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June 2, 1993

Is This Patient Taking the Treatment as Prescribed?

Author Affiliations

From the Design, Measurement, and Evaluation Program (Ms Stephenson and Drs Rowe, Haynes, Macharia, and Leon) and the Health Information Research Unit (Dr Haynes), McMaster University, Hamilton, Ontario. Ms Stephenson is now with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario; Dr Rowe is now with the University of Ottawa, Northeastern Family Medicine Program, Sudbury, Ontario; Dr Macharia is now with the Department of Pediatrics, Faculty of Medicine, University of Nairobi (Kenya); Dr Leon is now with the Department of Dermatology, Faculty of Medicine, National Autonomous University of Mexico, Mexico City.

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


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