The Journal of compliance in health care : JCHC最新文献

Impressive reductions in breast cancer mortality have been demonstrated through regular screening programs using mammograms and clinical breast examinations. Nevertheless, only a small proportion of American women obtain annual mammograms. The US HEALTHCHECK breast cancer screening program offered free breast cancer screening to age-eligible members of a Health Maintenance Organization. Subscribers were mailed packets of materials and asked to return a Breast Risk Assessment Form to determine their eligibility to receive a free mammogram. This study was conducted to assess why women did or did not return a Breast Risk Assessment Form. Brief telephone interviews were conducted with a random sample of compliers and noncompliers (n = 502). Women who complied by returning the Risk Assessment Form said more frequently that they were unlikely to get breast cancer, were older, and more likely to have read the materials and to have rated them positively than women who did not return the Risk Assessment Form.

Patients' noncompliance with medication regimens is a common explanation for the failure of outpatient therapy. Advances in understanding medication noncompliance and approaches to dealing with the problem have been considerably hindered because no satisfactory technique for measuring medication compliance exists. This report describes a new method for electronically monitoring compliance involving tablet medications through the use of a device that automatically records the date and time medication is removed. Data are rapidly recoverable from the monitor and can be presented in two easily interpreted formats. Simple to use, reliable, accurate, relatively small, and inexpensive, the monitor should be useful in clinical drug trials, compliance research, and clinical medicine.

Noncompliance--not following through on a treatment plan--is explained by the traditional acceptance of therapists that many psychiatric patients are not motivated for offered therapy. Despite the twenty-year availability, methodologies to facilitate a successful continuum of care have not been widely implemented. Instead, the patient has been blamed for his lack of motivation. The importance of the therapist's behavior, the context, the setting, and the environment of the treatment continuum are discussed. Long-standing but nontraditional program goals and concepts that facilitate a successful continuum of care are presented.

Another model for integrating a wide diversity of evidence related to compliance is proposed, termed the Health Compliance (HC) model. The HC model incorporates situational-antecedent, consequence, and organismic factors, including cognitive processes, as they relate functionally to compliance behaviors. A selective review of the compliance literature suggests the scope and organizational possibilities of the model.

Patient noncompliance is discussed from an historical perspective with special attention given to the fact that although the medical profession was aware of noncompliance from the earliest times the first research on noncompliance was not done until the 1940's. Trends within the literature on patient noncompliance published between 1943 and 1984 are examined. The largest share of contributions being made to the noncompliance literature was and is from journals devoted to general medicine and psychiatry. The largest share of research is with patients suffering from hypertension, psychiatric patients, and children. An increasing amount of attention is being paid to diabetic patients. The bulk of the research on compliance remains patient-focused, with relatively little but much needed research designed to study characteristics of providers, regimens, or the health care setting. There are good reasons for compliance researchers to consider diabetology as a worthwhile area for investigations.