Drug compliance among adult hypertensive patients.

The general problem considered in the study was drug compliance or adherence to a therapeutic regimen among adult hypertensive patients and the purpose of the study was to identify factors significantly associated with compliance behavior. A specific Health Belief Model was used in establishing the data base. The Health Belief Model utilized in the study was proposed by Rosenstock and is based on motivation theory as well as Kasl and Cobb's definitions of health behaviors. Becker has offered some refinements of the model based on recent research among pediatric clinic populations. The model sets forth factors believed related to compliance behavior and the inter-relationships of those factors with compliance behavior. Rosenstock and Becker have concluded that the Health Belief Model is useful in study preventive health behavior. Caldwell has stated that treatment of hypertension is preventive medicine. For these reasons, it was thought that the Health Belief Model might provide a useful tool for study of hypertensive patients and their compliance behavior. The final study group was 80 adult hypertensive patients who were part of the total patient population seen in an urban clinic. Patients included in the study: had been seen at least once in the previous four months; were not at their ideal diastolic blood pressure as quantified by therapists; were prescribed medications during the study; and returned medications for determination of compliance of pill count. The statistically significant results, as assessed by cross-tabulations using the chi square statistic, were between attendance compliance and mean compliance deviation, as well as, between knowledge of dosage schedule and compliance percentage rate. Pearson correlation of the number of medications with mean compliance deviation and Pearson correlation ob the number of doses per day with mean compliance deviation were also statistically significant. The Pearson correlations indicated that compliance increased as the complexity of the regimen increased. The results of the cross-tabulations were interpreted as indicating the importance of patient contact with an interested therapist and accurate knowledge of the dosage schedule by the patient. It was also possible that therapist spent more time with patient on more complex regimens. Some relationships investigated which were not statistically significant included: demographic and socio-psychological variables; seriousness and susceptibility beliefs; cues to action; length of treatment; and side effects. These were cross-tabulated with mean compliance deviation. The results of this study indicated the profile of a patient with compliance behavior would be one who kept clinic appointments, knew the dosage schedule of his medications, and had a more complex regimen. The first two characteristics are acceptable and logical expectations for compliance. The questions of the complexity of the regimen warrants further study. Recommendations for further study included: a larger study population; a different method of population selection for better distribution of the independent variable; controls to improve validity; personalized questions for more accurate assessment of beliefs; inquiry into negative benefits for comparison with positive benefits; and development and use of a long term measure of compliance to examine maintenance of compliance behavior.