N. Homedes et A. Ugalde, PATIENTS COMPLIANCE WITH MEDICAL TREATMENTS IN THE THIRD-WORLD - WHATDO WE KNOW, Health policy and planning, 8(4), 1993, pp. 291-314
Responding to the slogan of Health for All for the Year 2000, third wo
rld governments have expanded the provision of primary health services
, and with it, the number of prescriptions has increased phenomenally.
However, we know very little about how third world patients are using
prescribed medicines. In order to assess the available information, w
e reviewed 37 empirical studies on compliance located through electron
ic lines and networking. By and large, the orientation of the studies
is biomedical. The authors measure levels of compliance and advance re
commendations to increase them. We found little consistency in the def
inition of compliance and a variety of methodologies used in its measu
rement. In spite of methodological problems, most researchers found lo
w levels of adherence to medical regimens. Low levels of adherence rai
se questions about the quality of care, iatrogenic effects caused by t
he inadequate use of modern medicines, and the health and economic imp
act of health investments. At the same time it is recognized that, giv
en current prescribing practices and lack of efficacy of many medicine
s, compliance may add little to the quality of care. Compliance and pr
escribing behaviours should always be examined together and as part of
quality of care assessments.