Noncompliance In Patients Research Articles

Predictors of Noncompliance to Antihypertensive Therapy among Hypertensive Patients Ghana: Application of Health Belief Model.

This study determined noncompliance to antihypertensive therapy (AHT) and its associated factors in a Ghanaian population by using the health belief model (HBM). This descriptive cross-sectional study conducted at Kintampo Municipality in Ghana recruited a total of 678 hypertensive patients. The questionnaire constituted information regarding sociodemographics, a five-Likert type HBM questionnaire, and lifestyle-related factors. The rate of noncompliance to AHT in this study was 58.6%. The mean age (SD) of the participants was 43.5 (±5.2) years and median duration of hypertension was 2 years. Overall, the five HBM constructs explained 31.7% of the variance in noncompliance to AHT with a prediction accuracy of 77.5%, after adjusting for age, gender, and duration of condition. Higher levels of perceived benefits of using medicine [aOR=0.55(0.36-0.82),p=0.0001] and cue to actions [aOR=0.59(0.38-0.90),p=0.0008] were significantly associated with reduced noncompliance while perceived susceptibility [aOR=3.05(2.20-6.25), p<0.0001], perceived barrier [aOR=2.14(1.56-2.92), p<0.0001], and perceived severity [aOR=4.20(2.93-6.00),p<0.0001] were significantly associated with increased noncompliance to AHT. Participant who had completed tertiary education [aOR=0.27(0.17-0.43), p<0.0001] and had regular source of income [aOR=0.52(0.38-0.71), p<0.0001] were less likely to be noncompliant. However, being a government employee [aOR=4.16(1.93-8.96), p=0.0002)] was significantly associated increased noncompliance to AHT. Noncompliance to AHT was considerably high and HBM is generally reliable in assessing treatment noncompliance in the Ghanaian hypertensive patients. The significant predictors of noncompliance to AHT were higher level of perceived barriers, susceptibility, and severity. Intervention programmes could be guided by the association of risk factors, HBM constructs with noncompliance to AHT in clinical practice.

Approaches for the Management of Non-Compliance in Patients with Chronic Illness

Patients with chronic illnesses often require complicated care, characterized by frequent follow-ups, exacerbations, and alterations in treatment. Understandably, patient non-compliance is not an uncommon occurrence, and may significantly diminish the quality of health care received. This paper explores the current approaches to chronic illness management, including strategies to identify and reduce non-compliance, as well as the physician’s responsibilities in chronic illness management as guided by the CanMEDS roles. It also introduces a novel approach to the identification and management of non-compliance in patients with chronic illness: the Patient-System Interaction Model (PSIM).

Depressive Symptoms Predict Anti-tumor Necrosis Factor Therapy Noncompliance in Patients with Inflammatory Bowel Disease.

Noncompliance in use of anti-tumor necrosis factor (anti-TNF) therapy in patients with moderate-to-severe inflammatory bowel disease (IBD) can be a factor in medication failure. Few studies have evaluated the contribution of depressive symptoms to medication noncompliance in anti-TNF therapies. A retrospective chart review was performed in a single-center tertiary care IBD center for patients with Crohn's disease and ulcerative colitis starting anti-TNF therapy over a 2-year period. Medication noncompliance was defined as interruption of medication (not filling anti-TNF prescription if injectable or not getting infliximab infusion for 30days beyond needed date for continuation) due to patient-driven circumstances. Depressive symptoms were evaluated at baseline using the well-validated Patient Health Questionnaire-9 (PHQ-9), with PHQ-9≥10 indicative of at least moderate depressive symptoms. Statistical analysis was performed using Cox proportional hazards regression controlling for age, sex, psychiatric history, and disease. A total of 246 patients (75 with ulcerative colitis, 171 with Crohn's disease) were started on anti-TNF therapy. Seventy-nine patients (32%) had a prior psychiatric diagnosis reported in the medical record. Thirty-three patients (13%) were noncompliant in follow-up. Sixty patients (24%) had at least moderate depressive symptoms at baseline (PHQ≥10). Depressive symptoms at baseline were significantly associated with noncompliance in follow-up (hazards ratio 2.28, CI 1.1-4.6, p<0.05). Depressive symptoms at baseline were associated with medication noncompliance of anti-TNF therapies at follow-up when controlling for age, sex, disease type, and history of psychiatric disease.

Nieprzestrzeganie zaleceń lekarskich przez pacjentów z jaskrą

Nieprzestrzeganie zaleceń lekarskich przez pacjentów z jaskrą

Factors of premorbid period indicating the risk of medicated noncompliance in patients with schizophrenia

BackgroundMethods of assessment of medicated compliance are based upon preceding experience of taking therapy and cannot be applied at the first admission.ObjectiveTo investigate premorbid characteristics in schizophrenic patients and reveal the factors indicating noncompliance.MethodsWe used medical record background, interview, Medical Compliance Prediction Scale for Psychiatry for evaluation of the level of compliance, program STATISTICA10 for identification of the average level of compliance in the subgroups of each factor by Kruskal–Wallis test and revealing those subgroups for each factor where the average level of compliance was statistically significantly lower (P &lt; 0.05).ResultsWe examined 120 patients (status corresponded to the ICD-10 diagnostic criteria for schizophrenia, age–18 and older, duration of the disease–5 years and more, patients taking typical or atypical antipsychotics or combined therapy) according to factors of premorbid period such as gender, family history of mental disorders, personality traits, nurture in the family, education level, marital status; substance use, age at the onset of disease.ConclusionsLevel of compliance was lower in subgroups of men, patients having several relatives with mental disorders, patients having personality with predominance of irritable and impulsive traits, patients with neglect in parental families, patients with education level lower than high school and with education level higher than bachelor; patients not working or studying to onset of disease; patients who were divorced or widowed; patients living alone; patients using psychoactive substances; patients aged 21 years and older to the onset of disease.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Timed Get Up and Go Test and Geriatric 8 Scores and the Association With (Chemo-)Radiation Therapy Noncompliance and Acute Toxicity in Elderly Cancer Patients

To investigate whether the Geriatric 8 (G8) and the Timed Get Up and Go Test (TGUGT) and clinical and demographic patient characteristics were associated with acute toxicity of radiation therapy and noncompliance in elderly cancer patients being irradiated with curative intent. Patients were eligible if aged ≥65years and diagnosed with breast, non-small cell lung, prostate, head and neck, rectal, or esophageal cancer, and were referred for curative radiation therapy. We recorded acute toxicity and noncompliance and identified potential predictors, including the G8 and TGUGT. We investigated 402 patients with a median age of 72years (range, 65-96years). According to the G8, 44.4% of the patients were frail. Toxicity grade ≥3 was observed in 22% of patients who were frail according to the G8 and 9.1% of patients who were not frail. The difference was 13% (confidence interval 5.2%-20%; P=.0006). According to the TGUGT 18.8% of the patients were frail; 21% of the frail according to the TGUGT developed toxicity grade ≥3, compared with 13% who were not frail. The difference was 7.3% (confidence interval -2.7% to 17%; P=.11). Overall compliance was 95%. Toxicity was most strongly associated with type of primary tumor, chemotherapy, age, and World Health Organization performance status. Compliance was associated with type of primary tumor and age. The usefulness of the TGUGT and G8 score in daily practice seems to be limited. Type of primary tumor, chemoradiotherapy, age, and World Health Organization performance status were more strongly associated with acute toxicity. Only chemoradiotherapy and age were associated with noncompliance. Overall the compliance was very high. To allow better-informed treatment decisions, a more accurate prediction of toxicity is desirable.

Treatment compliance and noncompliance in psychoses.

Background:Compliance or noncompliance with treatment significantly influences course and outcome of psychiatric disorders. While noncompliance has been extensively researched, compliance has received less attention. The current study was conducted to elicit reasons for compliance and noncompliance in patients having psychoses attending psychiatric clinics.Materials and Methods:A total of 196 compliant and 150 noncompliant patients were interviewed using self-designed tools to elicit sociodemographic data, details of illness, and treatment. Factors contributing to compliance and noncompliance were grouped under illness-related, clinician-related, medication-related, family-related, and economic-related domains and compared.Results:Compliance was significantly more in females and middle- and high-socioeconomic status patients. They had less substance use, high physical comorbidity, high attendance in the outpatient department, and better remission. Clinician-related, family-related, and medication-related domains were contributing more to compliance whereas illness-related and economic-related domains seemed to have more bearing on noncompliance.Conclusions:Compliance and noncompliance are determined multidimensionally. Domains related to clinician, family, and medications have to be reinforced to enhance compliance. Illness-related and economic domains have to be resolved to reduce noncompliance.

Non-Compliance and Related Factors in Patients With Bipolar I Disorder: A Six Month Follow-Up Study.

BackgroundMedication treatment compliance among bipolar patients is quite widespread.ObjectivesTreatment compliance depends on multiple factors. The aim of this study was to evaluate the predicting factors of noncompliance in patients with bipolar I disorder admitted to an Iranian hospital during a six-month follow up period.Materials and MethodsThis cross-sectional study included 47 bipolar I disorder subjects who were admitted to the Iran psychiatric hospital and that were chosen using a non-randomized convenient sampling model. The patients were assessed at baseline, and at two and six months after admission. For evaluating the patients, we used the medication possession ratio (MPR), the drug attitude inventory (DIA-10), the young mania rating scale (Y-MRS) and the scale for the assessment of positive symptoms (SAPS). The data were analyzed using a general linear model by SPSS 16 software.ResultsThe repeated measures analysis revealed that medication compliance increased successively (P = 0.045), and age, gender and symptom severity did not alter the pattern.ConclusionsThere is an increasing pattern in treatment compliance in bipolar I disorder patients, regardless of the known predicting factors for nonadherence.

Role of Clinical Pharmacist in Promoting Patient Compliance through Assessment of Reasons for Non-Compliance and Minimum Maintenance Dose Titrations in Schizophrenic Patients

Context: Medication non-compliance is an important area of concern in schizophrenia as it contributes to relapse and re-hospitalization of the patients. Constant advancement and study of therapeutic interventions designed to improve medication adherence and the outcome of dose titrations are required to reap the most valuable benefits from the pharmacologic treatment of schizophrenia. Aim &amp; Objective: The aim of the present study is to find out the reasons for drug non-compliance and the effectiveness of treatment outcomes after dose titrations in schizophrenic patients and the main objective is to educate the patient by counseling about the disease, drugs and the importance of medication adherence. Materials and Methods: This study was conducted over a period of six months. All male and female subjects of age group 30-40 receiving anti-psychotic medications for a minimum of 1 year before the study starts and who were noncompliant to the prescribed medications were included. Results: Females were prominent in the non-adherent group and males were found to be higher in Group-B. Most of the schizophrenic patients were suffering with paranoid schizophrenia, living in the urban environment and running their nuclear families. Majority of the Subjects in the non-adherent group were illiterates and unemployed, where as in the dose titration group many have completed their primary education and were employed. Compared to first generation antipsychotics, second generation antipsychotic drugs were most commonly prescribed. Almost 56.07% do not have the support from their families. The main reasons stated by the patients to be noncompliant were difficulty in access to treatment, financial obstacles, forgetfulness. Dose titrations were made at an interval of 1 month for four antipsychotics (haloperidol, chlorpromazine, olanzapine and risperidone) and patients were benefited by the titration which was observed through the PANSS scores at each visit. Conclusion: Findings suggest that there is a need for identification and reduction of factors responsible for noncompliance. Strategies to improve adherence have the potential to reduce these costs. Dose titration shows beneficial effect to improve patient quality of life. Hence they should be implemented in clinical practice depending upon the individual patient.

Compliance With Neoadjuvant Chemotherapy in T4 Oral Cancers: Place, Person, Socioeconomic Status, or Assistance

PurposeApproximately 15% to 20% of our patients with head and neck cancer receiving neoadjuvant chemotherapy (NACT) discontinue therapy because of various nonmedical reasons. We sought to analyze the factors associated with treatment default and noncompliance among these patients.Patients and MethodsWe performed a retrospective analysis of patients with T4 oral cancer treated with NACT between January 2011 and December 2012. We included patients who discontinued treatment for nonmedical reasons before the second cycle of NACT. The factors analyzed were income, education, socioeconomic status, age, sex, place of residence, habits, and payment pattern (government supported or personal capacity). Pearson χ2 test was used to identify significant factors associated with noncompliance.ResultsOf 486 patients, 91 patients (18.7%) were noncompliant. Percentages of noncompliant patients in the age groups < 30, between 30 and 60, and > 60 years were 25.0%, 17.4%, and 25.5%, respectively (P = .27). Percentages of noncompliance in patients residing within the city, same state, or different state were 20.7%, 20.9%, and 17.1%, respectively (P = .44). Noncompliance rates were 20.3%, 15.7%, 18.1%, and 22.5% in upper middle, lower middle, upper lower, and lower economic strata, respectively (P = .60). Similarly, there was no significant difference in noncompliance according to occupation, education level, payment pattern, sex, or habits.ConclusionOur analysis failed to identify any specific significant factor associated with noncompliance with NACT among our patients with T4 oral cancers.

Non-compliance in asthmatic patients in easy asthma clinic at Srinagarind Hospital, Thailand

previously validated and consists of open and closed ended questions. Following the implementation of various recruitment strategies, consumers were recruited and provided written informed consent. Results: 205 consumers were recruited. The average completion time for the questionnaire was 15 minutes (SD1⁄46.5). Only 11 (5%) consumers required assistance for completion. The three most commonly reported side effects were sedation (77%), difficulty waking up (59%) and anxiety (55%). In contrast the three side effects ranked as most bothersome were weight gain (23%) followed by feeling tired during the day (22%) and difficulty falling asleep (14%). The M3Q provided consumers with the opportunity to write about the impact these side effects had on their lives. Over half (53%) of the consumers reported thinking of stopping their medication; of these 64% had actually stopped taking their medication at some point. Side effects were the most common reason given for non-adherence. Conclusions: The M3Q was completed within a reasonable time frame with little need for clarification, allowing consumers to easily express their subjective experiences with side effects and contrasted the most common side effects with the most bothersome. Further research involving clinicians reviewing completed questionnaires will examine the clinical application of the M3Q.

Attitudes toward Medication and Reasons for Non-Compliance in Patients with Schizophrenia.

Background:Non-compliance for the medication is an important area of concern in schizophrenia as it contributes to relapse and re-hospitalization of the patients. One of the ways to improve the drug compliance is to know crucial factors responsible for poor drug compliance and hence that proper strategies may be planned to improve patient's drug compliance.Aim:The aim of the following study is to find out the attitudes of patients toward medication and reasons for drug non-compliance in schizophrenia and its association with clinical and socio-demographic variables.Materials and Methods:The study was conducted on follow-up patients with schizophrenia for the duration of 5 months. Their socio-demographic details were noted and illness related variables were evaluated using Positive and Negative Syndrome scale (PANSS). Patient's attitudes toward medication and the reasons for treatment non-compliance were assessed using the standardized tools, which consist of Drug Attitude Inventory-10 scale and Rating of Medication Influences scale respectively.Results:Nearly 41.9% of our study sample were non-compliant to medication. A significant association has been found between non-compliance and younger age group, unemployment, early age of onset, high positive PANSS score and poorer insight into the illness. The significant reasons for non-compliance in our study were Denial of illness, financial burden, less access to treatment facilities, Side-effects of the medication, Feeling that the medication was unnecessary and Substance abuse.Conclusions:Findings suggest that there is a need to provide adequate information about mental illness and medications prescribed, to enhance medication compliance and to develop community mental health care facilities.

Identification and Prevention of Antiepileptic Drug Noncompliance: The Collaborative Use of State-Supplied Pharmaceutical Data

Background. Antiepileptic drugs (AEDs) noncompliance is associated with increased risk of seizures and morbidity in seizure disorder patients. Objective. To identify risk factors that correlated to higher levels of morbidity, measured by emergency room (ER) utilization by seizure disorder members taking AED. Methods. Patients with primary or secondary diagnosis of seizures, convulsions, and/or epilepsy and prescribed AEDs during an 11-month period were included in the study. Variables were analyzed using multivariate statistical analysis including logistic regression. Results. The study identified 201 members. No statistical significance (NS) between age, gender, number of tablets, type of drug, or other risk factors was associated with increased mortality. Statistical significance resulted with medication compliance review of 0–14 days, 15–60 days, and 61+ days between refills. 68% of patients with ER visit had noncompliance refill between 0 and 14 days compared to 52% of patients in non-ER group (P = 0.04). Contrastingly, 15% of ER group had refills within 15–60 days compared with 33% of non-ER group (P = 0.01). There was NS difference between two groups when noncompliance was greater than 60 days (P = 0.66). Conclusions. The study suggests that careful monitoring of pharmaceutical refill information could be used to identify AED noncompliance in epileptic patients.

Precise assessment of noncompliance with the antihypertensive therapy in patients with resistant hypertension using toxicological serum analysis

The aim of our study was to assess the prevalence of pseudo-resistance caused by noncompliance with treatment among patients with severe resistant hypertension and to analyze the contributing factors. Three hundred and thirty-nine patients (195 men) with resistant essential hypertension were studied. The first group consisted of 176 patients admitted for hospitalization for exclusion of a secondary cause to our hypertension centre (103 men); the second one consisted of 163 out-patients (92 men) investigated for the first time in an out-patient hypertension clinic. Unplanned blood sampling for assessment of serum antihypertensive drug concentrations by means of liquid chromatography-mass spectrometry was performed in all patients. Our main finding is a surprisingly low compliance with drug treatment in out-patients with resistant hypertension (23% partially noncompliant and 24% totally noncompliant - in total, 47% prevalence of noncompliance). Eighty-one percent of hospitalized patients were positive, in 10% the results were partially positive and in 9% of the patients, the drugs were all negative. The compliance among hospitalized patients was probably better due to lower numbers of prescribed drugs and expected thorough investigation. More frequently, noncompliance was found in nonworking (potential purpose-built behaviour), younger and less well educated patients. The most frequent noncompliance was to doxazosine, spironolactone and hydrochlorothiazide. We have observed a surprisingly low compliance with treatment among out-patients with severe hypertension. We conclude that the evaluation of antihypertensive drugs concentrations is a useful and precise method for assessment of noncompliance in patients with resistant hypertension. This evaluation is useful before starting the diagnostic work-up of secondary forms of hypertension and before assignment patients into protocols with new therapy modalities such as renal denervation.

Factors responsible for noncompliance to drug therapy in the elderly and the impact of patient education on improving compliance

Background Noncompliance to drug therapy, a common problem in geriatric patients, adversely affects disease outcomes. In India, data addressing noncompliance in elderly patients, the factors responsible for it and possible solutions for the problem are very limited.

Analyzing the Pattern of Prescription Noncompliance in Patients of Cardiac and Diabetic Clinic of a Tertiary Care Hospital

Analyzing the Pattern of Prescription Noncompliance in Patients of Cardiac and Diabetic Clinic of a Tertiary Care Hospital

Medication Noncompliance and Patient Satisfaction Following Percutaneous Coronary Intervention

This study evaluated the relationship between medication noncompliance and patient satisfaction in patients with drug-eluting stent revascularization in Armenia. Reasons for medication noncompliance are multifactorial--often related to health system, patient, condition, therapy, and socioeconomic factors. The analytical cross-sectional survey used a simple random sample of patients aged 18 and over who had undergone percutaneous coronary artery intervention with drug-eluting stent from 2006 to 2008 (n = 271) at Nork Marash Medical Center, Yerevan, Armenia. Medication noncompliance was assessed using the Morisky Adherence Scale. Patient satisfaction items were selected from the Patient Satisfaction Questionnaire (PSQ-18). Respondents' mean age was 57.5 ± 9.8 years. Most (87.8%) were male. Nearly one-third of patients (31.0%) were noncompliant. Most reported good health (91.9%). Respondents most often cited out-of-pocket costs as a reason for noncompliance (19.2%). Age, gender, health status, smoking status, and cost were associated with medication noncompliance (P < 0.05). Noncompliance was not associated with elapsed time after the intervention or satisfaction (P > 0.05). Medication noncompliance was positively related to cost (odds ratio [OR]= 2.57, 95% CI = 1.33-4.97) and inversely related to health status (OR = 0.46, 95% CI = 0.25-0.85) and age (OR = 0.94, 95% CI = 0.91-0.97). Medication noncompliance is a multifactorial problem. Strategies reducing the economic burden on patients should improve compliance and, thus, treatment outcomes. These findings further efforts to benchmark performance in Armenia and other post-Soviet countries against western standards and experiences.

No negative symptoms in healthy volunteers after single doses of amisulpride, aripiprazole, and haloperidol

Noncompliance and poor outcome in patients with schizophrenia are closely related to the negative symptoms secondary to antipsychotics. No controlled study has evaluated whether amisulpride and aripiprazole induce negative symptoms. The aim of this study was to assess the effects of single doses of amisulpride, aripiprazole, haloperidol, and risperidone in healthy volunteers. Seventy-eight young volunteers took part in this double-blind, randomized, placebo-controlled, parallel study of four antipsychotics: 400 mg amisulpride, 10 mg aripiprazole, 3 mg haloperidol, and 2 mg risperidone. Assessments of negative symptoms were done 4 h after administration using both subjective rating scales (Neuroleptic Induced Deficit Syndrome Scale and Subjective Deficit Syndrome Scale) and an objective rating scale (Scale for the Assessment of Negative Symptoms). Risperidone only produced significant increases on the avolition score of the Neuroleptic Induced Deficit Syndrome Scale and blunted affect and alogia scores of the Scale for the Assessment of Negative Symptoms compared with placebo. The effect on blunted affect persisted after controlling for mental sedation. Amisulpride, aripiprazole, and haloperidol did not induce negative symptoms. Aripiprazole and risperidone induced mild extrapyramidal symptoms. The most common adverse events were somnolence and cognitive slowing. These data indicate that a single risperidone dose induces negative symptoms in normal volunteers, whereas amisulpride, aripiprazole, and haloperidol do not. These characteristics of antipsychotics should be considered when choosing optimal drugs for patients with psychosis.

Do Patient-Reported Androgen-Deprivation Therapy Side Effects Predict Anxiety and Depression Among Prostate Cancer Patients Undergoing Radiotherapy? Implications for Psychosocial Therapy Interventions

Antiandrogen therapy (AAT) is a common adjunct treatment for prostate cancer (PCa) patients and has shown significant benefits to long-term outcomes from radiation or surgery. Although AAT has some adverse side effects and data from breast cancer patients indicate that such side effects from hormonal therapies may contribute to anxiety and depression and may also hinder AAT treatment compliance, this issue has not been investigated within a sample of PCa patients. This study explores the incidence of AAT side effects in a sample of PCa patients, the links between those side effects and anxiety and depression, the possible ways in which these factors may contribute to AAT treatment noncompliance in PCa patients, and how psychosocial treatments might be developed to attend to this issue. 147 PCa patients completed questionnaires on demographic factors, treatment compliance, AAT side effects, anxiety and depression. About 18% of the sample reported AAT side effects, and there was a significant association between the presence of side effects and elevated anxiety and depression scores. Increased frequency of side effects was significantly associated with elevated anxiety, but not depression. The most powerful relationship between AAT side effects and anxiety-depression was for the subfactors of (1) Fatigue, Pain and Discomfort, and (2) Psychological Agitation and Pessimism. Although fatigue, pain, and discomfort may be outcomes of the hormonal treatment itself, psychological agitation and pessimism represent a discrete psychological pathway between AAT side effects and anxiety and depression and (potentially) treatment noncompliance. Methods of addressing patients’ loss of optimism in their treatment outcomes are discussed.

Recurrent Diabetic Ketoacidosis in Inner-City Minority Patients

OBJECTIVETo conduct a bedside study to determine the factors driving insulin noncompliance in inner-city patients with recurrent diabetic ketoacidosis (DKA).RESEARCH DESIGN AND METHODSWe analyzed socioeconomic and psychological factors in 164 adult patients with DKA who were admitted to Grady Hospital between July 2007 and August 2010, including demographics, diabetes treatment, education, and mental illness. The Patient Health Questionnaire-9 and the Short Form-36 surveys were used to screen for depression and assess quality of life.RESULTSThe average number of admissions was 4.5 ± 7 per patient. A total of 73 patients presented with first-time DKA, and 91 presented with recurrent DKA; 96% of patients were African American. Insulin discontinuation was the leading precipitating cause in 68% of patients; other causes were new-onset diabetes (10%), infection (15%), medical illness (4%), and undetermined causes (3%). Among those who stopped insulin, 32% gave no reasons for stopping, 27% reported lack of money to buy insulin, 19% felt sick, 15% were away from their supply, and 5% were stretching insulin. Compared with first-time DKA, those with recurrent episodes had longer duration of diabetes (P < 0.001), were a younger age at the onset of diabetes (P = 0.04), and had higher rates of depression (P = 0.04), alcohol (P = 0.047) and drug (P < 0.001) abuse, and homelessness (P = 0.005). There were no differences in quality-of-life scores, major psychiatric illnesses, or employment between groups.CONCLUSIONSPoor adherence to insulin therapy is the leading cause of recurrent DKA in inner-city patients. Several behavioral, socioeconomic, psychosocial, and educational factors contribute to poor compliance. The recognition of such factors and the institution of culturally appropriate interventions and education programs might reduce DKA recurrence in minority populations.