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Article
August 23, 1993

Adherence to Treatment and Health Outcomes

Author Affiliations

From the Departments of Medicine (Dr R. I. Horwitz) and Epidemiology and Public Health (Dr S. M. Horwitz), Yale University School of Medicine, New Haven, Conn.

Arch Intern Med. 1993;153(16):1863-1868. doi:10.1001/archinte.1993.00410160017001
Abstract

Adherence (or compliance) is the extent to which a person's behavior coincides with medical or health advice. Recent evidence indicates that patients who adhere to treatment, even when that treatment is a placebo, have better health outcomes than poorly adherent patients. Based on this evidence, we now believe that the outcomes of treatment are not solely attributable to the specific action of a drug, but may also depend on other nonspecific therapeutic effects. We consider the implications of these findings for the design and interpretation of clinical research as well as for the care of patients.

(Arch Intern Med. 1993;153:1863-1868)

References
1.
Haynes RB, Taylor DW, Sackett DL, eds. Compliance in Health Care . Baltimore, Md: Johns Hopkins University Press; 1979.
2.
Weinberger MH.  Systemic hypertension . In: Kelly WN, Devita VT, DuPont HL, et al, eds. Textbook of Internal Medicine . Philadelphia, Pa: JB Lippincott; 1989.
3.
Coronary Drug Project Research Group.  Influence of adherence to treatment and response of cholesterol on mortality in the Coronary Drug Project . N Engl J Med. 1980;303:1038-1041.Article
4.
Pizzo PA, Robichaud KJ, Edwards BK, Schumaker C, Kramer BS, Johnson A.  Oral antibiotic prophylaxis in patients with cancer: a double-blind randomized placebo-controlled trial . J Pediatr. 1983;102:125-133.Article
5.
Hogarty GE, Goldberg SC, The Collaborative Study Group.  Drug and sociotherapy in the aftercare of the schizophrenic patient: one-year relapse rates . Arch Gen Psychiatry . 1973;28:54-64.Article
6.
Fuller R, Roth H, Long S.  Compliance with disulfiram treatment of alcoholism . J Chronic Dis. 1983;36:161-170.Article
7.
Horwitz RI, Viscoli CM, Berkman L, et al.  Treatment adherence and risk of death after a myocardial infarction . Lancet . 1990;336:542-545.Article
8.
The Steering Committee of the Physician's Health Study Research Group.  Preliminary report: findings from the aspirin component of the ongoing physician's health study . N Engl J Med. 1988;318: 262-264.Article
9.
Protocol for the Postmenopausal Estrogen/ Progestin Interventions Trial (PEPI) . Winston-Salem, NC: Bowman Gray School of Medicine; 1989.
10.
Epstein LH, Cluss PA.  A behavioral medicine perspective on adherence to long-term medical regimens . J Consult Clin Psychol. 1982;50:950-971.Article
11.
Beta Blocker Heart Attack Trial Research Group.  A randomized trial of propranolol in patients with acute myocardial infarction: mortality results . JAMA . 1982;247:1707-1714.Article
12.
Rubermain W, Weinblatt E, Goldberg JD, Chandhary BS.  Psychosocial influences on mortality after myocardial infarction . N Engl J Med. 1984;311:552-559.Article
13.
Lipids Research Clinics Program.  The Lipids Research Clinics Coronary Primary Prevention Trial Results, II: the relationship of reduction in incidence of coronary heart disease to cholesterol lowering . JAMA . 1984;251:265-274.
14.
Sackett DL, Snow JC.  The magnitude of compliance and noncompliance . In: Haynes RB, Taylor DW, Sackett DL, eds. Compliance in Health Care . Baltimore, Md: Johns Hopkins University Press; 1979.
15.
Czajkowski SM, Chesney MA.  Adherence and the placebo effect . In: Shumaker SA, Schron EB, Ockene JD, eds. The Handbook of Health Behavior Change . New York, NY: Springer Publishing Co Inc; 1990.
16.
Brown EY, Viscoli CM, Horwitz RI.  Preventive health strategies and the policy makers' paradox . Ann Intern Med. 1992;116:593-597.Article
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