Compliance of Medical Outpatients with Prescribed Medication: A Protocol for a Controlled Trial of Clinical Intervention

Abstract

<p>Lack of compliance with therapeutic regimens is an important cause of inadequate or incomplete medical care.</p> <p>For the purposes of furthering knowledge about problems of compliance, this thesis first surveys issues of compliance as reported in the current scientific literature and then proceeds with the development of specific strategies to improve compliance and finally with the development of a research design for testing these strategies in a controlled clinical fashion among a cohort of medical patients newly initiated into therapy.</p> <p>The compliance-intervention strategies include, first, special techniques in patient education, utilizing potent behavior-oriented teaching materials, second, a flexible, opportunistic approach to fitting medical appointments and medication-taking into a patient's existing rituals and daily routine, a process here termed "tailoring", and, third, a behavior modification paradigm which reinforces prescribed behavior.</p> <p>Hypertension has been chosen as a disease appropriate for the testing of the strategies because of its high prevalence and its known harmful effects, because of tho existence of efficacious treatments for it, and because of the small proportion of its victims who are receiving adequate treatment, whether for lack of detection of the condition or lack of compliance with its therapy.</p> <p>A steel mill (Dominion Foundries and Steel Company) in Hamilton, Ontario, has been selected as an ideal study site for several reasons. First, the Company is owned by its employees and this has led to an exceptionally stable employee group. Second, it has an active and cooperative employee health service. Thirdly, the health service staff has become concerned about the problem of untreated hypertension through its periodic health assessment program and the high prevalence of hypertension among employees lost from active duty through vascular disease.</p> <p>At the time of this writing the project has been funded through the Medical Research Council and is just getting underway.</p>