The Johns Hopkins Gazette: August 3, 1998
August 3, 1998
VOL. 27, NO. 41


Compliance Interventions Yield Maximum Benefits

Johns Hopkins Gazette Online Edition

Researchers from the School of Public Health have found that patients with chronic diseases such as diabetes, high blood pressure and cancer receive the most benefit from "compliance interventions"--the strategies doctors use to get patients to follow orders, such as checking whether a person has lost weight, refilled a prescription or gotten a cholesterol test.

The investigation, which appeared in the August issue of Medical Care, also showed that compliance interventions are more effective in increasing appointment making and prescription filling than in appointment keeping and pill taking.

At the same time, however, the authors found that almost all compliance interventions did at least some good and that, in terms of such things as lives saved or heart attacks averted, even the smallest increases in patient compliance reduced suffering and costs significantly when multiplied by the large numbers of patients in any health care system.

Patient noncompliance is a serious medical problem, with most researchers agreeing that at least half of patients for whom drugs are prescribed don't receive full benefit because of failure to follow instructions. An estimated one-third of patients use their medications in ways that pose a serious threat to health.

The investigators made a statistical analysis of results from 153 previous studies that had measured the effectiveness of compliance interventions. "There were no magic bullets evident in our review," said lead author Debra L. Roter, professor, Health Policy and Management. "One-on-one education by the physician, classes for groups of parents, telephone calls, mailings, pharmacists' reports about pill counts and prescription history-- all had nearly the same impact on compliance."

Although no single strategy or program showed a clear advantage over any other, the study did show that mixed interventions were more effective than a single intervention. And, as one might expect, educational interventions employing two or more different ways of learning helped more patients than did those using just one strategy, perhaps reflecting the fact that people learn in different ways.

Patients with chronic diseases benefited especially from compliance interventions, with diabetic patients benefiting the most and those with asthma, cancer, hypertension and mental illness benefiting moderately. Patients with acute infections needing antibiotic treatment benefited the least.

The researchers also found that mailing a form letter to remind patients about appointments or tests increased compliance as much as making a more time-consuming telephone call. In contrast, offering patients rewards or incentives to keep appointments was largely ineffective by itself.