Denial, delay and disappointment: discovering and overcoming the causes of drug errors and missed appointments

Although the medical management of epilepsy is possible with effective therapeutics, such management is complicated by patient errors of self-medication. Efforts to improve adherence to prescribed regimens of anticonvulsant medication have not been extensively studied, although several promising results have been obtained. Research on adherence to medication regimens has been more extensive in other chronic conditions, such as hypertension, that have similarities to epilepsy in their demand for long-term treatment, often in the absence of symptoms, with drugs that may produce side effects. From the combined research on factors associated with drug errors, we have analyzed characteristics of the patient, of the regimen, of the illness, and of the patient - provider relationship. The most promising areas for improving compliance appear to be the influence of family and friends, the complexity of the treatment regimen, the patient's belief in severity of the illness, and the patient - provider relationship. Strategies to improve compliance can target 3 sets of factors: predisposing factors including patients' motivation and perception, factors that enable patients to comply more easily, and factors that reinforce compliance. Physician-directed interventions tailored to each of these categories of factors, taken together, can make up a comprehensive health education program. A model for the interventions and their evaluations is presented.