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June 2, 1993, Vol 269, No. 21 >
ARTICLE | June 2, 1993

Is This Patient Taking the Treatment as Prescribed? FREE

Barbara J. Stephenson, RN; Brian H. Rowe, MD, MSc; R. Brian Haynes, MD, PhD; William M. Macharia, MD, MSc; Gladys Leon, MD, MSc
[+] Author Affiliations

Reprint requests to McMaster University Medical Center, 1200 Main St W, Room 3H7, Hamilton, Ontario, Canada L8N 3Z5 (Dr Haynes).


JAMA. 1993;269(21):2779-2781. doi:10.1001/jama.1993.03500210079036
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References

CLINICAL SCENARIOS 

Case 1  A 28-year-old woman presents to the emergency department in acute distress with a 3-day history of worsening asthma. Her prescribed medications include an inhaled β2-agonist and an inhaled steroid. When questioned, she breathlessly admits to "occasionally" missing her medications but indicates that this is "maybe only once or twice."

Case 2  A 55-year-old man with posttraumatic seizure disorder has been taking phenytoin since his injury. His seizures were initially adequately controlled but he recently has been having weekly seizures. In an office visit he resentfully denies missing any of his medication.

THE IMPORTANCE OF CLINICAL EXAMINATION  Physicians should measure compliance for patients prescribed a self-administered treatment because noncompliance is common and physicians can help patients to improve their compliance1,2 and increase the benefit they derive from therapy. Compliance with long-term self-administered medication therapy is approximately 50% for those who remain in care.3

REFERENCES

1 +
Sackett DL, Haynes RB, Guyatt GH, Tugwell P.  Helping patients follow the treatments you prescribe.  In: Clinical Epidemiology: A Basic Science for Clinical Medicine . 2nd ed. Boston, Mass: Little Brown & Co Inc; 1991;:249-281.
2 +
Macharia WM, Leon G, Rowe BH, Stephenson BJ, Haynes RB.  An overview of interventions to improve compliance with appointment keeping for medical services. JAMA . 1992;;267:1813-1817.
3 +
Sackett DL, Snow JC.  The magnitude of compliance and noncompliance.  In: Haynes RB, Taylor DW, Sackett DL, eds. Compliance in Health Care . Baltimore, Md: John Hopkins University Press; 1979;:11-22.
4 +
Haynes RB, Dantes R.  Patient compliance and the design and interpretation of clinical trials. Controlled Clin Trials . 1987;;8:12-19.
5 +
Haynes RB, Gibson ES, Taylor DW, Bernholz C, Sackett D.  Process versus outcome in hypertension: a positive result. Circulation . 1982;;65:28-33.
6 +
Markowitz M.  Eradication of rheumatic fever: an unfulfilled hope. Circulation . 1970;;41:1077-1084.
7 +
Leventhal H, Cameron L.  Behavioral theories and the problem of compliance. Patient Educ Counseling . 1987;;10:117-138.
8 +
Haynes RB.  Determinants of compliance: the disease and the mechanics of treatment.  In: Haynes RB, Taylor DW, Sackett DL, eds. Compliance in Health Care . Baltimore, Md: Johns Hopkins University Press; 1979;:49-62.
9 +
Haynes RB, Taylor DW, Sackett DL, Gibson ES, Bernholz C, Mukherjee J.  Can simple clinical measurements detect patient noncompliance? Hypertension . 1980;;2:757-764.
10 +
England ML, Hershman JM.  Serum TSH concentration as an aid to monitoring compliance with thyroid hormone in hypothyroidism. Am J Med . 1986;;292:264-266.
11 +
Mollica JA.  Monitoring compliance through analysis of drug and metabolite levels. Controlled Clin Trials . 1984;;5:505-509.
12 +
Sclar DA.  Improving medication compliance: a review of selected issues. Clin Ther . 1991;;13:436-440.
13 +
Cramer JA, Mattson RH, Prevey ML, Scheyer RD, Ouellette VL.  How often is medication taken as prescribed? JAMA . 1989;;261:3273-3277.
14 +
Rudd P, Ahmed S, Zachary V, Barton C, Bonduelle D.  Improved compliance measures: applications in an ambulatory hypertensive drug trial. Clin Pharmacol Ther . 1990;;48:676-685.
15 +
Deuschle K, Jordahl C, Hobby G.  Clinical usefulness of riboflavin-tagged isoniazid for self-medication in tuberculosis patients. Am Rev Respir Dis . 1960;;82:1-10.
16 +
Wolff K, Hay A, Raistrick D, Calvert R, Feely M.  Measuring compliance in methadone maintenance patients: use of a pharmacologic indicator to estimate methadone plasma levels. Clin Pharmacol Ther . 1991;;50:199-207.
17 +
National Heart, Lung, and Blood Institute Working Group on Patient Compliance.  Management of patient compliance in the treatment of hypertension. Hypertension . 1982;;4:415-423.
18 +
Gilbert JR, Evans CE, Haynes RB, Tugwell P.  Predicting compliance with a regimen of digoxin therapy in family practice. Can Med Assoc J . 1980;; 123:119-122.
19 +
Roth HP, Caron HS, Hsi BP.  Measuring intake of a prescribed medication: a bottle count and a tracer technique compared. Clin Pharmacol Ther . 1970;;7:49-54.
20 +
Richardson JL, Skilton DR, Krailo M, Levine AM.  The effect of compliance with treatment on survival among patients with haematologic malignancies. J Clin Oncol . 1990;;8:356-364.
21 +
Inui TS, Carter WB, Pecoraro RE.  Screening for noncompliance among patients with hypertension: is self-report the best available measure? Med Care . 1981;;19:1061-1064.
22 +
Oxman AD, Guyatt GH.  Guidelines for reading literature reviews. Can Med Assoc J . 1988;;138:697-703.
23 +
Stewart M.  The validity of an interview to assess a patient's drug taking. Am J Prev Med . 1987;; 3:95-100.
24 +
Fletcher SW, Pappius EM, Harper SJ.  Measurement of medication compliance in a clinical setting. Arch Intern Med . 1979;;139:635-638.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Sackett DL, Haynes RB, Guyatt GH, Tugwell P.  Helping patients follow the treatments you prescribe.  In: Clinical Epidemiology: A Basic Science for Clinical Medicine . 2nd ed. Boston, Mass: Little Brown & Co Inc; 1991;:249-281.
2 +
Macharia WM, Leon G, Rowe BH, Stephenson BJ, Haynes RB.  An overview of interventions to improve compliance with appointment keeping for medical services. JAMA . 1992;;267:1813-1817.
3 +
Sackett DL, Snow JC.  The magnitude of compliance and noncompliance.  In: Haynes RB, Taylor DW, Sackett DL, eds. Compliance in Health Care . Baltimore, Md: John Hopkins University Press; 1979;:11-22.
4 +
Haynes RB, Dantes R.  Patient compliance and the design and interpretation of clinical trials. Controlled Clin Trials . 1987;;8:12-19.
5 +
Haynes RB, Gibson ES, Taylor DW, Bernholz C, Sackett D.  Process versus outcome in hypertension: a positive result. Circulation . 1982;;65:28-33.
6 +
Markowitz M.  Eradication of rheumatic fever: an unfulfilled hope. Circulation . 1970;;41:1077-1084.
7 +
Leventhal H, Cameron L.  Behavioral theories and the problem of compliance. Patient Educ Counseling . 1987;;10:117-138.
8 +
Haynes RB.  Determinants of compliance: the disease and the mechanics of treatment.  In: Haynes RB, Taylor DW, Sackett DL, eds. Compliance in Health Care . Baltimore, Md: Johns Hopkins University Press; 1979;:49-62.
9 +
Haynes RB, Taylor DW, Sackett DL, Gibson ES, Bernholz C, Mukherjee J.  Can simple clinical measurements detect patient noncompliance? Hypertension . 1980;;2:757-764.
10 +
England ML, Hershman JM.  Serum TSH concentration as an aid to monitoring compliance with thyroid hormone in hypothyroidism. Am J Med . 1986;;292:264-266.
11 +
Mollica JA.  Monitoring compliance through analysis of drug and metabolite levels. Controlled Clin Trials . 1984;;5:505-509.
12 +
Sclar DA.  Improving medication compliance: a review of selected issues. Clin Ther . 1991;;13:436-440.
13 +
Cramer JA, Mattson RH, Prevey ML, Scheyer RD, Ouellette VL.  How often is medication taken as prescribed? JAMA . 1989;;261:3273-3277.
14 +
Rudd P, Ahmed S, Zachary V, Barton C, Bonduelle D.  Improved compliance measures: applications in an ambulatory hypertensive drug trial. Clin Pharmacol Ther . 1990;;48:676-685.
15 +
Deuschle K, Jordahl C, Hobby G.  Clinical usefulness of riboflavin-tagged isoniazid for self-medication in tuberculosis patients. Am Rev Respir Dis . 1960;;82:1-10.
16 +
Wolff K, Hay A, Raistrick D, Calvert R, Feely M.  Measuring compliance in methadone maintenance patients: use of a pharmacologic indicator to estimate methadone plasma levels. Clin Pharmacol Ther . 1991;;50:199-207.
17 +
National Heart, Lung, and Blood Institute Working Group on Patient Compliance.  Management of patient compliance in the treatment of hypertension. Hypertension . 1982;;4:415-423.
18 +
Gilbert JR, Evans CE, Haynes RB, Tugwell P.  Predicting compliance with a regimen of digoxin therapy in family practice. Can Med Assoc J . 1980;; 123:119-122.
19 +
Roth HP, Caron HS, Hsi BP.  Measuring intake of a prescribed medication: a bottle count and a tracer technique compared. Clin Pharmacol Ther . 1970;;7:49-54.
20 +
Richardson JL, Skilton DR, Krailo M, Levine AM.  The effect of compliance with treatment on survival among patients with haematologic malignancies. J Clin Oncol . 1990;;8:356-364.
21 +
Inui TS, Carter WB, Pecoraro RE.  Screening for noncompliance among patients with hypertension: is self-report the best available measure? Med Care . 1981;;19:1061-1064.
22 +
Oxman AD, Guyatt GH.  Guidelines for reading literature reviews. Can Med Assoc J . 1988;;138:697-703.
23 +
Stewart M.  The validity of an interview to assess a patient's drug taking. Am J Prev Med . 1987;; 3:95-100.
24 +
Fletcher SW, Pappius EM, Harper SJ.  Measurement of medication compliance in a clinical setting. Arch Intern Med . 1979;;139:635-638.

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