EFFECTIVENESS OF INTERVENTIONS TO IMPROVE PATIENT COMPLIANCE - A METAANALYSIS

OBJECTIVES. This article summarizes the results of 153 studies publish ed between 1977 and 1994 that evaluated the effectiveness of intervent ions to improve patient compliance with medical regimens. METHODS. The compliance interventions were classified by theoretical focus into ed ucational, behavioral, and affective categories within which specific intervention strategies were further distinguished. The compliance ind icators broadly represent five classes of compliance-related assessmen ts: (1) health outcomes (eg, blood pressure and hospitalization), (2) direct indicators (eg, urine and blood tracers and weight change), (3) indirect indicators (eg, pill count and refill records), (4) subjecti ve report (eg, patients' or others' reports), and (5) utilization (app ointment making and keeping and use of preventive services). An effect size (ES) r, defined as Fisher's Z transformation of the Pearson corr elation coefficient, representing the association between each interve ntion (intervention versus control) and compliance measure was calcula ted. Both an unweighted and weighted r were calculated because of larg e sample size variation, and a combined probability across studies was calculated. RESULTS. The interventions produced significant effects f or all the compliance indicators (combined Z values more than 5 and le ss than 32), with the magnitude of effects ranging from small to large . The largest effects (unweighted) were evident for refill records and pill counts and in blood/urine and weight change studies. Although sm aller in magnitude, compliance effects were evident for improved healt h outcomes and utilization. Chronic disease patients, including those with diabetes and hypertension, as well as cancer patients and those w ith mental health problems especially benefited from interventions. CO NCLUSIONS. No single strategy or programmatic focus showed any clear a dvantage compared with another. Comprehensive interventions combining cognitive, behavioral, and affective components were more effective th an single-focus interventions.