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November 22, 1995

Quality of Outpatient Care: Diabetes-Reply

Author Affiliations

Harvard School of Public Health Boston, Mass

JAMA. 1995;274(20):1585. doi:10.1001/jama.1995.03530200020020

In Reply.  —Drs Bowman and Konen raise an important concern about compliance and also provide additional evidence of the ineffectiveness of educational programs in changing human behavior. Patient compliance may well be a greater barrier to improving diabetes status than physician compliance. The latter may be more tractable, however. In addition, the ethical considerations are different. As a society we have some obligation to provide proven remedies. Whether individual citizens have an obligation to accept them is more debatable.As I noted, even with a rigorous effort Norman et al1 were able to obtain only a 75% compliance rate. A reasonable national compliance norm for a given test or treatment might prove to be only 60%. But if an individual plan's compliance rate was only 30%, that would be immensely valuable information for patients and physicians. Without required reporting, neither would be aware that care was substandard.Dr Clemenson

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