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(Circulation. 1996;93:4-6.)
© 1996 American Heart Association, Inc.

Articles

Compliance Enhancement

A Call for Multidisciplinary Team Approaches

Martha N. Hill, RN, PhD; Nancy Houston Miller, RN, BSN

From the Johns Hopkins University, Baltimore, Md (M.N.H.), and Stanford Cardiac Rehabilitation Program, Stanford University School of Medicine, Palo Alto, Calif (N.H.M.).

Correspondence to Martha N. Hill, RN, PhD, Associate Professor, Nursing, Medicine and Public Health, The Johns Hopkins University, 1830 E Monument St, Room 233, Baltimore, Md 21205-2100.

	Introduction

 
Concern about the cost and quality of health care has stimulated an interest in documenting improved patient outcomes. Large multisite clinical trials, such as MRFIT,¹ HDFP,² SHEP,³ and 4S,⁴ used multidisciplinary educational and behavioral interventions to demonstrate dramatic reductions in cardiovascular morbidity and mortality through the modification of risk factors. Other large multisite clinical trials, such as TOHP I⁵ and TOMS,⁶ used similar strategies to demonstrate significant differences in lifestyle modification and quality of life associated with effective risk reduction. But similar outcomes have not been achieved in clinical practice.

Why are we not achieving the same results in clinical practice that we see in randomized controlled clinical trials? We believe one major reason is that the multidisciplinary team approach used in clinical trials to reduce risk is insufficiently incorporated into standard clinical practice.

In the case of secondary prevention for coronary artery disease, improved outcomes depend on patients' following appropriate risk reduction plans. The recent American Heart Association consensus statement "Preventing Heart Attack and Death in Patients With Coronary Disease"⁷ outlines a set of risk reduction recommendations for clinicians and emphasizes the central role of patient compliance (or "adherence") in achieving improved medical outcomes. The statement says that "attention to enhancing patient compliance is an integral part of any risk reduction program," adding that the proportion of patients who continue risk factor interventions over the long term "can be significantly increased by a team approach in which healthcare professionals-including physicians, nurses, and dietitians- manage risk reduction therapy by using . . . [Full Text of this Article]

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