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Correlations between subjective compliance, objective compliance, and factors determining compliance in geriatric hypertensive patients treated with triamterene and hydrochlorothiazide.

There are correlations between objective and subjective compliances on the one hand and factors determining compliance (3 times drug intake per day, no support by the family to get over the disease and no nicotine abuse). In agreement with the literature, mainly subjective criteria (due to disease, therapy, doctor, and environment) influence compliance strongly. To realize their personal psychological task to help the patients even better it is of importance for the doctors to analyze the variability of these parameters. Measures to improve compliance, such as better psychological guidance for the patient taking these factors and the patient's personality into consideration, can be helpful to improve the relatively poor compliance reported in the literature to be as little as 20-50%.

Age Factors↗

Differences in bladder compliance with time and associations of bladder management with compliance in spinal cord injured patients.

PURPOSE: Controversy continues on the optimal method of bladder management in spinal cord injured patients. We investigated the effects of bladder management on bladder compliance and changes in compliance with time. MATERIALS AND METHODS: We retrospectively reviewed the charts, and video urodynamic and upper tract radiographic studies of 316 patients with spinal cord injury. Patients were categorized according to interval since injury and bladder management method, including clean intermittent catheterization, spontaneous voiding and chronic Foley catheterization. Those with upper tract complications were compared with asymptomatic controls at the bladder compliance threshold values of 10.0, 12.5, 15.0 and 20.0 cc/cm. water. RESULTS: No significant differences were noted among bladder management method groups for followup, level, completeness or mechanism of injury. A bladder compliance threshold of 12.5 cc/cm. water was selected for the remaining comparisons based on the frequency of complications compared with asymptomatic controls. Patients using intermittent catheterization had a significantly higher incidence of normal compliance than the Foley management group for suprasacral, complete and incomplete injury (p<0.01). Normal bladder compliance was more common in patients with suprasacral than sacral and incomplete than complete spinal cord injury for each bladder management type. Logistic regression analysis of compliance versus bladder management and age of injury (interval since injury) revealed that intermittent catheterization and spontaneous voiding were associated more with normal compliance than Foley catheterization (RR = 9.2, 5.4 and 1.0, respectively). Combined data showed that each successively older age of injury cohort was at 23% greater risk for loss of normal compliance than the preceding cohort. Low compliance was statistically associated with vesicoureteral reflux, radiographic upper tract abnormality, pyelonephritis and upper tract stones (p<0.01, <0.01, 0.04 and <0.01, respectively). CONCLUSIONS: Clean intermittent catheterization protects bladder compliance in spinal cord injured patients regardless of the level or completeness of injury and helps to prevent low compliance with time. Also, in the population studied low compliance was associated with upper tract complications. Therefore, clean intermittent catheterization is the superior method for preserving bladder compliance and preventing the upper tract complications associated with low compliance.

Adult↗

The ideal compliance world: integrating physicians into the compliance program.

Compliance officers are in a unique position to provide guidance to physicians and will succeed in gaining physician support and buy-in when appropriate steps are taken to integrate physicians into the compliance program. First and foremost, the compliance officer's primary responsibility is to apprise physicians of the seriousness nature of current compliance issues. When physicians are provided with clear information through a variety of media, they will understand that compliance program goals and objectives will resolve compliance-related issues dilemmas. Next, the compliance officer should expect no less than the ideal compliance world. Recruit physician champions who will actively participate in compliance program planning and development. Call upon medical staff members to get involved in implementation stages of compliance action plans and engage physician leaders to educate and train their physician peers on compliance-related issues. Most importantly, minimize individual physician liability by providing adequate education programs to physicians. Help them to master the art of coding and documentation and to mitigate any prospect of fraud and abuse or compliance-related concerns. Last, collaboration is the key--the compliance officer must provide guidance to the physician so that the physician may continue to fulfill the role of leader and healer. In turn, the physician must recognize that his or her actions and those of the hospital and system are inseparable and that they must actively participate in compliance program initiatives.

Cooperative Behavior↗

Pediatric psychotropic medication compliance: a literature review and research-based suggestions for improving treatment compliance.

Without good compliance the best psychiatric treatment is ineffective. This article reviews what is known or can be inferred about compliance with psychiatric medications in the pediatric population. The review includes discussions of assessment techniques, risk and protective factors, the relevant research literature, and research-based practical techniques to improve compliance. A Medline search surveying the years from 1966 to August 2000 yielded only seven peer-reviewed papers reporting on compliance with pediatric psychopharmacology. All seven studies looked at stimulant compliance among children with attention deficit hyperactivity disorder. Reported levels of compliance range from 56% to 75%. These rates, although low, are likely to be overestimates of actual compliance. We review two related areas of research for which there are small but significant bodies of knowledge: pharmacological compliance studies among adult psychiatric populations and pediatric medical populations. This literature supports the idea that medication compliance is a significant obstacle to the effective treatment of patients. Because compliance rates are lower for children as compared to adults and psychiatric patients as compared to medical patients, we suspect that children with psychiatric illness may be at great risk for poor medication compliance. Fortunately, the research literature demonstrates several simple techniques that clinicians can use to improve medication compliance among their patients. The treatment alliance; education; and medication duration, dosing, palatability, and cost can all be tailored to improve medication compliance.

Adult↗

[Cross-national comparison of drug compliance and non-compliance associated factors in the elderly with polypharmacotherapy].

BACKGROUND: Population of seniors in the Czech Republic consumes more than 35 % of all prescribed medications. Currently, Czech seniors take on the average 4-5 prescribed drugs. However, our knowledge about factors influencing drug compliance is scarce particularly in seniors with polypharmacotherapy. Non-compliance can contribute to treatment failure and increases the risk of adverse drug reactions. The aim of the study is to compare drug compliance in the elderly in 11 European countries and to assess the impact of demographic and drug-related factors on non-compliance to medication. METHODS AND RESULTS: Cross-sectional comparative study in 3881 elderly subjects living in the community receiving home-care services in 11 European countries participating in ADHOC (Aged in Home Care) study. In the sample of Czech subjects we performed in-depth analysis of causes and factors associated with non-compliance in patients with polypharmacotherapy. 12.5% (n=456) of European seniors were non-compliant with prescribed medication with significantly higher prevalence of non-compliance in the CR (33.5 %) and Germany (17.0 %). In the Czech sample following non-compliance risk factors have been identified: taking > or = 7 drugs per os (OR= 2.2), 10 single applications/day (OR= 2.5), more than twice daily dosing (OR= 2.4), problems with drug preparation (OR= 4.6), polypharmacotherapy 5 years and longer (OR= 5.5) and drug preparation without supervision or help (OR= 2.8). The highest prevalence of non-compliance was found for antidepressants (80 %), antiasthmatics (68 %), fibrates (60 %), nonsteroidal antiinflammatory drugs, vasodilatators, anticoagulants/antiplatelet drugs and nootropics (50 %). Among the most common causes, patients reported forgetting to take the drug (74.3 % patients), mistrust in drug effect (10.6%) and fear of taking "too many drugs" (8.6 %). CONCLUSIONS: Non-compliance to prescribed drug regimen is a prevalent problem in one third of the Czech seniors and was found to be the highest among 11 European countries. Doctors prescribing to older people have to monitor purposefully compliance and strenghten co-operation and motivation of the patient to adhere with prescribed drug regimen. Particularly in seniors with polypharmacotherapy it seems necessary to simplify drug regimen as much as possible. In elderly patients with physical disability, cognitive impairment or depression supervision and/or help of another person with drug preparation and application may improve drug compliance.

Aged↗

Age-related abnormalities in arterial compliance identified by pressure pulse contour analysis: aging and arterial compliance.

The objective of this study was to evaluate age-related changes in pulsatile arterial function. Aging alters arterial pulsatile function and produces consistent changes in the pressure pulse contour. A reduced systemic arterial compliance that can be derived from analysis of the pulse contour is regarded as the best clinical index of impaired pulsatile arterial function and may mark the presence of early vascular damage. We analyzed intra-arterial brachial artery waveforms in 115 healthy normotensive volunteers (83 men, 32 women) and radial artery waveforms obtained with the use of a calibrated tonometer device in 212 healthy volunteers (147 women, 65 men). A computer-based assessment of the diastolic pressure decay and a modified Windkessel model of the circulation were used to quantify changes in arterial waveform morphology in terms of large artery or capacitive compliance, oscillatory or reflective compliance in the small arteries, inertance, and systemic vascular resistance. Large artery compliance and oscillatory compliance correlated negatively with age for both invasive and noninvasive groups (r=-0.50 and r=-0.55; r=-0.37 and r=-0.66; P<0.001 for all). The slopes of the regression lines for the decline in oscillatory compliance with age were significantly steeper than those recorded for large artery compliance estimates. The change in blood pressure with age independently contributed to the decrease in large artery compliance but not oscillatory compliance in both groups. Consistent age-related changes were found in the pressure pulse contour by analysis of waveforms obtained invasively or noninvasively from the upper limb. The change in the oscillatory or reflective compliance estimate was independent of blood pressure change and may represent a better marker than large artery or capacitive compliance of the degenerative aging process in altering pulsatile arterial function.

Adult↗

Compliance and adverse drug reactions: a prospective study with ethinylestradiol using continuous compliance monitoring.

This study examined the relationship between adverse reactions and patient compliance with ethinylestradiol at 40 micrograms twice daily versus 20 micrograms four times daily. In a randomized study 61 female patients with primary infertility were prescribed the drug twice daily (n = 31) or four times daily (n = 30). Ethinylestradiol was administered for 7 days before the sperm cervical mucus penetration-test was performed for hormonal standardization of the cervical mucus quality. Drug compliance was measured by continuous monitoring using the Medication Event Monitoring System. Two parameters were evaluated: percentage of prescribed doses taken (administration compliance) and adherence to the prescribed dose schedule (regimen compliance, number of days with two or four dosing events recorded). Adverse drug reactions were assessed using a standardized questionnaire. Fourty-four women experienced side effects, of which 81% were rated by patients as being mild. Patient compliance was higher with the twice daily than with the four times daily regimen: 85% versus 65% prescribed doses taken (P < 0.05). There was no significant difference in compliance comparing patients with and without adverse reactions (82% versus 72%, respectively), but compliance was lower and more irregular with at least 3 versus one or two adverse reactions reported: 54% versus 84% in administration compliance and 31% versus 58% in regimen compliance (P < 0.05). Compliance was also lower in patients with nausea and vomiting than in those without these symptoms, 59% versus 91% and 34% versus 66% (P < 0.005), respectively, and lower with moderate or severe compared to mild side effects; 48% versus 85% and 25% versus 59% (P < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

The Amsterdam Hip Protector Study: compliance and determinants of compliance.

Hip protectors appear to be effective in reducing the incidence of hip fractures. However, compliance is often poor. Therefore, the objective of this study was to examine the compliance and determinants of compliance with external hip protectors. A prospective study was performed in residents from apartment houses for the elderly, homes for the elderly and nursing homes with a high risk for hip fracture (n=276). The study was performed within the framework of the Amsterdam Hip Protector Study, a randomized controlled trial examining the effect of external hip protectors on the incidence of hip fractures. Compliance was assessed by unannounced visits at 1, 6 and 12 months after inclusion in the study. During the visits, a member of the research team checked whether the participant was wearing the hip protector and, if so, whether it was worn correctly. Furthermore, data on potential determinants of compliance were collected by interviewing the participants or their nurses. Compliance was 60.8% after 1 month (n=217), 44.7% after 6 months (n=246), and 37.0% after 12 months (n=230). Of those wearing the hip protector, 86.7%, 91.7% and 96.5% of the participants were wearing the hip protector correctly after 1, 6 and 12 months respectively; and 14.8%, 16.1% and 8.8% respectively reported wearing the hip protector at night. Compliance after 12 months was predicted by the compliance after 1 month (RR=2.04; 90% CI: 1.05-3.96). Furthermore, people who experienced one or more falls in the half year before baseline had a lower probability of being compliant at 6 months (RR=0.72; 90% CI: 0.52-0.99). In conclusion, compliance is a very important issue in hip protector research and implementation. Although, the compliance percentages were moderately high during the unannounced visits in this study, not everyone was wearing the protector correctly and most participants did not wear the hip protector during the night.

Aged↗

Cardiac rehabilitation exercise programme. Compliance and compliance-enhancing strategies.

Compliance-enhancing strategies in cardiac rehabilitation should be investigated only if it has been shown that the condition under consideration is an important cause of mortality and premature disability, that the intervention or therapy is effective, and that compliance with the intervention is poor. Coronary artery disease is the leading cause of death and premature disability in industrialized countries. Evidence from randomised controlled trials of supervised exercise rehabilitation after documentation of coronary artery disease suggests a reduction in fatal event rates, and an initial improvement in both exercise tolerance and psychosocial status, although these differences between experimental and control subjects are reduced over time. Poor compliance with supervised exercise programmes is a problem. This suggests that compliance enhancement with programmes of exercise rehabilitation for cardiac patients is an appropriate area of research. A number of issues recur in compliance research including the investigation of compliance-enhancing strategies in exercise rehabilitation. These relate to the specification of definition of compliance, the description of the experimental protocol or strategy, the selection and description of the sample to be studied, the randomisation of the sample, the selection of compliance measures, contamination and co-intervention, monitoring for decay, and various ethical issues. Compliance-enhancing strategies must be designed with these methodological issues in mind. These issues are discussed with specific reference to randomised controlled trials of compliance-enhancing strategies to cardiac exercise rehabilitation.

Coronary Disease↗

Dosage frequency and drug-compliance behaviour--a comparative study on compliance with a medication to be taken twice or four times daily.

The objective of the study was to investigate patient compliance with two different dosage regimens. Ethinyloestradiol 80 micrograms daily was prescribed to 35 female outpatients to be taken as 20 micrograms four times daily or 40 micrograms twice daily for 7 days. It was given to standardise cervical mucus before a sperm cervical mucus penetration-test (SCMPT) was performed. Sixty-five patients with primary infertility (mean age 29.9 y) completed the study. Compliance was assessed by microprocessor-based compliance monitoring. Besides compliance (percentage of prescribed doses taken), the adherence of the patients to the dosage schedule was evaluated--'regimen compliance'. The latter parameter of drug intake behaviour was calculated by the number of days in which 2 (BID) or 4 openings (QID) were recorded by the electronic monitor. As a third parameter, the deviation from the prescribed dosing intervals, i.e. 12 or 6 h, was also determined. Partial compliance was the predominant finding and only 9 patients (13.8%) were over-compliant. Mean compliance was 75.7% in all 65 patients as a group, range 7.1 to 143%. The mean compliance with the QID regimen was 67% compared to 85% with the BID regimen. 'Regimen compliance', the percentage of doses taken on schedule, was 36% and 63% for the QID and BID regimens, respectively. Drug-intake behaviour was more erratic with the QID than the BID regimen, as indicated by the 55% of opening intervals recorded which exceeded the range of 3-9 h (mean: 6 h), compared to only 19% exceeding 6-18 h intervals (mean: 12 h).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: prospective assessment with implications for enhancing compliance.

Non-compliance with therapy is a significant problem, particularly when the disease process is chronic and therapeutic regimens are employed for prolonged periods. We assessed the prevalence and variables associated with compliance with antiretroviral therapy in patients with human immunodeficiency virus infection, by means of a longitudinal observational study of 46 patients aged 23 to 68 years, with human immunodeficiency virus infection, followed at the Pittsburgh VA Medical Center. Data on demographics, medical status, physical functioning (Karnofsky performance scores), CD4 lymphocyte count, depression (Beck depression inventory), coping (inventory of coping with illness scale scores), and psychological and emotional stress (profile of mood states scale scores), were prospectively assessed on all patients at baseline and every 6 months. Compliance was assessed at 6 and 12 months: patients taking > or = 80% of antiretroviral therapy were considered compliant. Overall, 63% of patients were compliant with antiretroviral therapy. Age, education, employment, religious support, and perceived quality of life did not correlate with compliance. By univariate analysis, lack of prior intravenous drug use was significantly associated with compliance (p = 0.01). Compliant patients had significantly better adaptive coping (p = 0.03), and less depression (p = 0.04). By multivariate analysis, black race was significantly associated with non-compliance independent of intravenous drug use and educational status. History of prior opportunistic infection (which presumably heightens the perceived severity of illness) (p = 0.02), and lesser psychological disturbance scores (p = 0.02) were associated with compliance. Compliance was observed despite the greater number of prescription medications taken by compliant patients (p = 0.04). At 12 months, Karnofsky scores were better in compliant patients (p = 0.02), although mortality was not different. Besides identifying predictors of compliance, our data suggest that symptoms of depression and psychological stress be sought in patients with non-adherence.

Activities of Daily Living↗

Comparison of the digoxin marker with capsule counting and compliance questionnaire methods for measuring compliance to medication in a clinical trial.

During the last quarter of the third year of follow-up in the Helsinki Heart Study, compliance to medication was measured in 1739 patients with digoxin used as a marker substance, capsule counting and a compliance questionnaire. The estimates for good and poor compliers were found to be highly dependent on the method and the cut-off points chosen for the compliance allocation. The methods studied here were more reliable for the detection of poor rather than good compliance. In the poor compliance group, defined with the use of the digoxin marker, there was 39% of subjects who returned less than 5% of their capsule dosage or reported a deviation less than 5%. In the good compliance group, defined by the digoxin marker, only 11.8% of patients either returned or reported a deviation of at least 25% of their dose. The compliance was better when measured by the questionnaire than by capsule counting. The size of the poor compliance group, defined by the use of the digoxin marker, was as large as a group who had returned at least 27% of their capsule dose and a group who had reported a deviation of 11% or more from their dosing schedule. The size of the group allocated to the good compliance category by the use of the digoxin marker was equivalent in size to a group of patients who had returned less than 15% of their prescribed dose or reported a deviation of less than 6% from their prescription. When the strictest criteria for the combination of all three methods were used, 57% of subjects were classified as good and 31% as poor compliers to medication in the third year of the primary prevention trial designed to reduce the incidence of coronary heart disease.

Capsules↗

Cross-sectional compliance overestimates arterial compliance because it neglects the axial strain.

A high resolution echo-tracking system permits the calculation of cross-sectional compliance considering vessel diameter variations alone, and assumes that longitudinal movement of the vessel wall due to pulse pressure is negligible. However, using piezoelectric crystals sutured on the adventitia of the vessel wall we demonstrated that arterial length changes up to 5% (mean 2.7%) as a function of pulse pressure. Therefore, cross-sectional compliance seems to provide a limited approximation of the real phenomenon because it neglects axial vessel movement. Axial vessel movement is taken into account when the vessel compliance is calculated according to the principle of continuity of the mass: [equation: see text]. To verify this hypothesis we measured the blood flow gradient through 10 cm long segments of 10 pig carotid arteries (Qin - Qout) and divided it for the derivative of blood pressure over a given time (deltaP/deltat). For the same vessels, we calculated the cross-sectional compliance (CC) using the echo-tracking system (NIUS 02). We found a CC of (5.91 +/- 0.4) x 10(-7) micro m(2)/mm Hg and a segmental carotid compliance or dynamic compliance (C(d)) of (6.21 +/- 0.2) x 10(-8) micro m(3)/mm Hg. The impact of axial strain in calculations of compliance results in a dynamic compliance, which is one order of magnitude smaller than traditionally calculated arterial compliance.

Animals↗

[Conviction as a basis for compliance and strategies for improving compliance].

The aim of the present study was to correlate statements made by 100 patients of an internal medicine ward regarding their compliance before hospitalization, with their personal knowledge of an convictions about their own pharmacotherapy. Data were collected in structured interviews of 9 questions carried out by a medical person not involved in current treatment. The patient sample (mean age +/- SE: 6.8 +/- 1.3 years) included 42 women and 58 men whose mean number of prescribed medications before hospitalization was 4.7 +/- o.22. Good treatment compliance was reported by 78% of the patients, while 13% admitted non- compliance. Knowledge about the drugs they had been prescribed ranged from perfect (30%) to none (34%) and was significantly different between compliers and non-compliers, with patients who know their medications at least by name being fairly compliant (p = 0.048). Independently of the statement about compliance, the patients used three main strategies to ensure regular intake of daily medication: visual aids (69%), coupling to a ritual (26%) or supervision by a third person (6%). Criteria such as gender, the number of prescribed medications, personal perseverance, or personal definition of the sense of the prescribed pharmacotherapy, or the arguments expected to be used by a physician when recommending a pharmacotherapy did not differ between compliers and non-compliers. Thus, compliance appears to have its roots mainly in the conviction level of each patient : intention will be transformed into action when deemed correct according to the individual's personal criteria. This may lead to both compliance and to non-compliance with medical recommendations. This study, which is based on patient reports, supports the conclusion that drug compliance may be enhanced by increasing patient's knowledge about their own pharmacotherapy and by having patients use specific strategies to guarantee regular daily intake of drugs. Prospective studies should therefore address the question of whether providing specific information according to a patient's convictions will untimately translate into improved compliance.

Aged↗

Variability in arterial diameter and compliance: compliance modulation reserve.

BACKGROUND: Some antihypertensive drugs are known to increase arterial compliance in hypertensives; how far compliance can be increased is unknown. DESIGN: We studied eight mildly hypertensive patients to determine how far radial artery compliance can be acutely increased, i.e. the extent of the compliance modulation reserve. METHODS: We evaluated radial artery compliance by a new technique, assessing it throughout the cardiac cycle before and after the intra-arterial infusion of a vasodilator agent (papaverine). RESULTS: Before papaverine, compliance decreased progressively through diastolic to systolic blood pressure values. This was the case also during the papaverine infusion. However, over the full systolo-diastolic pressure range, compliance was increased by about 40% with papaverine. CONCLUSIONS: In hypertensive subjects radial artery compliance can be markedly increased on a acute basis, indicating that those antihypertensive drugs that improve compliance have a considerable reserve to act upon.

Adult↗

The relationship between TLV-TWA compliance and TLV-STEL compliance.

The purpose of this study was to investigate the relationship between the American Conference of Governmental Industrial Hygienists' (ACGIH) time-weighted average (TLV-TWA) and short-term exposure limit (TLV-STEL) Threshold Limit Values (TLVs). It is of value to determine if one or the other of these exposure limits is inherently more stringent so that exposure monitoring strategies may be devised which efficiently use available resources and effectively control exposures to meet both exposure limits. The ACGIH short-term exposure limit (TLV-STEL) imposes three conditions on short-term (15-minute) exposures. These conditions involve exceeding the TLV-TWA and TLV-STEL levels and the time-separation of those short-term exposures that exceed the TLV-TWA level. These conditions were analyzed to produce eight unique component probabilities for TLV-STEL non-compliance. The sum of these eight components is the total probability of TLV-STEL non-compliance. Mathematical expressions for the eight probability components are derived in terms of the probability that a single 15-minute exposure exceeds the time-weighted average threshold limit value (TLV-TWA) and the geometric standard deviation of these 15-minute exposures. These expressions were applied to various hypothetical workplaces, and the relationship between TLV-TWA and TLV-STEL compliance is presented. The results showed that non-compliance of 15-minute exposures with the TLV-STEL level is only one part of overall TLV-STEL non-compliance. The additional ACGIH provisions for TLV-STEL compliance--the number of 15-minute exposures exceeding the TLV-TWA level and the number of clean periods separating such exposures--can be important factors in determining TLV-STEL compliance. It is concluded that compliance with all provisions of the ACGIH TLV-STEL adds a degree of stringency that greatly enhances the likelihood of TLV-TWA compliance for most workplace environments.

Beryllium↗

Reduction of compartment compliance increases venous flow pulsatility and lowers apparent vascular compliance: implications for cerebral blood flow hemodynamics.

The global compliance of a fixed-volume, incompressible compartment may play a significant role in determining the inherent vascular compliance. For the intracranial compartment, we propose that the free-displacement of the cerebral spinal fluid (CSF) directly relates to cerebral vascular compliance. To test this hypothesis, an in vivo surrogate intracranial compartment was made by enclosing a rabbit's kidney within a rigid, fluid-filled container. Opening/closing a port atop the box modulated the free flow of box fluid (open-box state). We observed that the pulsatility of the renal venous outflow increased in response to hampering the free flow of fluid in-and-out of the container (closed-box state). To associate the observed pulsatility changes with the compliance changes, a parametric method was proposed for the computation of the apparent compliance (C(app)) of the whole renal vascular system. The calculated C(app) for each experiment's closed-box state was favorably compared to a time-domain compliance assessment method at the mean heart rate. In addition, it was revealed that C(app) in the open-box state was greater than that in the closed-box state only when the calculations were performed at frequencies lower than the heart rate and closer to the ventilation rate. These experimental results support the concept that the vessel compliance of vascular systems enclosed within a rigid compartment is a function of the global compartment compliance.

Animals↗

[Drug Compliance Scale. I. Development of the Drug Compliance Scale].

The failure of patients to comply with treatment regimens recommended by their physicians is a significant clinical problem. Researches on the assessment of compliance have, however, been precluded by methodological difficulties such as lack of adequate measures. The purpose of this study was to develop a self-administered questionnaire to evaluate drug compliance. First, questionnaire containing a 52-items complied by two doctors, a pharmacist and a nurse, was tested on 81 outpatients, all volunteers, attending the departments of psychosomatic medicine and internal medicine. Four items were temporarily removed for later analysis because they directly inquired about drug compliance (drug compliance items). The other 48 items were analyzed and three factors consisting of 26 items were further studied: expectation on taking medicine, rejection to taking medicine and seeking knowledge of drugs. Chronback's alpha coefficients representing internal consistency of the three factors were sufficiently high (ranging from .75 to .84). Furthermore, we preformed a simplified pill count to validate the 4 drug compliance items. There was a weak to moderate correlation between the result of pill count and each of 4 drug compliance items. A new self-administered questionnaire of 30 items was thus developed and named the Drug Compliance Scale.

Drug Administration Schedule↗