The concept of compliance is important because negative outcomes such as increased seizure frequency, increased hospital admissions, loss of driving privileges, loss of employment, status epilepticus, and death are often related to the inability to take medications as ordered (non-compliance).

The findings of this literature review will be used to determine what is currently known about patient compliance, identify the gaps in the literature, and, based on findings, suggest clinical and research implications. The authors conducted a comprehensive review of compliance literature using the key words ‘patient compliance,’ ‘epilepsy,’ and ‘patient adherence,’ in ‘Medline’ and ‘Cumulative Index to Nursing & Allied Health’ (‘CINAHL’) to retrieve all the related research studies from 1975 until the present. In addition, a manual search was conducted using the reference lists of related articles. Inclusion criteria were: articles in which at least one dependent variable was compliance rate with a detailed description of the measurement of compliance; research articles focusing on examining medication compliance issues in adult patients with epilepsy; and articles written in English. Articles were not included if they focused on the pharmacological aspects of antiepileptic medications and not compliance.

The authors found 22 research studies for this review, which were divided into five groups related to content focus as follows:

• rates of compliance;

• measurement of compliance;

• correlates of compliance;

• intervention to improve compliance rate; and

• qualitative studies exploring compliance behaviors.

The Measurement and Rates of Compliance
Multiple strategies have been used to measure medication compliance. Each method has serious measurement flaws and no ‘gold standard’ for measuring compliance exists.

Patient self-report, the most commonly used measure of patient compliance, can provide information about the patterns of medication use and patients’ perception and barriers to medication compliance. However, it is reported that this method often overestimates compliance rates because patients do not always remember or report exactly how they took their medications. Moreover, they may not want to disappoint their healthcare provider by reporting that they have not kept up with the prescription.

Pill counts and prescription refills have been used to provide a more objective measure of compliance. Each method presents similar problems. Researchers have counted pills during clinic visits to identify the number of pills taken by the patients. Likewise, researchers have tracked the frequency of prescription refills and compared actual refill times to ideal refill times. Studies have demonstrated that prescription refills, when using records from central pharmacies, correlate well with the compliance data measured by medication serum concentration and self-report. Neither pill counts nor prescription refills provide information about patterns of actual medication-taking behavior. There is no way to be sure that patients take all the medications on time and in correct dosage once the medications are gone.