Patient compliance with treatment is essential. However, it is difficult to examine the issue of compliance from claims and administrative databases that include no direct input from patients. In order to measure compliance, we now have to define a meaningful compliance score within the administrative database. One way of doing this is to investigate patient medication information. Patients with chronic diseases taking maintenance medications usually receive a 30-day or 90-day supply on a regular basis, as long as they are taking the medications at the required intervals. Therefore, one way we can examine the level of compliance is by measuring the time intervals between medication refills.
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Patient compliance is a difficult thing to measure. (Chatkin, et al., 2006; Kaiser, 2007; Klauer, Zettl, Klauer, & Zettl, 2008; Lasmar, et al., 2007; Sungkanuparph, et al., 2008) Yet it is well known that patient compliance improves patient outcomes. (Z. Chen, et al., 2009; Cochrane, Bala, Downs, Mauskopf, & Ben-Joseph, 2000; Greengold, et al., 2009; N. Koh, et al., 2008; McCarthy, Datta, Khachatryan, Coleman, & Rachet, 2008; Raju, Hollis, & Neglen, 2007; Sunyecz, Mucha, Baser, Barr, & Amonkar, 2008) For this reason, studies have been conducted to examine the impact of interventions on patient compliance. (Cotte, et al., 2008; Giuffrida & Torgerson, 1997; Hoevenaars, et al., 2008; Jansen, et al., 2009; Klein, et al., 2009; N. Koh, et al., 2008; Llor, et al., 2009; O'Reilly, 2007; Opstelten, et al., 2009; Raju, et al., 2007; VanHecke, Grypdonck, & Defloor, 2008) These intervention studies usually require the actual measure of patient doses taken; unused pills are counted. Therefore, they are very expensive and conducted with a small number of patients.
Other studies suggest that compliance should be measured using electronic monitoring devices. (J. R. Curtis, et al., 2009) The device records a positive signal whenever a dose is taken. However, again such devices are expensive, and the resulting studies will be small.
There are also issues with compliance on the part of the medical staff, including such basics as washing hands between patients or tasks. Therefore, both patient and caregiver compliance with routine tasks should be examined. (Creedon & Creedon, 2008; Samraj, Westbury, Pallett, & Rowen, 2008) In addition, compliance with treatment guidelines on the part of the caregivers should be considered. (Mol, et al., 2005) It is possible that the provider is using some nonstandard treatment and disregarding protocols.