo de este estudio es describir la adherencia al tratamiento de diabetes mellitus&#44; dislipidemia e hipertensi&#243;n arterial&#44; e identificar los factores que la influencian&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional transversal retrospectivo sobre 16&#46;208 pacientes mayores de 65 a&#241;os de la Cohorte EpiChron&#44; que iniciaron tratamiento en monoterapia de un antidiab&#233;tico&#44; un hipolipidemiante o un antihipertensivo en 2010&#46; La adherencia se midi&#243; mediante el c&#225;lculo de la relaci&#243;n de posesi&#243;n de medicaci&#243;n durante un a&#241;o de seguimiento&#44; consider&#225;ndose adherentes los casos con posesi&#243;n de medicaci&#243;n &#8805;80&#37;&#46; Se realiz&#243; un estudio descriptivo y un modelo de regresi&#243;n log&#237;stica para identificar los factores predictores de baja adherencia&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La adherencia a los antidiab&#233;ticos&#44; antihipertensivos e hipolipidemiantes fue del 72&#44;4&#59; 50&#44;7 y 44&#44;3&#37;&#44; respectivamente&#46; Se observ&#243; un aumento en la adherencia del 3-8&#37; por cada enfermedad cr&#243;nica adicional del paciente&#46; La presencia de enfermedad mental no afect&#243; a la adherencia&#44; y el sexo&#44; edad y n&#250;mero de f&#225;rmacos prescritos no presentaron efectos consistentes&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los resultados obtenidos ponen de manifiesto una adherencia al tratamiento sub&#243;ptima en las enfermedades cr&#243;nicas estudiadas&#46; La adherencia aument&#243; con el n&#250;mero de enfermedades cr&#243;nicas&#44; mientras que sexo&#44; edad y n&#250;mero de f&#225;rmacos no presentaron un efecto consistente&#46; Es necesario investigar si existen otros factores que puedan influir en la adherencia terap&#233;utica&#44; ya que su mejora puede tener mayor impacto en la salud que cualquier avance en las terapias&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Moreno Juste A&#44; Gimeno Miguel A&#44; Poblador Plou B&#44; Gonz&#225;lez Rubio F&#44; Aza Pascual-Salcedo MM&#44; Menditto E&#44; et al&#46; Adherencia al tratamiento de hipertensi&#243;n arterial&#44; hipercolesterolemia y diabetes en poblaci&#243;n anciana de una cohorte espa&#241;ola&#46; Med Clin &#40;Barc&#41;&#46; 2019&#59;153&#58;1&#8211;5&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Antidiabetic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hypolipidemic agents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Antihypertensive drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sex &#40;n&#44; &#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1555 &#40;52&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4220 &#40;59&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3449 &#40;55&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1395 &#40;47&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2856 &#40;40&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2733 &#40;44&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age &#40;n&#44; &#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>65&#8211;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1213 &#40;41&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3497 &#40;49&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2422 &#40;39&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>75&#8211;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1301 &#40;44&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2826 &#40;39&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2731 &#40;44&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">436 &#40;14&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">753 &#40;10&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1029 &#40;16&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Adherence to treatment</span><a class="elsevierStyleCrossRef" href="#tblfn1005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleItalic">&#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2068969.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn1005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar1005">Measured as medication possession ratio &#40;MPR&#41;&#46; A patient was considered adherent if MPR &#8805;80&#37;&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Incidence of new users undergoing oral monotherapy with antidiabetics&#44; hypolipidemic agents or antihypertensive drugs in patients aged 65 and over from the EpiChron Cohort during the July 1 and December 31&#44; 2010 period&#44; according to age and sex&#44; and therapeutic adherence to each one of those pharmacological groups&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR &#40;95&#37; CI&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Antidiabetic</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sex &#40;female vs&#46; male&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;01 &#40;0&#46;862&#8211;1&#46;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;883&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Age</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>75&#8211;84 vs&#46; 65&#8211;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;960 &#40;0&#46;812&#8211;1&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;630&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8805;85 vs&#46; 65&#8211;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;832 &#40;0&#46;655&#8211;1&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;133&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">No&#46; of coprescribed drugs</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;959 &#40;0&#46;942&#8211;0&#46;977&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">No&#46; of chronic diseases</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;079 &#40;1&#46;05&#8211;1&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Presence of mental illness</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;864 &#40;0&#46;712&#8211;1&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;137&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Hypolipidemic agents</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sex &#40;female vs&#46; male&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;812 &#40;0&#46;731&#8211;0&#46;902&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Age</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>75&#8211;84 vs&#46; 65&#8211;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;858 &#40;0&#46;770&#8211;0&#46;957&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8805;85 vs&#46; 65&#8211;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;675 &#40;0&#46;563&#8211;0&#46;809&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">No&#46; of coprescribed drugs</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;02 &#40;1&#46;01&#8211;1&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">No&#46; of chronic diseases</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;07 &#40;1&#46;05&#8211;1&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Presence of mental illness</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;924 &#40;0&#46;813&#8211;1&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;221&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">Antihypertensive drugs</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sex &#40;female vs&#46; male&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;877 &#40;0&#46;785&#8211;0&#46;980&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Age</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>75&#8211;84 vs&#46; 65&#8211;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;01 &#40;0&#46;897&#8211;1&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;878&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8805;85 vs&#46; 65&#8211;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;949 &#40;0&#46;808&#8211;1&#46;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;529&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">No&#46; of coprescribed drugs</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;01 &#40;0&#46;999&#8211;1&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;072&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">No&#46; of chronic diseases</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;03 &#40;1&#46;01&#8211;1&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Presence of mental illness</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;01 &#40;0&#46;881&#8211;1&#46;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;893&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2068970.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; of being adherent is provided for each explanatory variable&#44; accompanied by its 95&#37; confidence interval&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Effect of sex&#44; age&#44; number of prescribed drugs&#44; number of chronic diseases and the presence of mental illness on adherence to treatment by new users undergoing oral monotherapy with antidiabetics&#44; hypolipidemic agents or antihypertensive drugs&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The World Health Report 2008 &#8211; primary healthcare&#58; how wide is the gap between its agenda and implementation in 12 high-income health systems&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Gauld"
                            1 => "R&#46; Blank"
                            2 => "J&#46; Burgers"
                            3 => "A&#46;B&#46; Cohen"
                            4 => "M&#46;K&#46; Dobrow"
                            5 => "N&#46;K&#46; Ikegami"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Health Policy"
                        "fecha" => "2012"
                        "volumen" => "7"
                        "paginaInicial" => "38"
                        "paginaFinal" => "58"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multimorbidity patterns in primary care&#58; interactions among chronic diseases using factor analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Prados-Torres"
                            1 => "B&#46; Poblador-Plou"
                            2 => "A&#46; Calder&#243;n-Larra&#241;aga"
                            3 => "L&#46;A&#46; Gimeno-Feliu"
                            4 => "F&#46; Gonz&#225;lez-Rubio"
                            5 => "A&#46; Poncel-Falc&#243;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0032190"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS ONE"
                        "fecha" => "2012"
                        "volumen" => "7"
                        "paginaInicial" => "e32190"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22393389"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy&#58; study protocol of a cluster randomized clinical trial &#40;Multi-PAP project&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Prados-Torres"
                            1 => "I&#46; del Cura-Gonz&#225;lez"
                            2 => "D&#46; Prados-Torres"
                            3 => "J&#46;A&#46; L&#243;pez-Rodr&#237;guez"
                            4 => "F&#46; Leiva-Fern&#225;ndez"
                            5 => "A&#46; Calder&#243;n-Larra&#241;aga"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13012-017-0584-x"
                      "Revista" => array:5 [
                        "tituloSerie" => "Implement Sci"
                        "fecha" => "2017"
                        "volumen" => "12"
                        "paginaInicial" => "54"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28449721"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Polypharmacy patterns&#58; unravelling systematic associations between prescribed medications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Calder&#243;n-Larra&#241;aga"
                            1 => "L&#46;A&#46; Gimeno-Feliu"
                            2 => "F&#46; Gonz&#225;lez-Rubio"
                            3 => "B&#46; Poblador-Plou"
                            4 => "M&#46; Lairla-San Jos&#233;"
                            5 => "J&#46;M&#46; Abad-D&#237;ez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0084967"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLOS ONE"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "paginaInicial" => "e84967"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24376858"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient adherence to treatment&#58; three decades of research&#58; a comprehensive review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46; Vermiere"
                            1 => "H&#46; Hearnshaw"
                            2 => "P&#46;D&#46; Van Royen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Pharm Ther"
                        "fecha" => "2001"
                        "volumen" => "26"
                        "paginaInicial" => "331"
                        "paginaFinal" => "342"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11679023"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multimorbidity&#44; polypharmacy&#44; referrals&#44; and adverse drug events&#58; are we doing things well&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Calder&#243;n-Larra&#241;aga"
                            1 => "B&#46; Poblador-Plou"
                            2 => "F&#46; Gonz&#225;lez-Rubio"
                            3 => "L&#46;A&#46; Gimeno-Feliu"
                            4 => "J&#46;M&#46; Abad-D&#237;ez"
                            5 => "A&#46; Prados-Torres"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3399/bjgp12X659295"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Gen Pract"
                        "fecha" => "2012"
                        "volumen" => "62"
                        "paginaInicial" => "e821"
                        "paginaFinal" => "e826"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23211262"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adherence to long-term therapies&#58; evidence for action"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "World Health Organization"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cohort profile&#58; the epidemiology of chronic diseases and multimorbidity&#46; The EpiChron Cohort Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Prados-Torres"
                            1 => "B&#46; Poblador-Plou"
                            2 => "A&#46; Gimeno-Miguel"
                            3 => "A&#46; Calder&#243;n-Larra&#241;aga"
                            4 => "A&#46; Poncel-Falc&#243;"
                            5 => "L&#46;A&#46; Gimeno-Feli&#250;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Int J Epidemiol"
                        "fecha" => "2018"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "World Health Organization&#46; Collaborating Centre for Drugs Statistics Methodology &#8211; ATC&#47;DDD Index&#46; Available from&#58; <a href="https://www.whocc.no/atc_ddd_index/">https&#58;&#47;&#47;www&#46;whocc&#46;no&#47;atc&#95;ddd&#95;index&#47;</a> &#91;Internet&#59; accessed 19&#46;03&#46;18&#93;&#46;"
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Measuring medication adherence in health-related databases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Menditto"
                            1 => "V&#46; Orlando"
                            2 => "S&#46; Malo-Fumanal"
                            3 => "A&#46; Prados-Torres"
                            4 => "C&#46; Cahir"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "editores" => "E&#46;Costa"
                        "titulo" => "Adherence to medical plans for active and healthy ageing"
                        "paginaInicial" => "189"
                        "paginaFinal" => "206"
                        "serieFecha" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An observational study examining the effect of comorbidity on the rates of persistence and adherence to newly initiated oral anti-hyperglycaemic agents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;P&#46; O&#39;Shea"
                            1 => "M&#46; Teeling"
                            2 => "Bennet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/pds.3535"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pharmacoepidemiol Drug Saf"
                        "fecha" => "2013"
                        "volumen" => "22"
                        "paginaInicial" => "1336"
                        "paginaFinal" => "1344"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24142802"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Self-reported adherence among individuals at high risk of metabolic syndrome&#58; effect of knowledge and attitude"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46;A&#46; Alefishat"
                            1 => "R&#46;K&#46; Abu Farha"
                            2 => "M&#46;M&#46; Al-Debei"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000453037"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Princ Pract"
                        "fecha" => "2017"
                        "volumen" => "26"
                        "paginaInicial" => "157"
                        "paginaFinal" => "163"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27816978"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adherence to statins and LDL-cholesterol goal attainment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;D&#46; Chi"
                            1 => "S&#46;S&#46; Vansomphone"
                            2 => "I&#46;L&#46;A&#46; Liu"
                            3 => "T&#46;C&#46; Cheetham"
                            4 => "K&#46;R&#46; Green"
                            5 => "R&#46;D&#46; Scott"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Manag Care"
                        "fecha" => "2014"
                        "volumen" => "20"
                        "paginaInicial" => "e105"
                        "paginaFinal" => "e112"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24884955"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-adherence to antihypertensive medication&#58; the role of mental and physical comorbidity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Calder&#243;n-Larra&#241;aga"
                            1 => "E&#46; Diaz"
                            2 => "B&#46; Poblador-Plou"
                            3 => "L&#46;A&#46; Gimeno-Feliu"
                            4 => "J&#46;M&#46; Abad-D&#237;ez"
                            5 => "A&#46; Prados-Torres"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2016.01.069"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "2016"
                        "volumen" => "207"
                        "paginaInicial" => "310"
                        "paginaFinal" => "316"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26814635"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Compliance and persistence with concomitant statin and oral antihyperglycemic therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Q&#46; Zhang"
                            1 => "C&#46; Zhao"
                            2 => "M&#46;J&#46; Davies"
                            3 => "L&#46; Radican"
                            4 => "T&#46; Seck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Manag Care"
                        "fecha" => "2011"
                        "volumen" => "17"
                        "paginaInicial" => "746"
                        "paginaFinal" => "752"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22084894"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient characteristics associated with medication adherence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;J&#46; Rolnick"
                            1 => "P&#46;A&#46; Pawloski"
                            2 => "B&#46;D&#46; Hedblom"
                            3 => "S&#46;E&#46; Asche"
                            4 => "R&#46;J&#46; Bruzek"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3121/cmr.2013.1113"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Med Res"
                        "fecha" => "2013"
                        "volumen" => "11"
                        "paginaInicial" => "54"
                        "paginaFinal" => "65"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23580788"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Analysis of factors associated with statin adherence in a hierarchical model considering physician&#44; pharmacy&#44; patient&#44; and prescription characteristics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Pedan"
                            1 => "L&#46; Varasteh"
                            2 => "S&#46; Schneeweiss"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.18553/jmcp.2007.13.6.487"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Manag Care Pharm"
                        "fecha" => "2007"
                        "volumen" => "13"
                        "paginaInicial" => "487"
                        "paginaFinal" => "496"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17672810"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673617322900"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effects of initial drug choice and comorbidity on antihypertensive therapy compliance&#46; Results from a population-based study in the elderly"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Monane"
                            1 => "R&#46;L&#46; Bohn"
                            2 => "J&#46;H&#46; Gurwitz"
                            3 => "R&#46;J&#46; Glynn"
                            4 => "R&#46; Levin"
                            5 => "J&#46; Avorn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0895-7061(97)00056-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Hypertens"
                        "fecha" => "1997"
                        "volumen" => "10"
                        "paginaInicial" => "697"
                        "paginaFinal" => "704"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9234822"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors influencing antihypertensive medication compliance in Taiwan&#58; a nationwide population-based study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;-Y&#46; Lee"
                            1 => "C&#46;-C&#46; Huang"
                            2 => "H&#46;-C&#46; Shih"
                            3 => "K&#46;-H&#46; Huang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/2047487312451252"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Prev Cardiol"
                        "fecha" => "2013"
                        "volumen" => "20"
                        "paginaInicial" => "930"
                        "paginaFinal" => "937"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22689418"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adherence with statins in a real-life setting is better when associated cardiovascular risk factors increase&#58; a cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46; Latry"
                            1 => "M&#46; Molimard"
                            2 => "B&#46; Dedieu"
                            3 => "T&#46; Couffinhal"
                            4 => "B&#46; B&#233;gaud"
                            5 => "K&#46; Martin-Latry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2261-11-46"
                      "Revista" => array:6 [
                        "tituloSerie" => "BMC Cardiovasc Disord"
                        "fecha" => "2011"
                        "volumen" => "11"
                        "paginaInicial" => "46"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21791073"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673613612490"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A class comparison of medication persistence in people with type 2 diabetes&#58; a retrospective observational study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; McGovern"
                            1 => "W&#46; Hinton"
                            2 => "S&#46; Calderara"
                            3 => "N&#46; Munro"
                            4 => "M&#46; Whyte"
                            5 => "S&#46; de Lusignan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s13300-017-0361-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Ther"
                        "fecha" => "2018"
                        "volumen" => "9"
                        "paginaInicial" => "229"
                        "paginaFinal" => "242"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29302934"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adherence to antihypertensives in patients with comorbid condition"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Z&#46; Saadat"
                            1 => "F&#46; Nikdoust"
                            2 => "H&#46; Aerab-Sheibani"
                            3 => "M&#46; Bahremand"
                            4 => "E&#46; Shobeiri"
                            5 => "H&#46; Saadat"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5812/numonthly.29863"
                      "Revista" => array:5 [
                        "tituloSerie" => "Nephrourol Mon"
                        "fecha" => "2015"
                        "volumen" => "7"
                        "paginaInicial" => "e29863"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26539419"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Actualizaci&#243;n en Medicina de Familia&#58; Cumplimiento terap&#233;utico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Orueta"
                            1 => "P&#46; Toledano"
                            2 => "R&#46;M&#46; G&#243;mez-Calcerrada"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Fam Semer"
                        "fecha" => "2008"
                        "volumen" => "34"
                        "paginaInicial" => "235"
                        "paginaFinal" => "243"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association between adherence&#44; treatment satisfaction and illness perception in hypertensive patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Saarti"
                            1 => "A&#46; Hajj"
                            2 => "L&#46; Karam"
                            3 => "H&#46; Jabbour"
                            4 => "A&#46; Sarkis"
                            5 => "N&#46; El Osta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/jhh.2015.86"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hum Hypertens"
                        "fecha" => "2016"
                        "volumen" => "30"
                        "paginaInicial" => "341"
                        "paginaFinal" => "345"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26310182"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adherence to evidence-based therapies after acute coronary syndrome&#58; a retrospective population-based cohort study linking hospital&#44; outpatient&#44; and pharmacy health information systems in Valencia&#44; Spain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Sanf&#233;lix-Gimeno"
                            1 => "S&#46; Peir&#243;"
                            2 => "I&#46; Ferreros"
                            3 => "R&#46; P&#233;rez-Vicente"
                            4 => "J&#46; Librero"
                            5 => "F&#46; Catal&#225;-L&#243;pez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.18553/jmcp.2013.19.3.247"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Manag Care Pharm"
                        "fecha" => "2013"
                        "volumen" => "19"
                        "paginaInicial" => "247"
                        "paginaFinal" => "257"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23537459"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adherence to chronic medication in older populations&#58; application of a common protocol among three European cohorts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Menditto"
                            1 => "C&#46; Cahir"
                            2 => "M&#46; AzaPascual-Salcedo"
                            3 => "D&#46; Bruzzese"
                            4 => "B&#46; Poblador-Plou"
                            5 => "S&#46; Malo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2147/PPA.S164819"
                      "Revista" => array:6 [
                        "tituloSerie" => "Patient Prefer Adherence"
                        "fecha" => "2018"
                        "volumen" => "12"
                        "paginaInicial" => "1975"
                        "paginaFinal" => "1987"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30323567"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Medication adherence and persistence in type 2 diabetes mellitus&#58; perspectives of patients&#44; physicians and pharmacists on the Spanish health care system"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Labrador Barba"
                            1 => "M&#46; Rodriguez de Miguel"
                            2 => "A&#46; Hern&#225;ndez Mijares"
                            3 => "F&#46;J&#46; Alonso-Moreno"
                            4 => "M&#46;L&#46; Orera Pe&#241;a"
                            5 => "S&#46; Aceituno"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2147/PPA.S122556"
                      "Revista" => array:6 [
                        "tituloSerie" => "Patient Prefer Adherence"
                        "fecha" => "2017"
                        "volumen" => "11"
                        "paginaInicial" => "707"
                        "paginaFinal" => "718"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28435229"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "8&#46; Pharmacologic approaches to glycemic treatment&#58; standards of medical care in diabetes &#8211; 2018"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "American Diabetes Association"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Diabetes Care"
                        "fecha" => "2017"
                        "volumen" => "41"
                        "numero" => "Suppl&#46; 1"
                        "paginaInicial" => "S64"
                        "paginaFinal" => "S74"
                        "itemHostRev" => array:3 [
                          "pii" => "S0021915014016189"
                          "estado" => "S300"
                          "issn" => "00219150"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recommendations for evaluating compliance and persistence with hypertension therapy using retrospective data"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;T&#46; Halpern"
                            1 => "Z&#46;M&#46; Khan"
                            2 => "J&#46;K&#46; Schmier"
                            3 => "M&#46; Burnier"
                            4 => "J&#46;J&#46; Caro"
                            5 => "J&#46; Cramer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.HYP.0000222373.59104.3d"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hypertension"
                        "fecha" => "2006"
                        "volumen" => "47"
                        "paginaInicial" => "1039"
                        "paginaFinal" => "1048"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16651464"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Persistence with antihypertensive medications in uncomplicated treatment-na&#239;ve patients&#58; effects of initial therapeutic classes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46;M&#46; Ah"
                            1 => "J&#46;Y&#46; Lee"
                            2 => "Y&#46;J&#46; Choi"
                            3 => "B&#46; Kim"
                            4 => "K&#46;H&#46; Choi"
                            5 => "J&#46; Kong"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3346/jkms.2015.30.12.1800"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Korean Med Sci"
                        "fecha" => "2015"
                        "volumen" => "30"
                        "paginaInicial" => "1800"
                        "paginaFinal" => "1806"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26713055"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack414269"
        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0115" class="elsevierStylePara elsevierViewall">The authors would like to thank the members of the European Innovation Partnership on Active and Healthy Ageing &#40;EIP-AHA&#41; Action Group A1 for their collaboration&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/23870206/0000015300000001/v1_201906260821/S2387020619302724/v1_201906260821/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "43310"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015300000001/v1_201906260821/S2387020619302724/v1_201906260821/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020619302724?idApp=UINPBA00004N"
]