Patient compliance: the doctor's duty

Compliance with glaucoma treatment and treatment plans have been difficult to obtain since the initiation of the medical management of glaucoma. There have been many definitions of noncompliance put forth and multiple reasons for this noncompliance isolated. If doctors hope to improve compliance in their patients, they must take a more active role in educating their patients and modifying treatment plans to inspire greater compliance.     

Static pulmonary compliance in ponies.

Static pulmonary and total compliance during expiration was measured in fifteen healthy anesthetized ponies. Mean body weight of the ponies was 140.6 kg and ranged from 83.6 to 211.4 kg. For the fifteen ponies, mean values and SD were: total compliance (Ct), 168.7 plus or minus 47.2 ml/CMH2O, and mean pulmonary compliance (Cl), 368.4 plus or minus 90.3 ml/cmH2O. Both Ct and Cl were significantly dependent on body weight, calculated surface area, height at the withers, and circumference about the chest. Repeatability of compliance measurement from day to day was confirmed by measuring compliance on consecutive days in four ponies.     

Aids to compliance with medication.

Elderly people may need to take several forms of medication, including tablets and capsules, inhalers, insulin, and eye drops. This article describes various aids that are designed to facilitate compliance.     

Audit of compliance with antenatal protocols.

OBJECTIVE--To assess the implementation of action protocols dictated by antenatal risk factors noted at the initial (booking) antenatal visit. DESIGN--Retrospective study of 2000 women delivered between 1 March 1990 and 29 March 1991. SETTING--Maternity department of a district general hospital supporting a multiethnic population in inner London. MAIN OUTCOME MEASURES--Comparison of clinical actions performed against those dictated by the department''s protocols. Analysis according to clinical importance, gestation at booking, maternal age, parity, birth order, ethnic origin, and certainty of gestational age. RESULTS--Interobserver agreement between the two auditors was good (kappa statistic for risk factors detected, 0.78; for actions generated, 0.80). Of the 15,658 actions dictated by department protocols, 3673 (23.5%) were actually performed by the clinicians. The 63 combinations of risk factors and actions believed by consultants to be of particular clinical importance had an action rate of 28.3% compared with 18.6% for those considered less important (p < 0.001). Mothers who first visited the hospital antenatal clinic at or before 24 weeks'' gestation had 25.2% of relevant protocols fulfilled (p < 0.001). Compliance was significantly improved in women aged 36 or over (32.4%), black women (24.9%), and cases of uncertain gestation (24.5%). Parity and birth order were not associated with an altered action rate. Ethnic origin deemed as "other" (than white, black, Asian, or oriental) or "unknown" was associated with poor compliance (19.3%). CONCLUSIONS--Compliance to a set of agreed protocols was poor even though a computer system was available and a protocol manual had been distributed. Protocols were more likely to be implemented in women who booked early and in some groups of women deemed at high risk including older mothers, black women, and those denoted as having uncertain gestational age.     

Nasal wall compliance in vasomotor rhinitis.

Nasal compliance is a measure related to the blood volume in the nasal mucosa. The objective of this study was to better understand the vascular response in vasomotor rhinitis by measuring nasal cross-sectional area and nasal compliance before and after mucosal decongestion in 10 patients with vasomotor rhinitis compared with 10 healthy subjects. Nasal compliance was inferred by measuring nasal area by acoustic rhinometry at pressures ranging from atmospheric pressure to a negative pressure of -10 cmH2O. Mucosal decongestion was obtained with one puff per nostril of 0.05% oxymetazoline. At atmospheric pressure, nasal cross-sectional areas were similar in the vasomotor rhinitis group and the healthy subject group. Mucosal decongestion did not induce any decrease of nasal compliance in patients with vasomotor rhinitis in contrast with healthy subjects. Our results support the hypothesis, already proposed, of an autonomic dysfunction based on a paradoxical response of the nasal mucosa in vasomotor rhinitis. Moreover, the clearly different behavior between healthy subjects and vasomotor rhinitis subjects suggests that nasal compliance measurement may therefore represent a potential line of research to develop a diagnostic tool for vasomotor rhinitis, which remains a diagnosis of exclusion.     

Improving drug compliance after hospital discharge.

The effect of counselling on medication errors was assessed in 165 elderly patients after leaving hospital. Counselling was effective, with counselled patients making under one-third of the errors made by uncounselled patients. Three types of memory aid were tried to supplement counselling. The pill wheel increased errors, a tablet identification card was unhelpful, and only a tear-off daily calendar seemed to improve results modestly. Counselling was virtually as effective in improving compliance in poorly orientated patients. A designated member of staff should spend about 15 minutes with each elderly patient before discharge to ensure that the discharge drug regimen is fully understood and remembered, that old tablets are destroyed and that other people''s tablets are not taken.     

Placental compliance during fetal extracorporeal circulation.

The fetus requires large amounts of volume when weaning from cardiac bypass. This suggests that placental vasculature can act as a large capacitor in the fetal circulation. To assess placental compliance of fetal lambs, seven isolated in situ lamb placentas were placed on extracorporeal circulation. Umbilical artery blood flow was varied from 0 to 350 ml. min(-1). kg fetal wt(-1). Because the extracorporeal circuit is a closed system, volume changes in the placenta induced by umbilical artery pressure changes were measured from reciprocal volume changes in the reservoir. There was a wide range of change in absolute volume of blood within the fetal placental compartment (216.4 +/- 29.3 ml). Placental compliance was linear over the entire range of pressure changes exerted on the placental vasculature (r(2) = 0.83, P = 0.0001). This indicates that the placenta is a unique and sensitive capacitor in the fetal circulation. This information is important clinically because it establishes that aggressive resuscitation of the fetus using volume may be necessary when weaning the fetus from cardiac bypass.