Skip to main content
American Journal of Public Health logoLink to American Journal of Public Health
. 1976 Sep;66(9):847–853. doi: 10.2105/ajph.66.9.847

Communication, compliance, and concordance between physicians and patients with prescribed medications.

B S Hulka, J C Cassel, L L Kupper, J A Burdette
PMCID: PMC1653458  PMID: 961952

Abstract

Forty-six practicing physicians and 357 patients with diabetes mellitus or congestive heart failure were the subjects for this study, which focuses on the impact of medication regimen and doctor-patient communication in affecting patient medication-taking behavior and physician awareness of these behaviors. Four types of medication errors were defined: omissions, commissions, scheduling misconceptions and scheduling non-compliance. The average error rates were 19 per cent, 19 per cent, 17 per cent and 3 per cent, respectively. The combined average error was 58 per cent; scheduline non-compliance on the part of the patient was a minor component. Specific aspects of the medication regimen were associated with increased errors: (1) the more drugs involved between the doctor-patient pair, the greater the errors of omission and commission; and (2) the greater the complexity of the scheduling, the greater the errors of commission and scheduling misconceptions. If the patient did not know the function of all his drugs, errors of commission and scheduling misconception increased. Neither characteristics of patients nor the severity of disease were influential in determining the extent of medication errors. For patients with congestive heart failure, good communication of instructions and information from physician to patient was associated with low levels of all types of errors.

Full text

PDF
847

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BERRY D., ROSS A., HUEMPFNER H., DEUSCHLE K. Selfmedication behavior as measured by urine chemical tests in domiciliary tuberculous patients. Am Rev Respir Dis. 1962 Jul;86:1–7. doi: 10.1164/arrd.1962.86.1.1. [DOI] [PubMed] [Google Scholar]
  2. Blackwell B. Drug therapy: patient compliance. N Engl J Med. 1973 Aug 2;289(5):249–252. doi: 10.1056/NEJM197308022890506. [DOI] [PubMed] [Google Scholar]
  3. Blackwell B. The drug defaulter. Clin Pharmacol Ther. 1972 Nov-Dec;13(6):841–848. doi: 10.1002/cpt1972135part2841. [DOI] [PubMed] [Google Scholar]
  4. Burdette J. A., Babineau R. A., Mayo F., Hulka B. S., Cassel J. C. Primary medical care evaluation. The AAFP-UNC collaborative study. JAMA. 1974 Dec 23;230(12):1668–1673. [PubMed] [Google Scholar]
  5. Charney E., Bynum R., Eldredge D., Frank D., MacWhinney J. B., McNabb N., Scheiner A., Sumpter E. A., Iker H. How well do patients take oral penicillin? A collaborative study in private practice. Pediatrics. 1967 Aug;40(2):188–195. [PubMed] [Google Scholar]
  6. FEINSTEIN A. R., WOOD H. F., EPSTEIN J. A., TARANTA A., SIMPSON R., TURSKY E. 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. N Engl J Med. 1959 Apr 2;260(14):697–702. doi: 10.1056/NEJM195904022601405. [DOI] [PubMed] [Google Scholar]
  7. Gillum R. F., Barsky A. J. Diagnosis and management of patient noncompliance. JAMA. 1974 Jun 17;228(12):1563–1567. [PubMed] [Google Scholar]
  8. Gordis L., Markowitz M., Lilienfeld A. M. The inaccuracy in using interviews to estimate patient reliability in taking medications at home. Med Care. 1969 Jan-Feb;7(1):49–54. doi: 10.1097/00005650-196901000-00006. [DOI] [PubMed] [Google Scholar]
  9. Hulka B. S., Cassel J. C. The AAFP-UNC study of the organization, utilization, and assessment of primary medical care. Am J Public Health. 1973 Jun;63(6):494–501. doi: 10.2105/ajph.63.6.494. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hulka B. S., Kupper L. L., Cassel J. C., Efird R. L. Medication use and misuse: physician-patient discrepancies. J Chronic Dis. 1975 Jan;28(1):7–21. doi: 10.1016/0021-9681(75)90045-4. [DOI] [PubMed] [Google Scholar]
  11. Hulka B. S., Kupper L. L., Cassel J. C., Mayo F. Doctor-patient communication and outcomes among diabetic patients. J Community Health. 1975 Fall;1(1):15–27. doi: 10.1007/BF01318940. [DOI] [PubMed] [Google Scholar]
  12. MOHLER D. N., WALLIN D. G., DREYFUS E. G. Studies in the home treatment of streptococcal disease. I. Failure of patients to take penicillin by mouth as prescribed. N Engl J Med. 1955 Jun 30;252(26):1116–1118. doi: 10.1056/NEJM195506302522604. [DOI] [PubMed] [Google Scholar]
  13. Marston M. V. Compliance with medical regimens: a review of the literature. Nurs Res. 1970 Jul-Aug;19(4):312–323. [PubMed] [Google Scholar]
  14. Mattar M. E., Markello J., Yaffe S. J. Pharmaceutic factors affecting pediatric compliance. Pediatrics. 1975 Jan;55(1):101–108. [PubMed] [Google Scholar]
  15. Mazzullo J. M., 3rd, Lasagna L., Griner P. F. Variations in interpretation of prescription instructions. The need for improved prescribing habits. JAMA. 1974 Feb 25;227(8):929–931. [PubMed] [Google Scholar]
  16. Moulding T., Onstad G. D., Sbarbaro J. A. Supervision of outpatient drug therapy with the medication monitor. Ann Intern Med. 1970 Oct;73(4):559–564. doi: 10.7326/0003-4819-73-4-559. [DOI] [PubMed] [Google Scholar]
  17. Neely E., Patrick M. L. Problems of aged persons taking medications at home. Nurs Res. 1968 Jan-Feb;17(1):52–55. [PubMed] [Google Scholar]
  18. ROTH H. P., BERGER D. G. Studies on patient cooperation in ulcer treatment. I. Observation of actual as compared to prescribed antacid intake on a hospital ward. Gastroenterology. 1960 Apr;38:630–633. [PubMed] [Google Scholar]
  19. SCHWARTZ D., WANG M., ZEITZ L., GOSS M. E. Medication errors made by elderly, chronically ill patients. Am J Public Health Nations Health. 1962 Dec;52:2018–2029. doi: 10.2105/ajph.52.12.2018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Stewart R. B., Cluff L. E. A review of medication errors and compliance in ambulant patients. Clin Pharmacol Ther. 1972 Jul-Aug;13(4):463–468. doi: 10.1002/cpt1972134463. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES