About Allan Showalter, MD & AlignMap
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The Short Version
I’m a psychiatrist with a long-time interest in what is commonly called patient compliance (more about that label later). AlignMap is the name I’ve given to this site which focuses on the idea that significant improvements in the proportion of patients who complete their prescribed treatment is dependent on aligning the goals of patients, medical professionals, caregivers, clinical organizations, pharmaceutical companies, third party payers, medical device manufacturers, governmental health agencies, and other stakeholders.
Background
Since entering clinical practice, I’ve been curious about patient compliance. Why do some patients adhere to healthcare recommendations while others don’t and still others sometimes do and sometimes don’t? Why do some patients agree to take a medication but then never fill the prescription? Why do some faithfully show up at appointments to report that they never missed a pill, always follow their diabetic diet, or have completed their routine blood tests when it is all too obvious that they have been noncompliant? My experiences are not, of course, unusual; indeed, every clinician has observed similar phenomena. Nonetheless, I found the topic and its tangents intriguing, especially when my reading revealed that this problem had produced many thoughtful journal articles and books and no small volume of pontification, but precious little in the way of useful answers.
I now believe that current efforts to enhance compliance are, if not doomed, then at best restricted to isolated successes with unacceptably small benefits compared to the costs of the complex, labor-intensive programs that are most likely to be effective.
The problem is that “medical compliance” is little more than a name (a name, incidentally, that is almost unanimously held in contempt but is almost universally the terminology of use if not of choice) in search of a phenomenon. Other than calculating a purely mathematical compliance rate that measures the number of times a patient, for example, took a medication compared to the number of times that patient should have taken that medication, the meaning of medication compliance (or patient compliance or treatment adherence or … ) is so unclear that it is not only confusing but also dangerous.
I am now convinced that the focus should be shifted from compliance to the goal of optimal treatment implementation. This web site is an elaboration and discussion of this idea.
