18 Compliance-Related Problems in the Ambulatory Population By E. Paul Larrat, MBA, Albert H. Taubman, PhD, and Cynthia Willey, PhD Summary When prescription drugs are taken in the correct dose and the cor- rect manner, they have great poten- tial for improving the quality of med- ical care, but inappropriate and in- correct administration of these drugs can lead to severe health prob- lems. Risk factors for problems re- lated to prescription drug com- pliance were examined in a cross- sectional retrospective study (n = 1017) of ambulatory individuals who had undergone a Brown Bag Prescription Evaluation Program consultation. A pharmacist inter- viewer assessed drug-related prob- lems such as duplication of drug product, overutilization and under- utilization of medication, drug inter- actions, and side effects. Associa- tions between specific medication- related problems and patient charac- teristics (demographics, medical history, and insurance status) were studied. Factors that appear to be as- sociated with compliance problems include a patient's level of under- standing of both medication instruc- tions and the drug therapy, length of time since last physician visit, length of time on medication, total number of medications, and num- ber of drug allergies. The class of E. Paul Larrat, MBA, is coordinator, Ambulatory Care Programs and Con- tinuing Education, The University of Rhode Island, College of Pharmacy, Kingston, RI 02881. AlbertH. Taubman, PhD, is professor and chairman, Depart- ment of Pharmacy Practice, and Cynthia Willey, PhD, is assistant profes- so r, College of Pharmacy and College of Nursing, at the university. Received March 1989; revised Sep- tember 1989; accepted November 1989. medication taken was also found to be a significant predictor of excess risk. The age and sex of an individual appear to have little association with the development of compliance-re- lated problems. The study reinforces the need for frequent patient contact with a health care professional and the value of educating the patient about the medication regimen. Introduction R ecent changes in the health care system have placed increased emphasis on controlling treatment costs, in addition to maintaining high-quality patient care. A major concern of health care managers is the problem of patient noncompli- ance with prescribed medication therapy. Studies have shown that non- compliance not only has a negative impact on patient care but also wastes precious health care resources and decreases labor productivity. Noncompliance with a medication regimen is of particular concern to health care managers with respect to quality-of-care issues and the great sums of money spent on care needed as a result of inadequate compliance with drug therapy.1 A significant amount of research over the past few decades has Ameri can Pharmacy, Vol. NS30, No.2 February 1990/82