Medication non-adherence is common, per a study published in JAMA Network Open, and comprehensive medication monitoring “has merit” in identifying patient compliance.  

Although electronic health record (EHR) medication lists can often be inaccurate, a comparison of blood serum concentrations with electronic records showed that 78% to 100% of medications detected corresponded with prescribed medication lists, and medications detected that had not been prescribed were more often associated with alerts for adverse reactions.

Researchers conducted a cross-sectional cohort study that evaluated the accuracy of EHR and patient medication adherence by comparing medication blood concentrations with medication listed in the EHR. A serum assay panel capable of detecting 91% of US oral small-molecule drug prescriptions (263 medications) was applied to a total of 1346 clinical plasma or serum samples from 3 patient cohorts: a gastroenterology cohort, a residual cohort randomly selected from samples sent for routine testing, and an emergency department cohort of patients with hypertension. A subset of 189 oral medications with an empirical detection rate of ≥70% or a half-life >4 hours were used to calculate medication adherence, which was defined as the percentage of medications from prescription records detected in blood serum.

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Median medication adherence in the gastroenterology cohort was 100% (interquartile range [IQR], 84%-100%), 83% in the residual cohort (IQR, 50%-100%), and 78% in the emergency department cohort (IQR, 57%-100%). Patients who were adherent to 1 prescribed medication were more frequently adherent to other prescribed medications. Among patients prescribed ≥3 medications, no significant associations were seen between adherence and number of prescriptions or sex, but a modest association was seen between adherence and older age.

In the residual cohort, a median of 0 medications per patient (IQR, 0-2) that were not listed in electronic records were detected, compared with a median of 1 medication per patient (IQR, 0-2) in the gastroenterology cohort and 1 (IQR, 0-2) in the emergency department cohort. In all cohorts combined, 32.8% of medications were detected but not on the HER prescription lists, and 52.9% of the 601 alerts for major or severe adverse drug reactions (n=318) were linked to medications detected but not prescribed.

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Study investigators concluded that “this exploratory analysis showed that nonadherence is common and that the EHR medication list often did not agree with detected medications. The best determinant of whether patients take their medication is whether they take concomitant medications, demonstrating that behavior is one important parameter underlying variability in response to treatment.”


Sutherland JJ, Morrison RD, McNaughton CD, et al. Assessment of patient medication adherence, medical record accuracy, and medication blood concentrations for prescription and over-the-counter medications [published online November 2, 2018].  JAMA Netw Open. doi: 10.1001/jamanetworkopen.2018.4196