Document Type



This study describes the successful design and implementation of a medications calendar to increase medication compliance among Navajo patients who have difficulty complying with prescription instructions. This paper is presented as an example of a successful method for trying to ensure that medications are taken according to instructions. The MED calendar is designed to help non-English speaking and elderly patients in particular.Initially the calendars were hand made by the drivers from the Public Health Nursing Department. Their primary duty was to serve as interpreters for the Public Health Nurse. Poster board (20""x26"") was used to simulate a monthly calendar. The days of the week were marked on each grid on each board. The boards were then laminated and the laminated surface was used to mark the name and days of the month for which the calendar was being used. The patients medications were then placed in single unit dose packages. The dose packages were then taped to the calendar according to the prescribed schedule. The patient then received a detailed verbal explanation on when and how to take his or her medicine. The calendar was attached to the wall of the patient\'s residence with stick pins and medications were placed for 2-4 weeks at a time. The material cost of the original calendars was $1.75 without labor. Now a professional printer produces them at a total cost of $3.00 per unit. There were two primary safety considerations explored with the implementation of the MED calendars. The first was concern for the stability of the medication in a clear package as opposed to opaque bottle. The Chief of Pharmacy indicated that medicine can be kept in unit dose packages up to six months. The benefits of patient compliance were much greater than any small risk of medication instability. The second concern was safety around small children. In most cases the calendar can be placed high enough on the wall to be out of reach of the children. If this is not possible then the use of the MED calendar is not considered.MED calendars were well accepted by the patients. Navajo patients relate well to ordinary monthly calendars, and this does not require knowledge of the English language. Also, the calendars are highly visible making them difficult to ignore. Medication doses are more easily understood with a pictorial association. The calendars are durable and last at least two or three years. From 1985 to 1987, the MED calendars were used with non-compliant patients. Seventy-three percent of the patients showed some improvement. Improvement was measured by 1) improvement in clinical symptoms including decreased hospitalization, 2) accurate or improved pill count, and 3) patient\'s and/or doctor\'s affirmation of compliance. There are several difficulties noted in the use of the MED calendar. Safety in the presence of small children is a major concern. Some patients become very dependent on the MED calendar, and this becomes time consuming for the Public Health Nurse who must visit every 2-4 weeks to refill the unit dose packages. Sometimes the unit dose packages do not remain secured to the calendar. Finally, the large size of the calendar can create difficulties in transporting them and are therefore objectionable to some of the patients.The study concludes that the benefits of the MED calendar far outweigh the difficulties encountered in using this system of promoting and facilitating patient compliance.

Publication Date



Indian Health Service, Staff Office of Planning, Evaluation, and Research, Rockville, MD 20857 (E-110).