Predictors of non-compliance in primary care of patients with chronic disease

Non-compliance is a label attached to many patients without much thought as to the cause. A better understanding of the factors affecting compliance is imperative in order to improve outcomes. The purpose of our study was to investigate the predictors of non-compliance among persons living with chronic disease (i.e., diabetes, hypertension, hyperlipidemia and obesity) seen at two primary care clinics. Data were collected from the patient's electronic record from 2008 to 2010. The patient sample (n=267) were examined according to gender, age, ethnicity, marital status, employment, insurance, tobacco or alcohol use, clinic size and comorbidity using chi-square, t-tests and logistic regression. Compliance was measured by having at least two checkups per year. Significant differences were found by clinic site, insurance status and comorbid obesity. Almost all of the patients with some form of insurance were compliant compared to those without (94% v. 36%; p<.001) and were less likely to drop out after the first visit (22% v. 73%; p<.001). Additionally, almost all of the patients who were compliant were also obese (93.3% v. 6.7%; p<.01). Patients seen in the suburban clinic were more likely to be compliant than those from the urban clinic (44.2% v. 24.8%; p<.01) but further analyses indicates that they were also significantly more likely to have insurance (72% v. 48%; p<.01). These findings suggest that whether or not a person is insured is a major contributing factor for compliance. This project was supported, in part, by US Department of Health and Human Services, HRSA: Grant No. D58HP20796-01