XXX. Biostatistical problems in ‘compliance bias’

Most discussions of compliance are concerned with a patient's maintenance of an assigned therapeutic regimen. Since no drug, diet, or other agent of therapy can work unless it is taken, one of the main clinical reasons for studying compliance is to increase it. By finding out why patients fail to comply and how we can encourage compliance, we hope to develop better ways of enabling a presumably beneficial therapeutic regimen to accomplish its benefits. With these goals in mind, we may investigate the various clinico-sociobehavioral features that are determinants of compliance and the educational-communicational-packaging features that may enhance it. A substantial literature has begun to develop on compliance with therapeutic regimens. The references cited here are only a few of the many studies1 , 2. 11, 12, 16-18, 21 specifically devoted to this topic, and a detailed compendium of the literature was recently assembled for a major "Workshop/Symposium" conducted at the McMaster UniverSity Medical Center in Hamilton, Ontario, Canada. The organizers of

[1]  A. Barsky,et al.  Diagnosis and management of patient noncompliance. , 1974, JAMA.

[2]  T. Covington,et al.  Drug defaulting. I. Determinants of compliance. , 1974, American journal of hospital pharmacy.

[3]  L Lasagna,et al.  Variations in interpretation of prescription instructions. The need for improved prescribing habits. , 1974, JAMA.

[4]  John T. Wilson.  Compliance with Instructions in the Evaluation of Therapeutic Efficacy , 1973, Clinical pediatrics.

[5]  B. Blackwell.  The drug defaulter , 1972, Clinical pharmacology and therapeutics.

[6]  R. Stewart,et al.  A review of medication errors and compliance in ambulant patients , 1972, Clinical pharmacology and therapeutics.

[7]  A. Feinstein.  XI. Sources of ‘chronology bias’ in cohort statistics , 1971, Clinical pharmacology and therapeutics.

[8]  A. Feinstein.  x. Sources of ‘transition bias’ in cohort statistics , 1971, Clinical pharmacology and therapeutics.

[9]  B. Hsi,et al.  Measuring intake of a prescribed medication A bottle count and a tracer technique compared , 1970, Clinical pharmacology and therapeutics.

[10]  A. Feinstein,et al.  The role of tonsils in predisposing to streptococcal infections and recurrences of rheumatic fever. , 1970, The New England journal of medicine.

[11]  Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg. , 1970, JAMA.

[12]  A. Lilienfeld,et al.  Why patients don't follow medical advice: a study of children on long-term antistreptococcal prophylaxis. , 1969, The Journal of pediatrics.

[13]  A. Feinstein,et al.  Prophylaxis of recurrent rheumatic fever. Therapeutic-continuous oral penicillin vs monthly injections. , 1968, JAMA.

[14]  G. Lubash.  Antihypertensive Therapy, Principles and Practice: An International Symposium. , 1966 .

[15]  E. Freis.  Organization of a long-term multiclinic therapeutic trial in hypertension , 1966 .

[16]  H. F. Wood,et al.  A controlled study of three methods of prophylaxis against streptococcal infection in a population of rheumatic children. II. Results of the first three years of the study, including methods for evaluating the maintenance of oral prophylaxis. , 1959, The New England journal of medicine.