Do patients understand their physicians? prescription compliance in a rural area of the dominican republic

Abstract

Compliance with medical advice is an important component of medical care, but compliance cannot take place unless patients understand and retain physicians' advice. This paper is one of the first studies of the understanding and retention of medical advice in rural areas of the Third World. Researchers observed 119 medical consultations in a rural primary care clinic and later interviewed the patients in their homes. There were very few recommendations about diet, exercise and hygiene. Medicines were frequently prescribed, with an average of 1.9 medicines per patient, but patients were able to recall the dosage, the interval or frequency of use and duration of medication for only half of the prescriptions. The most basic information, the manner of administration of the medicine, was not known for 20% of the prescriptions. Less information was retained by the elderly, those with less than seven years of schooling and patients who were prescribed several drugs simultaneously. Recall of the physician's advice did not diminish with the passage of time; apparently, once the information was internalized, it was memorized. It is concluded that unless improvements in the communication of physicians' advice take place the therapeutic benefits of modern drugs is questionable. The study recommends that medical schools place more emphasis on teaching medical students to communicate effectively with rural patients and on making sure that patients understand clearly recommendations and instructions regarding medication. From our study it also follows that there is a need to assist rural people in the adequate use of medicines. In this respect it is suggested that rural health promoters be instructed to monitor patients at high risk for non-compliance and that the use of symbols for dosage, interval, time of use, manner of administration and duration of the medication be institutionalized in rural areas in Latin America. © 1986 Oxford University Press.