RECALL OF RECOMMENDATIONS AND ADHERENCE TO ADVICE AMONG PATIENTS WITHCHRONIC MEDICAL CONDITIONS

Background: Patient adherence to treatment regimens may be a critical mediator between physician recommendations and patient outcomes, but l evels of adherence have not been compared across disease groups, and p atient self-reports have not been well validated. Methods: To determin e recall of and adherence to physicians' recommendations among patient s with chronic medical conditions and to measure the correspondence be tween self reported adherence and discase activity, we analyzed data f rom the Medical Outcomes Study. A total of 1751 patients with diabetes mellitus, hypertension, and heart disease were identified among 20 22 3 patients visiting family physicians, general internists, cardiologis ts, and endocrinologists in 1980. Main outcome measures included recal l of 15 disease-specific recommendations, self-reported general and sp ecific adherence, and correlations between adherence and clinical meas ures of disease activity and control. Results: Among patients in all t hree disease groups, the proportion recalling recommendations to take prescribed medications (greater-than-or-equal-to 90%) exceeded the fra ction recalling recommendations to follow a restricted diet, exercise regularly, and perform various self-care activities (22% to 84%). Adhe rence to recalled recommendations was similar across conditions but va ried markedly according to the nature of the recommendations; for exam ple, 91% of diabetics took prescribed medications but 69% followed a d iabetic diet and 19% engaged in regular exercise. Adherence to recomme ndations was correlated with reduced serum glucose (r=-.33) and glycoh emoglobin (r=-.25) levels among insulin-dependent diabetics and with r educed diastolic blood pressure among patients with hypertension (r=-. 15). Conclusions: The majority of chronically ill patients failed to r ecall elements of potentially important medical advice and did not alw ays adhere to advice that was recalled. Self-reported adherence was co rrelated with clinical measures of disease activity and control. Addit ional research is needed not only to improve adherence to medical advi ce in patients with chronic illnesses but also to determine which life -style changes are truly beneficial for these patients.