Institute for the Study of
Healthcare Organizations & Transactions


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Compliance:  Not Just for Patients Anymore

In the traditional medical model of healthcare, compliance is a problem for the patient. The physician’s job is to diagnose disease and prescribe treatment, and the patient’s job is to do what is recommended.  Across a wide variety of chronic and life-threatening diseases, from asthma and hypertension to epilepsy and renal disease, compliance with prescribed medical regimens is universally acknowledged to be a central problem for health care professionals. According to some analyses, as many as 50 percent or more of patients take prescribed medicines improperly—if they take them at all. Although some drug treatments (such as AZT) have been developed that greatly slow the progression of HIV to AIDS, compliance with these treatments by HIV-infected individuals is often remarkably poor given what is at stake. The situation is just as bad, if not worse, for compliance with such disease prevention regimes as diet and exercise.

In the current environment, where striking advances in biomedical research are made almost every day, the problem of compliance underscores the fact that developing a pill is only one step toward effective treatment or prevention. We must also get patients to take their pills: This is a behavioral problem that must be addressed at the individual and sociocultural levels of analysis. Accordingly, physicians and social scientists interested in health behavior have spent a great deal of energy trying to figure out why patients fail to comply with medical recommendations, and what can be done to increase compliance rates for both treatment and prevention regimes. Some analyses focus on physician-patient communication, while others focus on cognitive factors, such as the patient’s mental representation of disease and its consequences, or sociocultural factors, such as the influence of the patient’s family and peers.

However, compliance should not be construed as only a problem for healthcare consumers. Healthcare providers also must adhere to good health practices as well. Two recent examples suggest that compliance may be at least as much a problem for physicians as it is for the patients they treat.

John F. Kihlstrom, PhD

Copyright © 2000 Institute for the Study of Healthcare Organizations & Transactions