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The impact of patient adherence on health outcomes for patients with chronic disease in the medical outcomes study

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Abstract

The association between adherence to medical recommendations and health outcomes (physical, role, and social functioning, energy/fatigue, pain, emotional well-being, general health perceptions, diastolic blood pressure, and glycohemoglobin) was examined in a 4-year longitudinal, observational study of 2125 adult patients with chronic medical conditions (hypertension, diabetes, recent myocardial infarction, congestive heart failure) and/or depression. Change score models were evaluated, controlling for disease and comorbidity. Patient adherence was associated minimally with improvement in health outcomes in this study. Only 11 of 132 comparisons showed statistically significant positive effects of adherence on health outcomes. We conclude that

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References

  • Allison, P. D. (1990). Change scores as dependent variables in regression analysis.Sociol. Method. 20: 93–114.

    Google Scholar 

  • Burnam, M. A., Wells, K. B., Leake, B., and Landesverk, J. (1988). Development of a brief screening instrument for detecting depressive disorders.Med. Care 26: 775–789.

    PubMed  Google Scholar 

  • Caron, H. S. (1985). Compliance: The case for objective measurement.J. Hypertens. 3 (Suppl. 1): 11–17.

    Google Scholar 

  • Connell, C. M., O'Sullivan, J. J., Fisher, E. B., and Storandt, M. (1988). Variables predicting adherence and metabolic control among retirement community residents with non-insulin dependent diabetes mellitus.J. Compliance Health Care 3: 135–149.

    Google Scholar 

  • Cox, D. J., Taylor, A. R., Nowacek, G., Holley-Wilocox P., Pohl, S. L., and Guthrow, E. (1984). The relationship between psychological stress and insulin-dependent diabetic blood glucose control: Preliminary investigations.Health Psychol. 3: 63–75.

    PubMed  Google Scholar 

  • Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests.Psychometrika 16: 297–334.

    Google Scholar 

  • Dawes, R. M. (1979). The robust beauty of improper linear models.Am. Psychol. 34: 571–582.

    Google Scholar 

  • DiMatteo, M. R., Hays, R. D., and Sherbourne, C. D. (1992). Adherence to cancer regimens: Implications for treating the older patient.Oncology 6: 50–57s.

    PubMed  Google Scholar 

  • Epstein, L. H. (1984). The direct effects of compliance on health outcome.Health Psychol. 3: 385–393.

    PubMed  Google Scholar 

  • Epstein, L. H., and Cluss, P. A. (1982). A behavioral medicine perspective on adherence to long-term medical regimens.J. Consult. Clin. Psychol. 50: 950–971.

    PubMed  Google Scholar 

  • Eraker, S. A., Kirscht, J. P., and Praker, M. H. (1984). Understanding and improving patient compliance.Ann. Intern. Med. 100: 258–268.

    PubMed  Google Scholar 

  • Feinstein, A. R. (1979). Compliance bias and the interpretation of therapeutic trials. In Haynes, R. B., Taylor, D. W., and Sackett, D. L. (eds.),Compliance in Health Care, Johns Hopkins University Press, Baltimore, pp. 309–322.

    Google Scholar 

  • Glasgow, R. E., McCaul, K. D., and Schafer, L. C. (1987). Self-care behaviors and glycemic control in Type I diabetes.J. Chron. Dis. 40: 399–417.

    PubMed  Google Scholar 

  • Greenfield, S. (1989). The state of outcome research: Are we on target?N. Engl. J. Med. 320: 1142–1143.

    PubMed  Google Scholar 

  • Hays, R. D., and DiMatteo, M. R. (1987). Key issues and suggestions for patient compliance assessment: Source of information, focus of measures, and nature of response options.J. Compliance Health Care 2: 37–53.

    Google Scholar 

  • Hays, R. D., Sherbourne, C. D., and Mazel, R. M. (1993). The RAND 36-Item Health Survey 1.0.Health Econ. 2: 217–227.

    PubMed  Google Scholar 

  • Henrich, J. B. (1992). The postmenopausal estrogen/breast cancer controversy.JAMA 268: 1900–1902.

    PubMed  Google Scholar 

  • Horowitz, R. I., and Horowitz, S. M. (1993). Adherence to treatment and health outcomes.Arch. Intern. Med. 153: 1863–1868.

    PubMed  Google Scholar 

  • Huber, P. J. (1967). The behavior of maximum likelihood estimates under nonstandard conditions.Proceedings of the Fifth Berkeley Symposium, 1965, University of California Press, Berkeley, pp. 221–233.

    Google Scholar 

  • Johnson, S. B., Freund, A., Silverstein, J., Hansen, C. A., and Malone, J. (1990). Adherence-health status relationships in childhood diabetes.Health Psychol. 9: 606–631.

    PubMed  Google Scholar 

  • Kaplan, R. M., and Berry, C. C. (1990). Adjusting for confounding variables. In Sechrest, L., Perrin, E., and Bunker, J. (eds.),Research Methodology: Strengthening Causal Interpretations of Nonexperimental Data, U.S. Department of Health and Human Services, Rockville, MD, pp. 105–114.

    Google Scholar 

  • Kessler, R. C., Foster, C., Webster, P. S., and House, J. S. (1992). The relationship between age and depressive symptoms in two national surveys.Psychol. Aging 7: 119–126.

    PubMed  Google Scholar 

  • Klatsky, A. L., Friedman, G. D., and Armstrong, M. A. (1990). Coffee use prior to myocardial infarction restudied: Heavier intake may increase the risk.Am. J. Epidemiol. 132: 479–488.

    PubMed  Google Scholar 

  • Kravitz, R., Hays, R. D., Sherbourne, C. D., DiMatteo, M. R., Rogers, W. H., Ordway, L., and Greenfield, S. (1993). Recall of recommendations and adherence to advice among patients with chronic medical conditions: Results from the Medical Outcomes Study.Arch. Intern. Med. 153: 1869–1878.

    PubMed  Google Scholar 

  • Lord, F. M. (1967). A paradox in the interpretation of group comparisons.Psychol. Bull. 68: 304–305.

    PubMed  Google Scholar 

  • Mann, S. J. (1992). Systolic hypertension in the elderly: Pathophysiology and management.Arch. Intern. Med. 152: 1977–1984.

    PubMed  Google Scholar 

  • Marquis, K. H., and Ware, J. E. (1979).Measures of diabetic patient knowledge, attitudes, and behavior regarding self care: Summary report, R-2480-HEW, The RAND Corporation, Santa Monica, CA.

    Google Scholar 

  • Martys, C. R. (1979). Adverse reactions to drugs in general practice.Br. Med. J. 2: 1194–1197.

    PubMed  Google Scholar 

  • McHorney, C. A., Ware, J. E., Rogers, W., Raczek, A. E., and Lu, J. F. R. (1992). The validity and relative precision of MOS Short- and Long-Form Health Status Scales and Dartmouth COOP Charts.Med. Care 30: S253-S265.

    Google Scholar 

  • Moore, T. J. (1989).Heart Failure, Random House, New York.

    Google Scholar 

  • Overall, J. E. (1989). Contradictions can never a paradox resolve.Appl. Psychol. Measure. 13: 426–428.

    Google Scholar 

  • Porter, A. C., and Raudenbush, S. W. (1987). Analysis of covariance: Its model and use in psychological research.J. Counsel. Psychol. 34: 383–392.

    Google Scholar 

  • Raymond, M. R. (1986). Missing data in evaluation research.Eval. Health Prof. 9: 395–420.

    Google Scholar 

  • Robins, L. N., Helzer, J. E., Croughan, J., and Ratcliff, K. S. (1981). National Institute of Mental Health Diagnostic Interview Schedule: Its history, characteristics, and validity.Arch. Gen. Psychiat. 38: 381–389.

    PubMed  Google Scholar 

  • Rogers, W., McGlynn, E., Berry, W., Nelson, E., Perrin, E., Zubkoff, M., Greenfield, S., Wells, K. B., Stewart, A. L., Arnold, S., and Ware, J. E. (1992). Methods of sampling. In Stewart, A. L., and Ware, J. E., Jr. (eds.),Measuring Functional Status and Well-Being: The Medical Outcomes Study Approach, Duke University Press, Durham, NC, pp. 27–47.

    Google Scholar 

  • Sacks, H., Chalmers, T. C., and Smith, H. (1982). Randomized versus historical controls for clinical trials.Am. J. Med. 72: 233–240.

    PubMed  Google Scholar 

  • Schaefer, L. C., McCaul, K. D., and Glasgow, R. E. (1986). Supportive and nonsupportive family behaviors: Relationships to adherence and metabolic control in persons with Type I diabetes.Diabetes Care 9: 179–185.

    PubMed  Google Scholar 

  • Seventh Special Report to the U.S. Congress on Alcohol and Health (1990). U.S. Department of Health and Human Services, Rockville, MD.

  • Sherbourne, C. D., Hays, R. D., Ordway, L., DiMatteo, M. R., and Kravitz, R. (1992). Antecedents of adherence to medical recommendations: Results from the Medical Outcomes Study.J. Behav. Med. 15: 447–468.

    PubMed  Google Scholar 

  • Stanley, J. C., and Wang, M. D. (1970). Weighting test items and test-item options, an overview of the analytical and empirical literature.Educ. Psychol. Measure. 30: 21–35.

    Google Scholar 

  • STATA Reference Manual: Release 3 (1992). Computing Resource Center, Santa Monica, CA.

  • Stewart, A. L., Sherbourne, C., Hays, R. D., Wells, K. B., Nelson, E. C., Kamberg, C. J. Rogers, W. H., Berry, S. D., and Ware, J. E. (1992). Summary and discussion of MOS measures. In Stewart, A. L., and Ware, J. E. (eds.),Measuring Functioning and Well-Being: The Medical Outcomes Study Approach, Duke University Press, Durham NC, pp. 345–371.

    Google Scholar 

  • Tarlov, A. R., Ware, J. E., Greenfield, S., Nelson, E. C., Perrin, E., and Zubkoff, M. (1989). Medical Outcomes Study: An application of methods for evaluating the results of medical care.JAMA 262: 907–913.

    PubMed  Google Scholar 

  • Ulmer, R. A. (1987). Editorial: Patient noncompliance and health care costs.J. Compliance Health Care 2: 3–4.

    Google Scholar 

  • Ware, J. E., Snow, K. K., Kosinski, M., and Gandek, B. (1993).SF-36 Health Survey Manual and Interpretation Guide, The Health Institute, Boston, MA.

    Google Scholar 

  • Ware, J. E., and Sherbourne, C. D. (1992). A 36-item short form health survey (SF-36): Results from the Medical Outcomes Study.Med. Care 30: 473–483.

    PubMed  Google Scholar 

  • Watkins, J. D., Williams, T. F., Martin, D. A., Hogan, M. D., and Anderson, E. (1967). A study of diabetic patients at home.Am. J. Public Health 57: 452–459.

    Google Scholar 

  • Webb, K. L., Dobson, A. J., O'Connell, D. L., Tupling, H. E., Harris, G. W., Moxon, J. A., Sulway, M. J., and Leeder, S. R. (1984). Dietary compliance among insulin-dependent diabetics.J. Chron. Dis. 37: 633–643.

    PubMed  Google Scholar 

  • Wells, K. B., Burnam, M. A., Leake, B., and Robins, L. N. (1988). Agreement between face-to-face and telephone administered versions of the depression section of the NIMH Diagnostic Interview Schedule.J. Psychiat. Res. 22: 207–220.

    PubMed  Google Scholar 

  • Wells, K. B., Stewart, A. L., Hays, R. D., Burnam, M. A., Rogers, W., Daniels, M., Berry, S., Greenfield, S., and Ware, J. E. (1989). The functioning and well-being of depressed patients: Results from the Medical Outcomes Study.JAMA 262: 914–919.

    PubMed  Google Scholar 

  • Wells, K. B., Burnam, M. A., Rogers, W., Hays, R., and Camp, P. (1992). Course of depression for adult outpatients: Results from the Medical Outcomes Study.Arch. Gen. Psychiat. 49: 788–794.

    PubMed  Google Scholar 

  • Willett, J. B. (1988). Questions and answers in the measurement of change. In Rothkopf, E. Z. (ed.),Review of Research in Education, Vol. 15, American Education Research Association, Washington, DC, pp. 345–422.

    Google Scholar 

  • Williams, T. F., Martin, D. A., Hogan, M. D., Watkins, J. D., and Ellis, E. V. (1967). The clinical picture of diabetic control, studied in four settings.Am. J. Public Health 57: 441–451.

    Google Scholar 

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Authors and Affiliations

  1. RAND, 1700 Main Street, 90407-2138, Santa Monica, California

    Ron D. Hays, Rebecca M. Mazel & Cathy Donald Sherbourne

  2. RAND and Division of General Medicine, University of California, 95817, Davis, Sacramento, California

    Richard L. Kravitz

  3. RAND and Department of Psychology, University of California, 92502, Riverside, California

    M. Robin DiMatteo

  4. The New England Medical Center, 750 Washington Street, 02111, Boston, Massachusetts

    William H. Rogers & Sheldon Greenfield

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  1. Ron D. Hays
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  2. Richard L. Kravitz
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  3. Rebecca M. Mazel
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  4. Cathy Donald Sherbourne
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  5. M. Robin DiMatteo
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  6. William H. Rogers
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  7. Sheldon Greenfield
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Additional information

This work was supported by grants from the Agency for Health Care Policy and Research (Grant HS 06171), the National Institute on Aging, The Robert Wood Johnson Foundation, The Henry J. Kaiser Family Foundation, the National Institute of Mental Health, and the Pew Charitable Trusts, as well as support from RAND and New England Medical Center. The views expressed are those of the authors and do not necessarily represent those of the sponsors or RAND.

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Hays, R.D., Kravitz, R.L., Mazel, R.M. et al. The impact of patient adherence on health outcomes for patients with chronic disease in the medical outcomes study. J Behav Med 17, 347–360 (1994). https://doi.org/10.1007/BF01858007

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