STUDIES IN THE EPIDEMIOLOGY AND PREVENTABILITY OF RHEUMATIC FEVER. IV. A QUANTITATIVE DETERMINATION OF COMPLIANCE IN CHILDREN ON ORAL PENICILLIN PROPHYLAXIS

Abstract

Reliability of rheumatic fever patients in maintaining regular oral daily penicillin prophylaxis was studied in 136 children and adolescents by testing their urine specimens for penicillin. Random weekly urine specimens were obtained from each child by school nurses and specimens were also obtained at the time of clinic visits. The children did not know the reasons for the tests. The development of a simple test using filter paper strips dipped in the urine permitted the school specimens to be mailed into the laboratory. In this way over 1,800 specimens were obtained over a 5-month period from children in 71 schools. On the basis of specimens obtained at school, 36% of the patients attending rheumatic fever prevention clinics took their penicillin one fourth of the time or less. Compliance determined from school specimens compared closely with that determined from specimens obtained at clinic visits. An initial sequence of three negative tests identified most non-compliers in this population. The methods described are a practical means for identifying non-compliers and are applicable to the follow-up of patients in rheumatic fever prevention programs which use penicillin prophylaxis. The finding of a high rate of non-compliance demonstrates the need for such a test in rheumatic fever patients. Furthermore, the test also provides the opportunity of studying the relationship of noncompliance to medical, social, cognitive, and attitudinal factors so that the most appropriate types of health care can be provided for chronically ill children.