Compliance with western medical treatment in a group of black ambulatory hospital patients

Abstract

Abstract Patient compliance with medical regimes provides quantifiable information concerning the effectiveness of medical treatment. It is also one of the ways in which health personnel can gauge whether patient needs are being met in medical transactions. In a country like the Republic of South Africa where most patients are Black and most doctors White, the barriers to understanding which precede compliance, are formidable. This study tests compliance among a group of 150 Black ambulatory patients attending various out-patients departments at a large urban hospital for Blacks in Soweto, Johannesburg. Three groups of respondents were identified—(1) an acute self-limiting disorder (upper respiratory infection). The patients here were all children and the information was provided by parents or guardians; (2) a chronic symptomatic disorder (diabetes); and (3) a chronic asymptomatic disorder (hypertension). Patients were interviewed in the hospital dispensary by 2 Black social workers and a Black medical student. Patient prescriptions were recorded and a number of questions about satisfaction with the consultation, were asked. A second part of the questionnaire was completed in an unannounced home visit from 3–14 days later. Interviewers checked and recorded the amount of the prescription remaining. Patients were considered non-compliant if more than 15% of the prescription they should have had by that date, remained in their possession. Non-compliance was found to be highest among the hypertensive patients, closely followed by diabetics. Compliance was highest in the group of patients with the acute infections. While the overwhelming majority of the parents of the acutely ill patients knew what was wrong with their children, only a third of the diabetic patients and a quarter of the hypertensives understood the nature of their disease despite their attendance at specialist clinics over a long period in many cases. Non-compliance can be related to this lack of understanding which is compounded in the South African context by the absence of knowledge of diseases, such as hypertension and diabetes in the Black indigenous culture. Crowded clinics, lack of continuity of medical care and failure to provide adequate health education are additional problem areas revealed by the study. The barriers of language and race must also be taken into account, as well as the authoritarian attitudes of the doctor which may inhibit patient participation.