Pediatric Nephrology

, Volume 20, Issue 12, pp 1823–1824 | Cite as

The impact of logistics and resilience on compliance

  • Jose GrünbergEmail author
Letter to the Editors


I have read with interest the article entitled “Why do they do that? The compliance conundrum” [1]. I would like to emphasize two points that I believe may complement Dr. Nevins’ editorial commentary: logistics and resilience as potential determinants of patient compliance. Noncompliance linked to logistics failures (NCLLF) is a major problem for poor people in developing countries. Public transportation is scarce, uncoordinated and, not exceptionally, chaotic. Thus, some patients who do wish to comply find insurmountable barriers in their way. Patients may face access barriers to medical appointments and medications for cost reasons. Even when those are free of charge, patients may face high costs because of the time and transportation costs involved and their inability to take time off from work. A survey was carried out in Uruguay to establish the patterns of travel to the hospital of 80 patients living more than 40 km away. The results illustrate these difficulties: 32 (40%)...


Peritoneal Dialysis Pediatric Nephrologist Health Care Staff Electricity Cost Chronic Peritoneal Dialysis 
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Copyright information

© IPNA 2005

Authors and Affiliations

  1. 1.Servicio de Nefrología de Niños y Adolescentes (SENNIAD)Instituto de Medicina Altamente Especializada, Hospital EvangélicoMontevideoUruguay

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