A general method of compliance assessment using centralized pharmacy records: Description and validation

John F. Steiner, Thomas D. Koepsell, Stephan D. Fihn, Thomas S. Inui

Research output: Contribution to journalArticle

378 Scopus citations


The prescription refill records of centralized pharmacies are a potential source of information about patient compliance with long-term medications. We developed a method for assessing compliance in such settings and validated our measures using pharmacy data and clinical information from patients with seizure disorders and hypertension. For patients taking the anticonvulsant medication phenytoin, compliance with the drug correlated significantly with mean plasma phenytoin level. For patients on antihypertensive medications, compliance with the treatment regimen correlated with control of diastolic blood pressure. Many patients (15% in the phenytoin validation, and 33% in the blood pressure validation) obtained substantial oversupplies of medications; for these patients, the direct relationship between compliance and drug effect was not evident. A majority of seizure patients with “subtherapeutic” mean plasma phenytoin levels were identified as noncompliant using our measures. We conclude that our method of assessing compliance in obtaining medications is feasible in “managed care” settings, appears to be a valid correlate of drug effects, and may be useful in research and patient care.

Original languageEnglish (US)
Pages (from-to)814-823
Number of pages10
JournalMedical care
Issue number8
StatePublished - Aug 1988
Externally publishedYes


  • Drug therapy
  • Hypertension
  • Patient compliance
  • Phenytoin

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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