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Article
June 9, 1989

How Often Is Medication Taken as Prescribed?A Novel Assessment Technique

Author Affiliations

From the Veterans Administration Medical Center, Epilepsy Center, West Haven, Conn (Mss Cramer and Ouellette and Drs Mattson, Prevey, and Scheyer); and the Departments of Neurology (Ms Cramer and Drs Mattson and Scheyer) and Psychology (Dr Prevey), Yale University School of Medicine, New Haven, Conn.

From the Veterans Administration Medical Center, Epilepsy Center, West Haven, Conn (Mss Cramer and Ouellette and Drs Mattson, Prevey, and Scheyer); and the Departments of Neurology (Ms Cramer and Drs Mattson and Scheyer) and Psychology (Dr Prevey), Yale University School of Medicine, New Haven, Conn.

JAMA. 1989;261(22):3273-3277. doi:10.1001/jama.1989.03420220087032
Abstract

The evaluation of the efficacy of medication is confounded when patients do not adhere to prescribed regimens. Overdosing, underdosing, and erratic dosing intervals can diminish drug action or cause adverse effects. Using a new method with epilepsy as a model, we assessed compliance with long-term medications among newly treated and long-term patients. Medication Event Monitor Systems (Aprex Corporation, Fremont, Calif) are standard pill bottles with microprocessors in the cap to record every bottle opening as a presumptive dose. Compliance rates averaged 76% during 3428 days observed: 87% of the once daily, 81% of the twice daily, 77% of the three times a day, and 39% of the four times a day dosages were taken as prescribed. Coefficients of variation of drug serum concentrations had no significant relationship to compliance rates. Pill counts overestimated compliance increasingly as compliance with the prescribed regimen declined. Neither drug serum concentrations nor pill counts would have identified the frequency of missed doses that were revealed with continuous dose observations.

(JAMA. 1989;261:3273-3277)

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