In Search of the Gold Standard for Compliance Measurement

With the help of strong societal pressures, we are learning to acknowledge several nontraditional factors in medicine. We must now consider relative costs, absolute effectiveness, and "informed" patient-consumers. These new concerns form part of a larger trend to translate more directly the dramatic scientific advances of recent years into the practical arena. Amid cries for parsimonious medicine and maximized benefit, compliance has emerged as a major issue. The problem of noncompliance is hardly new. But its recognition and acknowledgment have come haltingly, apparently since few health professionals considered it worthy of attention and, probably more importantly, because few of them believed in their responsibility. The concept of noncompliance as reflecting simple patient inadequacy or even depravity continues to prevail. Only in recent years have we learned enough about the phenomenon to define partially its sheer complexity,¹innumerable determinants,²difficult predictability,³⁻⁴and public policy implications.⁵Most of