Although patient nonadherence with health care recommendations is a known barrier to controlling health care costs and improving health outcomes, little is known about variables that affect adherence to recommended health behaviors among low-income patients. Four focus groups were conducted among a sample of low-income patients, to examine their perceptions of adherence with recommendations for appointment keeping, special diets, and medications. Continuity of care and patient fears emerged as common themes contributing to adherence. Continuity of care consisted of having a positive interpersonal relationship with a single primary physician, and a system of coordinated care among multiple specialty physicians. Fear of dying, not living well, getting worse, and feeling bad again were strong promoters of adherence. Among low-income patients and care delivery systems with capitated funding, efforts are needed to improve continuity of care and increase provider awareness of the fears that patients bring to a care encounter.
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References
1.
Bame, S. I., Petersen, N., & Wray, N. P. (1993). Variation in hemodialysis patient compliance according to demographic characteristics. Social Science and Medicine, 37, 1035-1043.
2.
Becker, M. H., & Maiman, L. A. (1975). Sociobehavioral determinants of compliance with health and medical care recommendations. Medical Care, 13, 10-24.
3.
Bindman, A. B., Grumbach, K., Osmond, D., Komaromy, M., Vranizan, K., Lurie, N., Billings, J., & Stewart, A. (1995). Preventable hospitalizations and access to health care. Journal of the American Medical Association, 274, 305-311.
4.
Butkus, D. E., Meydrech, E. F., & Raju, S. S. (1992). Racial differences in the survival of cadaveric renal allografts. New England Journal of Medicine, 327, 840-845.
5.
Carey, M. A. (1994). The group effect in focus groups: Planning, implementing, and interpreting focus group research. In J. M. Morse (Ed.), Critical issues in qualitative research methods (pp. 225-241). London: Sage.
6.
Carpinito, L. J. (1987). Nursing diagnosis application to clinical practice (2nd edition). Philadelphia: J. B. Lippincott.
7.
Chubon, S. J., Schultz, R. M., Lingle, E. W., & Coster-Schultz, M. A. (1994). Too many medications, too little money: How do patients cope?Public Health Nursing, 11, 412-415.
8.
Clements, M., & Hales, D. (1997, September 7). How healthy are we?Parade Magazine, 4-7.
9.
Col, N., Fanale, J. E., & Kronholm, P. (1990). The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Archives of Internal Medicine, 150, 841-845.
10.
Frazier, P. A., Davis-Ali, S. H., & Dahl, K. E. (1994). Correlates of noncompliance among renal transplant recipients. Clinical Transplant, 8, 550-557.
11.
Haynes, R., Taylor, D., & Sackett, D. (1979). Compliance in health care. Baltimore: Johns Hopkins University Press.
12.
Ibach, M. B. (1992). Predictors of compliance after hospitalization. Journal of the Louisiana State Medical Society, 147, 321-324.
13.
Josten, L. E., Mullett, S. E., Savik, K., Campbell, R., & Vincent, P. (1995). Client characteristics associated with not keeping appointments for public health nursing home visits. Public Health Nursing, 12, 305-311.
14.
Kalil, R. S., Heim-Duthoy, K. L., & Kasiske, B. L. (1992). Patients with a low income have reduced renal allograft survival. American Journal of Kidney Diseases, 20, 63-69.
15.
Keeler, E. B., Brook, R. H., Goldberg, G. A., Kamberg, C. J., & Newhouse, J. P. (1985). How free care reduced hypertension in the health insurance experiment. Journal of the American Medical Association, 254, 1926-1931.
16.
Kibbe, D. C., Bentz, E., & McLaughlin, C. P. (1993). Continuous quality improvement for continuity of care. Journal of Family Practice, 36, 304-308.
17.
Krumholz, A., Grufferman, S., Orr, S. T., & Stern, B. J. (1989). Seizures and seizure care in an emergency department. Epilepsia, 30, 175-181.
18.
Leitch, A. M., & Garvey, R. F. (1994). Breast cancer in a county hospital population: Impact of breast screening on stage of presentation. Annals of Surgical Oncology, 1, 516-520.
19.
Levine, A. M. (1989). Doctors, patients, and fear. Western Journal of Medicine, 150, 723-723.
20.
McKechnie, A. A., Wilson, F., Watson, N., & Scott, D. (1999). Anxiety states: A preliminary report on the value of connective tissue massage. Journal of Psychosomatic Research, 27, 125-129.
21.
Miller, S. M., Siejak, K. K., Schroeder, C. M., Lernan, C., Hernandez, E., & Helm, C. W. (1997). Enhancing adherence following abnormal Pap smears among low-income minority women: A preventive telephone counseling strategy. Journal of the National Cancer Institute, 89, 703-708.
22.
Monane, M., Bohn, R. L., Gurwitz, J. H., Glynn, R. J., & Avorn, J. (1999). Noncompliance with congestive heart failure therapy in the elderly. Archives of Internal Medicine, 154, 433-437.
23.
Newacheck, P. W., Butler, L. H., Harper, A. K., Piontkowski, D. L., & Franks, P. E. (1980). Income and illness. Medical Care, 18, 1165-1176.
24.
Payne, T. H., Galvin, M. S., Taplin, B., Austin, B., Savarino, J., & Wagner, E. H. (1999). Practicing population-based care in a health maintenance organization: Evaluation after 18 months. HMO Practice, 9, 101-106.
25.
Ruane, T. J., & Brody, H. (1987). Understanding and teaching continuity of care. Journal of Medical Education, 62, 969-974.
26.
Saunders, C. E. (1987). Patient compliance in filling prescriptions after discharge from the emergency department. The American Journal of Emergency Medicine, 5, 283-286.
27.
Schultz, R. M., Lingle, E. W., Chubon, S. J., & Coster-Schultz, M. A. (1995). Drug use behavior under the constraints of a Medicaid prescription cap. Clinical Therapeutics, 17, 330-340.
28.
Shea, S., Misra, D., Erlich, M. H., Field, L., & Francis, C. K. (1992). Correlates of nonadherence to hypertension treatment in an inner-city minority population. American Journal of Public Health, 82, 1607-1612.
29.
Shulman, N. B., Martinez, B., Brogan, D., Carr, A. A., & Miles, C. G. (1986). Financial cost as an obstacle to hypertension therapy. American Journal of Public Health, 76, 1105-1108.
30.
Simmons, M. R. (1992). Interventions related to compliance. The Nursing Clinics of North America, 27, 477-494.
31.
Stewart, D., & Shamdasani, P. (1990). Focus groups: Theory and Practice. Newbury Park, CA: Sage.
32.
Sung, J. F., Blumenthal, D. S., Coates, R. J., Williams, J. E., Alema-Mensah, E., & Liff, J. M. (1997). Effect of a cancer screening intervention conducted by lay health workers among inner-city women. American Journal of Preventive Medicine, 13, 51-57.
33.
Tanner, E. K., & Feldman, R. H. (1997). Strategies for enhancing appointment keeping in low-income chronically ill clients. Nursing Research, 46, 342-344.
34.
Thompson, J. M., McFarland, G. K., Hirsch, J. E., & Tucker, S. M. (Eds.). (1993). Mosby’s clinical nursing (3rd ed.). Chicago: Mosby.
35.
Wagner, E. H., Austin, B. T., & Von Korff, M. (1996). Organizing care for patients with chronic illness. Millbank Quarterly, 74, 511-544.
36.
Wall, E. M. (1981). Continuity of care and family medicine: Definition, determinants, and relationship to outcome. Journal of Family Practice, 13, 655-664.
37.
Weitzman, M., Moomaw, M. S., & Messenger, K. P. (1980). An after-hours pediatric walk-in clinic for an entire urban community: Utilization and effectiveness of follow-up care. Pediatrics, 65, 964-970.
