Conviction as a basis for compliance and strategies for improving compliance

The aim of the present study was to correlate statements made by 100 patien ts of an internal medicine ward regarding their compliance before hospitali sation, with their personal knowledge of and convictions about their own ph armacotherapy. Data were collected in structured interviews of 9 questions carried out by a medical person not involved in current treatment. The pati ent sample (mean age +/- SE: 66.8 +/- 1.3 years) included 42 women and 58 m en whose mean number of prescribed medications before hospitalisation was 4 .7 +/- 0.22. Good treatment compliance was reported by 78% of the patients, while 13% admitted noncompliance. Knowledge about the drugs they had been prescribed ranged from perfect (30%) to none (34%) and was significantly di fferent between compliers and non-compliers, with patients who knew their m edications at least by name being fairly compliant (p = 0.048). Independent ly of the statement about compliance, the patients used three main strategi es to ensure regular intake of daily medication: visual aids (69%), couplin g to a ritual (26%) or supervision by a third person (6%). Criteria such as gender, the number of prescribed medications, personal perseverance, or pe rsonal definition of the sense of the prescribed pharmacotherapy, or the ar guments expected to be used by a physician when recommending a pharmacother apy did not differ between compliers and non-compliers. Thus, compliance ap pears to have its roots mainly in the conviction level of each patient: int ention will be transformed into action when deemed correct according to the individual's personal criteria. This may lead to both compliance and to no n-compliance with medical recommendations. This study, which is based on pa tient reports, supports the conclusion that drug compliance may be enhanced by increasing patient's knowledge about their own pharmacotherapy and by h aving patients use specific strategies to guarantee regular daily intake of drugs. Prospective studies should therefore address the question of whethe r providing specific information according to a patient's convictions will ultimately translate into improved compliance.