PATIENTS COMPLIANCE WITH MEDICAL TREATMENTS IN THE THIRD-WORLD - WHATDO WE KNOW

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.