WASHINGTON (AP) -- When dealing with diseases requiring complex treatments, well-educated patients do better than those with less schooling, according to a RAND study.

Researchers at RAND, a nonprofit research institution in Santa Monica, Calif., examined the health of patients with HIV and with diabetes, both diseases that require carefully following directions and consistency in taking tests, keeping appointments and taking medicines.

The researchers then related the health of the patients to their level of education and found that schooling made a dramatic difference. The effect of education was even more important for a patient's health than income, age, race or gender, the study found.

"We found that the educated are much better able to adhere to the treatment regimen in the cases of HIV and diabetes," said Dana P. Goldman of RAND. He said that therapies for HIV and diabetes are "very, very complicated" and that people with advanced education have a proven experience in dealing with detailed and complex chores that have to be done consistently.

"Diabetes requires a person to monitor their blood sugar constantly and adjust their medication," said Goldman. "In HIV, patients have to take many different pills and coordinate them with other medications and their diet."

"The better educated are much better able to comply with this and that then affects their general health," he said.

In analyzing a study of HIV patients and relating the findings to education levels, the researchers found that 68 percent of college graduates with HIV are receiving highly active antiretroviral therapy, or HAART, a complex pill-taking routine that requires careful adherence. Among high school drop outs with HIV, the study found only 54 percent were on HAART.

Among those taking HAART, there was 57 percent compliance among college graduates and only 37 percent compliance among high school dropouts.

The effect of education was directly reflected in the general health of the HIV patients. About 31 percent of the high school dropouts in the study said their health was fair or poor. Among college graduates, only 17.8 of the HIV patients said their health was fair or poor.

When relating two diabetes studies to the level of education of the enrolled patients, the researchers found that only a third of the high school dropouts reported themselves to be in good or excellent health, while almost 75 percent of the college graduates were in good or excellent health.

Controlling diabetes requires frequent tests to determine the level of sugar in the blood. The study found that patients with a higher education checked their blood more often. The educated also got more exercise and were less likely to smoke cigarettes, the study found.

The researchers looked at the effect of an intensive diabetes treatment program where patients were seen often by doctors and received telephone reminders to test their blood and to take medication.

Goldman said this intensive care program improved the health of all the patients, but had the most dramatic effect on those with less than a college degree.

"You find that intensive treatment was much more beneficial for those with little education," said Goldman. "Those with an education were already doing a pretty good job."

The finding suggests that doctors should adjust the intensity of their care based on the educational background of their patients, he said.

"If someone comes in with a Ph.D., the doctor can maybe give them the information and suggest they follow up," said Goldman. "But if someone comes in without even a high school education, then the doctor should tell his nursing staff to follow up (and) to simplify the instructions."

The intensive follow-up is more expensive for the doctor, he said.

"We need to find out a way to compensate the providers so that they have an incentive to do this," said Goldman.

Richard M. Suzman, an associate director at the National Institute of Aging, one of the National Institutes of Health, said the study "takes a clever and useful approach to looking at health disparities."

Suzman said in a statement that it was known that education was a factor in good health outcomes, but the new analyses "give us hope that we can define strategies to help improve the health of people with less education."

Copyright 2002 The Associated Press. All rights reserved.