From diagnosis to drug taking: staff compliance with guidelines and patient compliance to prescriptions in Burkina Faso

Objective. We studied compliance with guidelines and prescriptions for six steps of the health care process to identify the step with the greatest nee d for improvement. Design. In a cross-sectional study we used hidden observation in health cen tres and counting of remaining drugs in home visits. We assessed provider c ompliance with guidelines for medical history physical examination, drug ch oice, and explanation of drug dosing, and patient compliance for drug buyin g and drug taking. Setting, The study took place in six rural health centres in Burkina Faso. Main outcome measures. We measured unconditional (UPC), conditional (CPC) a nd accumulated proportions of compliant procedures (APC). UPC determined th e proportion of compliant procedures independent from earlier steps. CPC wa s defined as the proportion of compliant procedures among those which were compliant in all previous steps. APC was the proportion of procedures compl iant in all steps including the step concerned. Results. Twenty-three per cent UPC medical history, 27% UPC (CPC = 39%) cli nical examination, 59% (83%) drug choice, 22% (40%) explanation of dosing, 71% (75%) drug buying, and 63% (67%) drug taking compliance. Two per cent o f the patients had compliant procedures for all steps of the process (APC). Conclusion. The majority of patients did not get treatment compliant with g uidelines. Diagnosis had the largest need for improvement. UPC, CPC and APC were useful to identify steps with the greatest need for improvement and t o assess quantitatively aspects of quality of care.