The Multilevel Compliance Challenge: Recommendations for a Call to Action

Abstract

Despite the universally accepted importance of compliance, strategies known for more than two decades to be effective are not routinely incorporated into clinical practice. For the benefits of primary and secondary prevention to be realized in diverse population groups and settings, emphasis must be placed on implementing strategies at the patient, provider, and organization levels. Current knowledge of compliance strategies, if integrated into a multilevel approach, offers enormous promise for decreasing risk and improving patient outcomes.

Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study

“…Miller et al, followed by other reports and reviews, previously highlighted the importance of such action at the various levels of the healthcare system 7, 21, 24, 43, 63…”

“…6, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32 Reflecting this perspective, a multilevel approach to medication nonadherence is novel,15, 33 as multilevel medication nonadherence factors have received little attention in transplantation 6, 11, 13, 14, 34. Should this new perspective reveal independent multilevel immunosuppressant nonadherence correlates, addressing such correlates would demand interventional approaches targeting not only patients but healthcare workers/family, organizations, and policymakers 6, 21, 24…”

Prevalence, awareness, treatment, and control of hypertension in the Czech Republic. Results of two nationwide cross-sectional surveys in 1997/1998 and 2000/2001, Czech Post-MONICA Study

“…Patients' compliance to drug therapy has been recognised as one of the major reasons why antihypertensive therapy fails. 5,36 The management of hypertension in the community is a public health problem. In the Czech population, there are only less than 20% of hypertensive patients having adequate BP control.…”

Factors Associated with Non‐adherence to Therapy with Warfarin in a Population of Chronic Heart Failure Patients

“…23 Although interventions to improve adherence may translate into improved clinical outcomes, a major deficit of most published approaches has been the uniform application of these interventions, rather than targeted efforts. In the economic constraints of the current healthcare environment, costly interventions must be directed to the highest risk individuals.…”