Patient Compliance State Of The Art: Program Design, Theoretical Models, & Their Limitations
The No-Nonsense Summary
The State of the Art
1. Compliance theories & programs have thus far had little impact on day to day clinical practice
2. Some compliance enhancement programs & models work with some patients some of the time, but none work with all patients all the time
3. Theories of adherence based on patients who behave rationally lead to the clinically & ethically flawed classification of patients, vis-à-vis compliance, as “Good Patients,” “Bad Patients,” and “Pitiful Patients”
4. All important contemporary theories of adherence are based on patients who behave rationally
Clinicians have battled noncompliance since at least the fifth century BC (and no doubt long before that) when Hippocrates advised physicians1 to “keep watch also on the faults of the patients which often make them lie about the taking of things prescribed.”2
Theories explicating noncompliance have been generated, adapted, and revised; automated reminders and medication dispensers constructed and sold; courses in doctor-patient communications and empathy added to the medical school curriculum; public service announcements featuring celebrities broadcast; four-color national magazine spreads printed; call centers staffed; brochures, films, and tapes distributed; web sites created; disease management programs developed; and laws passed, all in the hope of improving adherence.
Section Outline
- The Verdict: Limited Efficacy
- Overview of Current Compliance Models
- Overview of Current Compliance Program Design
- Good Patients, Bad Patients, Economic Man, and Other Nonexistent Species
PDF Download: State Of The Art
The State Of The Art Section, with citations, is available for download in PDF format: State Of The Art
- This is the now-clichéd quotation to which I’ve alluded in Noncompliance Basics↩
- Wright EC, Non-compliance-or how many aunts has Matilda? Lancet 1993; 9; 342(8876): 909-913.↩
