Adherence to the medical regimen continues to rank as a major clinical problem in the management of patients with essential hypertension, as in other conditions treated with drugs and life-style modification. This article reviews the psychometric properties and tests the concurrent and predictive va

/pdf/concurrent-and-predictive-validity-of-a-self-reported-571xyor17c.pdf

Concurrent and predictive validity of a self reported measure of medication adherence

Most research directed a t understanding ”activity undertaken by those who consider themselves ill, for the purpose of getting well” has yielded an unsystematic multiplicity of findings which are often either not predictive of such patient compliance,’” or are mutually contradictory.7.8 These difficulties arise, in part, from past dependence on a “medical” model of patient behavior, which stresses such easily identified and quantified dimensions as characteristics of the patient (e.g., demographic and social),6~B~lO the regimen (e.g., type, complexity, discomfort, duration),ll-l3 and the illness (e.g., medically-defined seriousness, duration, disability).7,14J5

The Health Belief Model and Sick Role Behavior

Over the past two decades, hundreds of articles, editorials, and commentaries have been published describing the considerable disruptive effects on quality of care of individuals noncompliance with health and medical advice While much research has been directed at determining factors responsible for poor compliance, past studies have tended to focus upon easily measured characteristics of the patients, regimen, or illness which, unfortunately, are usually neither predictive nor alterable This paper systematically reviews the literature on patient acceptance of recommended health behaviors, attempting to find social-psychological and related variables which have proven to be consistent predictors of compliance The review suggests that certain health beliefs (especailly personal estimates of vulnerability to, and seriousness of, the disease, and faith in the efficacy of care), health-related motivations, perceptions of psychological and other costs of the recommended action, various aspects of the doctor-patient relationship, and social influence are the most productive dimensions for present intervention and further exploration Building upon an earlier formulation, an hypothesized model is presented which combines these elements for explaining and predicting compliance behavior Further research should, with standardized questionnaires and analysis techniques, employ prospective, experimental designs for a variety of population groups, settings, and regimens, to evaluate the ability of practical attempts to modify the model variables and thus enhance compliance

https://www.jstor.org/stable/pdfplus/3763271.pdf

Sociobehavioral determinants of compliance with health and medical care recommendations.

The assessment of refill compliance using pharmacy records: Methods, validity, and applications

The problem of patient compliance, as well as the ability of the physician to understand, detect, and improve compliance, are described in relation to a new model of health decisions and p...

Understanding and Improving Patient Compliance

Patients were followed for 2 yr after an attack of peptic ulcer. Intake of an antacid regimen was monitored objectively. Quantitative data were obtained on error in statements about intake (i.e., “compliance”) made by 116 patients and errors in estimates of “compliance” made by 3 physicians. Although patients said their intake of antacid averaged 89% of the amount prescribed, their actual intake averaged only 47%. For patients who claimed they took 100%, intake variedfrom 2% to 130% with a mean of 59%. Patients who admitted missing only an occasional dose actually missed substantially more doses than those who claimed 100% compliance. Estimates of intake made by the 3 physicians were more accurate than patients' statements but averaged 50% higher than actual intakes. In patients with low intakes (median 13%), the median estimate by physicians was 55%—an overestimate of 400%. The correlation between actual intakes and physicians' estimates was +0.48, indicating that physicians' judgements were significantly better than chance but nevertheless low in accuracy. Physicians' accuracy did not improve as they gained familiarity with the patient. Demographic data were of limited value in estimating intake. These observations, along with others cited in the literature, indicate the importance of series of objective and quantitative measures of medicine intake. A single measurement, even though accurate, may be grossly misleading because monthly antacid intake for a given patient could vary from 80% above his mean (2 SD) to 80% below, and daily fluctuation could be even larger.

Accuracy of doctors' estimates and patients' statements on adherence to a drug regimen

Facedness and emotion related to lateral dominance, sex and expression type ☆

Twenty-seven ward residents estimated their individual patients' adherence to an antacid regimen (ATR). The physicians' estimates were then compared with counts of the bottles of antacid actually consumed by the patients. The median patient took 46% of the prescribed medicine but the median physician's error of estimate was 32%. Of the 27 physicians, 22 overestimated their patients' ATR. Further, physicians were unable to distinguish those patients who adhered well from those who adhered poorly, even when the judgments were restricted only to those in which the physician indicated most confidence. The correlations between estimated and measured ATR clustered about zero. Accuracy did not vary with the amount of medicine prescribed, the number of patients judged, height of estimated or measured ATR, or the range or variability of the estimates.

Patients' cooperation with a medical regimen. Difficulties in identifying the noncooperator.

Ninety-three right-handed and 53 left-handed adults were compared on a range of performance and preference measures of handedness and footedness. Performance measures included tests of accuracy, speed, and strength. Non-parametric statistical procedures were used to determine whether left-handers (LHs) were less lateralized than right-handers (RHs), and whether distributions for LHs were the mirror images of those for RHs. On performance measures, the distributions for LHs and RHs were generally normal and similar in central tendency, shape, and range. However, on preference measures, distributions were J-shaped, and LHs were significantly less lateralized and more widely dispersed than RHs. Correlations among performance measures were generally low for all subjects. Sex and familial left-handedness did not significantly moderate the responses of these right- and left-handers on performance or preference measures of lateral dominance.

Left‐handers and right‐handers compared on performance and preference measures of lateral dominance

The adequacy of bottle or pill counts for assessing patients' intake of medication has not been established. A bottle count was evaluated in this 2 year follow‐up of 105 patients with peptic ulcer. We added a trace of sodium bromide to a liquid antacid which enabled us to measure intake. There were 1,445 counts of empty bottles and 1,364 blood bromide level determinations. For 10 patients, the bottle counts did not appear to provide an accurate measure of medicine intake. These patients consistently turned in more empty bottles than iustified by their blood bromide levels. For the group as a whole, individual observations (covering time periods ranging from 1 to 3 months) showed only moderate correspondence between bottle counts and their matched bromide levels (r = 0.51). The correspondence was particularly poor when 7 or more bottles were "missing" (r = 0.22) or when the period of observation exceeded 35 days. Despite the inclusion of some erraneous observations, however, when a 12 or 24 month series of observations was pooled for each patient, the bottle count appeared to be moderately accurate (r = 0.80). A correlation of this magnitude stillleaves an errar of up to 36 per cent (i.e., 1 to 0.802 ), and the errar might be even larger if it were not possible to have the rigorous controls used in this study.

Herbert S. Caron

Papers

Accuracy of doctors' estimates and patients' statements on adherence to a drug regimen

Facedness and emotion related to lateral dominance, sex and expression type ☆

Patients' cooperation with a medical regimen. Difficulties in identifying the noncooperator.

Left‐handers and right‐handers compared on performance and preference measures of lateral dominance

Measuring intake of a prescribed medication A bottle count and a tracer technique compared