Patient Compliance with Medications

The purpose of this research is to examine the issue of patient compliance with medication protocols in cases of serious risks to the public health, with special emphasis on tuberculosis treatment.

One of the most striking features of US urban life since the mid-1980s has been the statistical rise in the incidence of TB. The early 1990s heralded a significant increase in TB diagnoses in a variety of settings that persists to the present day. In New York City alone, some 600,000 TB cases had been identified by 1993, and of those cases, 40% were also infected with HIV (Goldsmith, 1993; Goosby & Others, 1993). TB cases reached a rate of between 75 and 500 per 100,000 in correctional-facility settings by the end of 1992, compared to some 14 per 100,000 in the general population (Skolnick, 1992), prompting correctional officials to reinstitute x-ray rather than subcutaneous diagnosis protocols to handle the volume of cases or suspected cases of disease. In Los Angeles, a deadly combination of TB, HIV, homelessness, and immigration was identified as reaching epidemic proportions over the course of the 1990s (Barnes, 1997). Complicating the rise in TB incidence was that some strains of the disease developed resistance to traditional drug therapies, including multiple drugs (Goldsmith, 1993; Joseph, 1993).

Ironically, it was just at the time TB began to make serious inroads into US society that a good deal of public funding for health care was cut, placing a severe strain on public

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o have more and longer contacts with patients and thus more likely to have to address cultural concerns of a case. The fact that compliance issues are at least as much behavioral in orientation as medical implies a range of psychoemotional issues that must be addressed by medical practitioners. Communication takes time, and in the context of managed care, time is money. In that regard, Frankl, et al. (1991), suggest that the dynamic of cost-conscious managed care structures is an obstacle to relationship-centered health care But a number of studies have found that financial and technical concerns are less positively associated with failures of compliance with drug therapy than concerns that can be traced to communication problems (e.g., Melnikow, 2000; Chervinsky & Others, 1999). Whereas doctors tended to filter their perceptions of compliance with clinical advice through their own view of on the seriousness of a condition and the (sometimes theoretical, almost always somatic, rarely psychosocial) effectiveness of treatments, patients tended to focus on perceived practical value or benefit of such treatment (Goldberg & Others, 1998). Thus attention devoted to the sometimes complex social concerns of patients who need an incentiv

Category: Medical - P