FAUGHTE.Adherence to antiepilepsy drug therapy[J]. Epilepsy Behav,2012,25(3): 297-302.
Adherence to antiepilepsy drug () therapy is critical for effective disease management, yet adherence and persistence rates are low due to several barriers. The definitions of adherence (80% rate of total pills taken, medication possession ratio, and days covered by prescriptions filled) and methods of measurement (patient self-reports, serum drug levels, pill counts, electronic bottle tops, and reviews of pharmacy records) are not without limitations, and their applicability to is not clear. The use of simple adherence scales during office visits can provide an overall impression of a patient's adherence and can serve as a basis for practitioner-patient dialog. Efforts to improve adherence should focus on provider and healthcare system determinants versus those focused only on the patient. These interventions include non-judgmental communication, patient education, simplification of the dosage regimen with once-daily therapies, and the use of patient reminders.
MORISKY DE,DIMATTEO MR.Improving the measurement of self-reported medication nonadherence: response to authors[J]. J Clin Epidemiol,2011,64(3):255-257.
MORISKY DE,ANGA,KROUSEL-WOODM,et al.Predictive validity of a medication adherence measure in an outpatient setting[J]. J Clin Hypertens (Greenwich),2008,10(5): 348-354.
This study examines the psychometric properties and tests the concurrent and predictive validity of a structured, self-reported medication adherence measure in patients with hypertension. The authors also assessed various psychosocial determinants of adherence, such as knowledge, social support, satisfaction with care, and complexity of the medical regimen. A total of 1367 patients participated in the study; mean age was 52.5 years, 40.8% were male, 76.5% were black, 50.8% graduated from high school, 26% were married, and 54.1% had income <$5,000. The 8-item medication adherence scale was reliable (alpha=.83) and significantly associated with blood pressure control (P<.05). Using a cutpoint of <6, the sensitivity of the measure to identify patients with poor blood pressure control was estimated to be 93%, and the specificity was 53%. The medication adherence measure proved to be reliable, with good concurrent and predictive validity in primarily low-income, minority patients with hypertension and might function as a screening tool in outpatient settings with other patient groups.
MCAULEY JW,MCFADDEN LS,ELLIOTT JO,et al.An evaluation of self-management behaviors and medication adherence in patients with epilepsy[J]. Epilepsy Behav,2008,13(4):637-641.
Abstract Comprehensive treatment of epilepsy involves many facets including self-management behaviors. The primary purpose of this study was to characterize the self-management behaviors of our patients. Additionally, we wanted to assess if the behaviors differed depending on the level of seizure control. Adult patients with epilepsy were recruited for this cross-sectional study. We used two previously validated scales to assess various self-management behaviors and collected clinical data. Our sample consisted of 50 patients (23 women). The mean overall Epilepsy Self-Management Scale (ESMS) question score was 3.72+/-0.41. The mean question scores on the ESMS subscales Medication Management, Information Management, Safety Management, Seizure Management, and Lifestyle Management were 4.4, 2.7, 3.9, 4.0, and 2.6, respectively. Information Management and Safety Management subscale scores were higher in the patients continuing to have seizures. Based on the Morisky scale, patients fell into either the low (n=2), medium (n=27), or high (n=21) medication-taking behavior category. Self-management skills, beyond medication-taking behaviors, should be emphasized during patient interactions.
DASHD,SEBASTAIN TM,AGGARWALM,et al.Impact of health education on drug adherence and self-care in people with epilepsy with low education[J]. Epilepsy Behav,2015,44: 213-217.
This study was conducted to observe the effect of a structured educational program on drug adherence and self-care management in people with epilepsy in a developing country.A total of 180 consecutive people with epilepsy were enrolled from the epilepsy clinic of a tertiary care hospital in North India. Out of these, 90 were randomized to the epilepsy health education group and received the educational program and 90 were in the control group and received the standard of care but did not receive any structured educational program. The modified Morisky Medication Adherence Scale (MMAS) and Epilepsy Self-Efficacy Scale (ESES) were administered to assess drug adherence and self-care, respectively, on the day of enrollment. The patients enrolled in the epilepsy health education group received 4 sessions of the structured educational program. The MMAS and ESES questionnaires were again administered to both groups after 6months.Continuous and categorical variables were compared between control and epilepsy health education groups using a chi-square test, with p value less than 0.05 considered significant. A comparison between pretest and posttest MMAS scores and ESES scores was done using a paired t-test.In the epilepsy health education group, the pretest mean MMAS score was 6.58 whereas the posttest mean MMAS score was 7.53; the difference was significant (p=0.001). The mean MMAS scores for the control group's pretest and posttest were 6.46 and 6.58, respectively, which were not significantly different (p=0.224). On comparing the ESES scores at the beginning of the study and after 6months, there was no significant change in both groups.The present study proves the efficacy of a structured educational program in improving drug adherence in a cohort of people with epilepsy with low educational background.
FIALKOL,GARETY PA,KUIPERSE,et al.A large-scale validation study of the Medication Adherence Rating Scale (MARS)[J]. Schizophr Res,2008,100(1/3): 53-59.
Adherence to medication is an important predictor of illness course and outcome in . The Medication Adherence Rating Scale () is a ten-item self-report measure of medication adherence in [Thompson, K., Kulkarni, J., Sergejew, A.A., 2000. Reliability and validity of a new Medication Adherence Rating Scale () for the . Research. 42. 241-247]. Although initial results suggested that the scale has good reliability and validity, the sample was small. The current study aimed to establish the psychometric properties of the in a sample over four times larger. The scale was administered to 277 individuals with , along with measures of insight and psychopathology. Medication adherence was independently rated by each individual's keyworker. Results showed the internal consistency of the to be lower than in the original sample, though adequate. total score correlated weakly with keyworker-rated adherence, hence concurrent validity of the scale appeared only moderate to weak. The three factor structure of the was replicated. Examination of the factor scores suggested that the factor 1 total score, which corresponds to the Medication Adherence Questionnaire [Morisky,D.E., Green,L.W. and Levine,D.M., 1986. Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care. 24, 67-74] may be a preferable measure of medication adherence to the total scale score.
THOMPSONK,KULKARNIJ,SERGEJEW AA.Reliability and validity of a new Medication Adherence Rating Scale (MARS)for the psychoses[J]. Schizophr Res,2000,42(3): 241-247.
Medication compliance is one of the foremost problems affecting efficacy in psychiatric patients. To date, compliancy has most commonly been assessed with the Drug Attitude Inventory (DAI) developed by Hogan et al. (Hogan, T.P., Awad, A.G., Eastwood, R., 1983. A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychol. . 13, 177-183). The present study identified several deficiencies in the DAI. Using the partial credit version of the Item Response Theory measurement model, the DAI was refined with the aim of greater validity and clinical utility. The new inventory was administered to 66 patients, the majority of whom were diagnosed with . When available, levels and carer ratings of compliance were also recorded and used to verify compliancy. The new inventory appears to be a valid and reliable measure of compliancy for psychoactive medications.
FOGGA,STAUFENBERG EF,SMALLI,et al.An exploratory study of primary care pharmacist-led epilepsy consultations[J]. Int J Pharm Pract,2012,20(5): 294-302.
ABSTRACT Objective  Most epilepsies are managed with anti-epileptic drugs (AEDs), but medication non-adherence has been frequently reported. Satisfying patient information needs has demonstrated improved adherence. Multi-professional working has been encouraged to provide cost-effective health services by using the most appropriate healthcare professional. Research has demonstrated that pharmacist-led consultations are acceptable to patients with other medical conditions and therefore may be appropriate for patients with epilepsy. We aimed to determine the feasibility and acceptability of a pharmacist-led epilepsy consultation (PLEC) study. This encompassed estimating the eligibility and consent rate for a PLEC study, plus the acceptability of potential intervention outcome measures and likely effects. Methods  Eligible patients with a diagnosis of epilepsy and prescribed AEDs were invited by telephone to attend a PLEC. Baseline adherence, general mental well-being, epilepsy-related quality of life and satisfaction with information received about epilepsy medication were recorded. The intervention was a 30 min consultation to provide participants with an opportunity to ask questions related to their epilepsy therapy. Baseline data collection was repeated after 2 months. Results  Of 106 (97.2%) consenting patients, 82 (77.4%) attended the PLEC. The 2 month follow-up questionnaire was fully completed by 50 (67.6%) participants. The number (percentage  95% confidence interval) of participants reporting adherent behaviour pre-PLEC was 22 (44.0  13.7%) which increased to 30 (60  13.6%) post-PLEC (P < 0.03, McNemar test). Discussion  Accepting the limitations of a before-and-after study and small sample size, the findings suggest that a PLEC may improve adherence. A definitive trial is necessary to confirm the effect of a PLEC and establish the longevity and cost-effectiveness of the outcomes. Attrition of potential participants not contactable by telephone suggests the need for additional postal contact in subsequent trials. A reduction in loss to follow-up is also desirable and potentially achievable using telephone reminders.
MODI AC,MORITA DA,GLAUSER TA.One-month adherence in children with new-onset epilepsy: white-coat compliance does not occur[J]. Pediatrics,2008,121(4):e961-e966.
ABSTRACT Adherence to antiepileptic drug therapy plays an important role in the effectiveness of pharmacologic treatment of epilepsy. The purpose of this study was to use an objective measure of adherence to (1) document patterns of adherence for the first month of therapy for children with new-onset epilepsy, (2) examine differences in adherence by demographic and epilepsy variables, and (3) determine whether treatment adherence improves for a short time before a clinic visit (eg, "white-coat compliance"). Participants included 35 children with new-onset epilepsy (mean age: 7.2 years; 34% female; 66% white) and their caregivers. Children had a diagnosis of partial (60%), generalized (29%), or unclassified (11%) epilepsy. Adherence to treatment was electronically monitored with Medication Event Monitoring System TrackCap, starting with the first antiepileptic drug dose. Adherence was calculated across a 1-month period and for the 1, 3, and 5 days before and 3 days after the clinic appointment. Adherence for the first month of treatment in children with new-onset epilepsy was 79.4%. One-month adherence was higher in children of married parents and those with higher socioeconomic status but did not correlate with child's gender, age, epilepsy type, prescribed medication, seizure frequency, or length of time since seizure onset. Adherence across the entire 1-month period was not different from adherence for the 1, 3, or 5 days before or 3 days after the clinic visit. Poor adherence seen for children with new-onset epilepsy during the first month of antiepileptic drug therapy is a cause for concern. Several demographic variables influence adherence to treatment, whereas the proximity to a clinic visit does not. Additional studies are needed to document whether this trend continues longitudinally and determine the clinical impact of poor adherence.
MODI AC,RAUSCH JR,GLAUSER TA.Patterns of nonadherence to antiepileptic drug therapy in children with newly diagnosed epilepsy[J]. JAMA,2011,305(16): 1669-1676.
AYLWARD BS,RAUSCH JR,MODI AC.An examination of 1-year adherence and persistence rates to antiepileptic medication in children with newly diagnosed epilepsy[J]. J Pediatr Psychol,2015,40(1): 66-74.
ABSTRACT The primary aim of the current study was to use new methods to examine 1-year quality of medication dosing (adherence) and continuation with medication treatment (persistence) rates to antiepileptic drugs (AEDs) in children with newly diagnosed epilepsy. Medication-taking behaviors of AEDs were assessed using electronic monitors for 117 children with newly diagnosed epilepsy for the first year after diagnosis. Approximately 15% of participants were categorized as nonpersistent (i.e., failed to take medication for >15 consecutive days) 6-months after AED initiation, which increased to 26.6% of participants at 1 year. The majority of medication dosing events took place within a +/-2-hr interval as recommended. The group with lower socioeconomic status demonstrated more nonpersistence over time. Examining adherence and persistence in medication taking behaviors may yield different types of data for clinical and research purposes.
SHAH NM,HAWWA AF,MILLERSHIP JS,et al.Adherence to antiepileptic medicines in children: a multiple-methods assessment involving dried blood spot sampling[J]. Epilepsia,2013,54(6): 1020-1027.
Summary Top of page Summary Methods Results Discussion Conclusions Acknowledgments Disclosure References Purpose To evaluate adherence to prescribed antiepileptic drugs (AEDs) in children with epilepsy using a combination of adherence-assessment methods. Methods A total of 100 children with epilepsy (≤17 years old) were recruited. Medication adherence was determined via parental and child self-reporting (≥9years old), medication refill data from general practitioner (GP) prescribing records, and via AED concentrations in dried blood spot (DBS) samples obtained from children at the clinic and via self- or parental-led sampling in children's own homes. The latter were assessed using population pharmacokinetic modeling. Patients were deemed nonadherent if any of these measures were indicative of nonadherence with the prescribed treatment. In addition, beliefs about medicines, parental confidence in seizure management, and the presence of depressed mood in parents were evaluated to examine their association with nonadherence in the participating children. Key Findings The overall rate of nonadherence in children with epilepsy was 33%. Logistic regression analysis indicated that children with generalized epilepsy (vs. focal epilepsy) were more likely (odds ratio [OR]4.7, 95% confidence interval [CI]1.37–15.81) to be classified as nonadherent as were children whose parents have depressed mood (OR3.6, 95% CI1.16–11.41). Significance This is the first study to apply the novel methodology of determining adherence via AED concentrations in clinic and home DBS samples. The present findings show that the latter, with further development, could be a useful approach to adherence assessment when combined with other measures including parent and child self-reporting. Seizure type and parental depressed mood were strongly predictive of nonadherence.
FERRARI CM,DE SOUSA R M,CASTRO L H. Factors associated with treatment non-adherence in patients with epilepsy in Brazil[J]. Seizure,2013,22(5): 384-389.
To investigate factors associated with treatment non-adherence in Brazilian patients with epilepsy.Prospective cross-sectional study. We evaluated 385 epilepsy outpatients in a tertiary referral center, 18 years or older, literate, without cognitive impairment or active psychiatric disorders, who were independent in daily living activities. Data were analyzed with correlation tests and conjoint analysis using multivariate logistic regression.Non-adherence rate, measured by the Morisky-Green Test, was 66.2%, a moderate-to-low adherence level. Non-adherence was higher in men, in younger patients and in patients with uncontrolled seizures. Increasing treatment complexity was also associated with decreased treatment adherence.Strategies designed to improve treatment adherence should address peculiarities associated with younger ages and male gender. Physicians should be made aware that prescription of less complex treatment regimens may result in better treatment adherence, and, therefore, better seizure control. The challenge in adjusting AED treatment in this population is to minimize treatment complexity, thus increasing chances for treatment adherence.
TANGF,ZHUG,JIAOZ,et al.Self-reported adherence in patients with epilepsy who missed their medications and reasons for nonadherence in China[J]. Epilepsy Behav,2013,27(1): 85-89.
ABSTRACT OBJECTIVES: The objectives of this study were: (1) to evaluate self-reported adherence in adult patients with epilepsy in China who had missed taking their antiepileptic drugs (AEDs) at least once and (2) to determine why patients were not adherent to their medication to employ interventions targeted at barriers to adherence. METHODS: A questionnaire was used to collect the patients' demographic data, disease information, and reasons for why the patients did not take their AEDs. Adherence was also included as measured using a four-item Morisky questionnaire (Morisky-4 questionnaire). RESULTS: Of the 131 patients, 4.6%, 70.2%, and 25.2% showed high, medium, and low adherence, respectively. The reasons for nonadherence included forgetfulness (54.2%), being seizure-free for a period (48.9%), and fear of adverse drug effects (27.5%). CONCLUSIONS: Medium adherence was the predominant nonadherence pattern, and forgetfulness, being seizure-free for a period, and fear of adverse effects were the primary reasons for nonadherence to AEDs. To overcome barriers to nonadherence, it is essential to use tools that are sensitive to reasons for nonadherence.
CHESANIUKM,CHOIH,WICKSP,et al.Perceived stigma and adherence in epilepsy: evidence for a link and mediating processes[J]. Epilepsy Behav,2014,41(2): 227-231.
Perceived epilepsy-related stigma is problematic for maintaining the prescribed medication regimen in people living with epilepsy. The information–motivation–behavioral skills model is a useful framework for understanding the pathways linking perceived stigma and adherence in this population.
CHAPMAN SC,HOMER,CHATERA,et al.Patients' perspectives on antiepileptic medication: relationships between beliefs about medicines and adherence among patients with epilepsy in UK primary care[J]. Epilepsy Behav,2014,31: 312-320
We identified salient, adherence-related beliefs about AEDs. Patient-centered interventions to support medicine optimization for people with epilepsy should take account of these beliefs.
CLAXTON AJ,CRAMERJ,PIERCEC.A systematic review of the associations between dose regimens and medication compliance[J]. Clin Ther,2001,23(8):1296-1310.
ABSTRACT Previous reviews of the literature on medication compliance have confirmed the inverse relationship between number of daily doses and rate of compliance. However, compliance in most of these studies was based on patient self-report, blood-level monitoring, prescription refills, or pill count data, none of which are as accurate as electronic monitoring (EM). In this paper, we review studies in which compliance was measured with an EM device to determine the associations between dose frequency and medication compliance. Articles included in this review were identified through literature searches of MEDLINE, PsychInfo, HealthStar, Health & Psychosocial Instruments, and the Cochrane Library using the search terms patient compliance, patient adherence, electronic monitoring, and MEMS (medication event monitoring systems). The review was limited to studies reporting compliance measured by EM devices, the most accurate compliance assessment method to date. Because EM was introduced only in 1986, the literature search was restricted to the years 1986 to 2000. In the identified studies, data were pooled to calculate mean compliance with once-daily, twice-daily, 3-times-daily, and 4-times-daily dosing regimens. Because of heterogeneity in definitions of compliance, 2 major categories of compliance rates were defined: dose-taking (taking the prescribed number of pills each day) and dose-timing (taking pills within the prescribed time frame). A total of 76 studies were identified. Mean dose-taking compliance was 71% +/- 17% (range, 34%-97%) and declined as the number of daily doses increased: 1 dose = 79% +/- 14%, 2 doses = 69% +/- 15%, 3 doses = 65% +/- 16%, 4 doses = 51% +/- 20% (P < 0.001 among dose schedules). Compliance was significantly higher for once-daily versus 3-times-daily (P = 0.008), once-daily versus 4-times-daily (P < 0.001), and twice-daily versus 4-times-daily regimens (P = 0.001); however, there were no significant differences in compliance between once-daily and twice-daily regimens or between twice-daily and 3-times-daily regimens. In the subset of 14 studies that reported dose-timing results, mean dose-timing compliance was 59% +/- 24%; more frequent dosing was associated with lower compliance rates. A review of studies that measured compliance using EM confirmed that the prescribed number of doses per day is inversely related to compliance. Simpler, less frequent dosing regimens resulted in better compliance across a variety of therapeutic classes.
SWEILEH WM,IHBESHEH MS,JARAR IS,et al.Self-reported medication adherence and treatment satisfaction in patients with epilepsy[J]. Epilepsy Behav,2011,21(3): 301-305.
Reports about medication adherence and satisfaction in patients with epilepsy in Arab countries are lacking. The objective of this study was to assess medication adherence and its relationship with treatment satisfaction, number of antiepileptic drugs (AEDs) taken, and epilepsy control in a sample of Palestinian patients.This cross-sectional descriptive study was carried out at Al-Makhfya Governmental Outpatient Center in Nablus, Palestine, during the summer of 2010. A convenience sampling method was used to select patients over the study period. Medication adherence was measured using the eight-item Morisky Medication Adherence Scale (MMAS); treatment satisfaction was measured using the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4). Epilepsy was arbitrarily defined as “well controlled” if the patient had had no seizures in the last 302months and was defined as “poorly controlled” if he or she had had at least one seizure in the last 302months.A convenience sample of 75 patients was studied. On the basis of the MMAS, 11 patients (14.7%) had a low rate, 37 (49.3%) had a medium rate, and 27 (36%) had a high rate of adherence. Adherence was positively and significantly correlated with age (02=020.02) and duration of illness (02=020.01). No significant difference in adherence was found between patients with well-controlled and those with poorly controlled epilepsy. Similarly, there was no significant difference in adherence between patients on monotherapy and those on polytherapy. Mean satisfaction with respect to effectiveness, side effects, convenience, and global satisfaction were 73.602±0220.7, 82.402±0229.8, 69.502±0215.5, and 68.402±0218.3, respectively. There were significant differences in mean values in the effectiveness (02<020.01) and convenience (02<020.01) domains, but not the side effect (02=020.1) and global satisfaction (02=020.08) domains among patients with different levels of adherence. Patients on monotherapy had significantly higher satisfaction in the effectiveness domain (02=020.04) than patients on polytherapy. Similarly, patients with well-controlled epilepsy scored significantly higher in the Effectiveness (02=020.01) and Global Satisfaction (02=020.01) domains than those with poorly controlled epilepsy.In our convenience sample, we found that adherence to and satisfaction with AEDs were moderate and were not associated with seizure control or number of AEDs.
ETTINGER AB,GOOD MB,MANJUNATHR,et al.The relationship of depression to antiepileptic drug adherence and quality of life in epilepsy[J]. Epilepsy Behav,2014,36(1): 138-143.
We sought to examine the impact of depression upon antiepileptic drug (AED) adherence in patients with epilepsy. We administered the Center for Epidemiologic Studies Depression Scale (CES-D), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Seizure Severity Questionnaire (SSQ), and Quality of Life in Epilepsy-10 (QOLIE-10) and measured AED adherence by utilizing the medication possession ratio (MPR) in adult patients with epilepsy identified through a pharmacy claims database. From a sampling frame of over 10,000 patients identified in claims, 2750 were randomly selected and contacted directly by mail to participate in the cross-sectional survey. A total of 465 eligible patients completed a survey. Survey data were combined with administrative claims data for analysis. We conducted a path analysis to assess the relationships between depression, adherence, seizure severity, and quality of life (QOL). Patients with depression scored significantly worse on measures of seizure severity (p02=02.003), QOL (p02<02.001), and adherence (p02=02.001). On path analysis, depression and QOL and seizure severity and QOL were related, but only the NDDI-E scores had a significant relationship with medication adherence (p02=02.001). Depression as measured by the NDDI-E was correlated with an increased risk of AED nonadherence. Depression or seizure severity adversely impacted QOL. These results demonstrate yet another important reason to screen for depression in epilepsy.
OTEROS,HODESM.Maternal expressed emotion and treatment compliance of children with epilepsy[J]. Dev Med Child Neurol,2000,42(9): 604-608.
ABSTRACT This study investigated the association between family relationships and compliance in the treatment of childhood epilepsy. It was a prospective study of 21 families with a child who had epilepsy attending Central Middlesex Hospital, London. There were 13 boys and eight girls, with a mean age of 12.0 years(SD 2.9) at initial assessment. Mothers were interviewed for assessment of expressed emotion as a measure of parent-child relationships. Assessment of the mothers鈥檃djustment using the General Health Questionnaire (Goldberg 1978), and psychological adjustment of the children using the Rutter Scales (Rutter et al. 1970a), were completed by mothers and teachers. Reassessment was 3 to 4 years after initial contact, including a paediatric case-note review to assess clinic attendance and overall treatment compliance. Significantly more of the group who had a good level of compliance had recovered from epilepsy at follow-up. Good treatment compliance was found to be associated with less maternal hostility and criticism. Children and mothers in the good compliance group had fewer psychiatric symptoms. Poor treatment compliance and the associated psychological disturbances suggest that assertive paediatric and psychosocial intervention may be needed for some children with epilepsy.
HAZZARDA,HUTCHINSON SJ,KRAWIECKIN.Factors related to adherence to medication regimens in pediatric seizure patients[J]. J Pediatr Psychol,1990,15(4): 543-555.
Abstract Factors related to medication adherence were studied in 35 pediatric seizure patients at a public hospital serving primarily low-income minority patients. Adherence ratings by pediatric neurologists were based primarily on three blood assays drawn at monthly intervals and patients were rated as adherent on 1, 2, or 3 visits. Parent and child satisfaction with medical care was associated with greater adherence. Parental worry about the child's health was positively correlated with the number of behavioral restrictions placed on the child, and both variables were negatively related to adherence. The authors hypothesize that anxiety-based denial and perceived threats to patient autonomy may interfere with medication adherence. Implications for the development of intervention strategies for improving adherence among pediatric seizure patients are discussed.
DIMATTEO MR,LEPPER HS,CROGHAN TW.Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence[J]. Arch Intern Med,2000,160(14): 2101-2107.
Abstract BACKGROUND: Depression and anxiety are common in medical patients and are associated with diminished health status and increased health care utilization. This article presents a quantitative review and synthesis of studies correlating medical patients' treatment noncompliance with their anxiety and depression. METHODS: Research on patient adherence catalogued on MEDLINE and PsychLit from January 1, 1968, through March 31, 1998, was examined, and studies were included in this review if they measured patient compliance and depression or anxiety (with n>10); involved a medical regimen recommended by a nonpsychiatrist physician to a patient not being treated for anxiety, depression, or a psychiatric illness; and measured the relationship between patient compliance and patient anxiety and/or depression (or provided data to calculate it). RESULTS: Twelve articles about depression and 13 about anxiety met the inclusion criteria. The associations between anxiety and noncompliance were variable, and their averages were small and nonsignificant. The relationship between depression and noncompliance, however, was substantial and significant, with an odds ratio of 3.03 (95% confidence interval, 1.96-4.89). CONCLUSIONS: Compared with nondepressed patients, the odds are 3 times greater that depressed patients will be noncompliant with medical treatment recommendations. Recommendations for future research include attention to causal inferences and exploration of mechanisms to explain the effects. Evidence of strong covariation of depression and medical noncompliance suggests the importance of recognizing depression as a risk factor for poor outcomes among patients who might not be adhering to medical advice.
SPECHTU,ELSNERH,MAY TW,et al.Postictal serum levels of antiepileptic drugs for detection of noncompliance[J]. Epilepsy Behav,2003,4(5):487-495.
Medication noncompliance (NC) is thought to be a major cause of insufficient seizure control. In an explorative study we investigated whether postictal serum levels (PISLs) of drugs () are a reliable indicator of NC. Young adults with on a stable regimen were asked to contact medical service as soon as possible when a seizure occurred to obtain serum levels of their . PISLs were compared with the mean value of two routine serum levels of the same medication. PISLs lower than 50% of the individual reference value were regarded as an indicator of NC. PISL samples in 61 seizures of 52 patients treated mainly with carbamazepine, , or lamotrigine were evaluated. A drop in serum levels >50% indicating NC was noted in 44.3% of the seizures. Determination of PISLs seems to be a simple and useful method for detecting or ruling out irregular intake patterns as a cause of "breakthrough" seizures.
CARPENTIERN,JONASJ,FRISMANDS,et al.Direct evidence of nonadherence to antiepileptic medication in refractory focal epilepsy[J]. Epilepsia,2013,54(1): e20-e23.
The adherence to medication in drug-resistant focal epilepsy (RFE) remains largely unknown. The present work aimed to assess the frequency of recent adherence to antiepileptic drugs (AEDs) in patients with RFE. This prospective observational study screened all patients with RFE, admitted to the Nancy University Hospital between April 2006 and September 2008, for a 5-day hospitalization without AED tapering. The adherence to AEDs was assessed by measuring serum drug levels on day 1 (reflecting the recent "at home" adherence) and day 5 (reflecting the individual reference concentration when drug ingestion was supervised). A patient was considered nonadherent if at least one of their serum drug levels was different between days 1 and 5. The day-1 value was considered different from day 5 when it was at least 30% lower (underdosed) or 30% higher (overdosed). Nonadherent patients were classified as under-consumers in the case of one or more underdosed day-1 values, over-consumers in the case of one or more overdosed day-1 values, or undefined if they exhibited both underdosed and overdosed day-1 values. Forty-four of the 48 screened patients were included. Eighteen (40.9%) of 44 patients were nonadherent. Among them, 12 (66.7%) were over-consumers, 4 (22.2%) were under-consumers, and 2 (11.1%) were undefined nonadherents. The study indicates that recent adherence to antiepileptic medication in this group of patients with RFE is poor. Overconsumption is the most frequent form of nonadherence in this population and should be specifically assessed to prevent its possible consequences in terms of AEDs dose-dependent adverse events.
CRAMER JA,GLASSMANM,RIENZIV.The relationship between poor medication compliance and seizures[J]. Epilepsy Behav,2002,3(4): 338-342.
Predictors and consequences of inadequate compliance with seizure medications were assessed using a 10-item postal survey. Dose omissions were reported by 71% of the 661 respondents (2+/-2 doses of seizure medications), with 45% of patients reporting a seizure after a missed dose, at some time during treatment. Dose omission was more likely with longer use of seizure medications (more than 5 years, P<0.01). Having seizures after missed doses was associated with number of seizure medication doses (P=0.04) and number of seizure medication tablets/(P=0.01). Odds ratios showed that each increase in dose frequency (one, two, three, or four doses daily) increased the likelihood of a seizure after a missed dose by 36%. Taking larger numbers of tablets/increased the odds of having a seizure after missed doses by 43%. These data provide evidence that medication compliance remains an important issue in treatment.
GABR WM,SHAMS ME.Adherence to medication among outpatient adolescents with epilepsy[J]. Saudi Pharm J,2015,23(1): 33-40.
ABSTRACT Background and objective The promotion of medication adherence is considered as an integral component of pharmaceutical care practice and patient healthcare. An approach which focuses on the choice and dose of antiepileptic drug will have limited success without medication adherence. This study sought to assess medication adherence among adolescents who are suffering from epilepsy for improvement. Methods A total of 116 patients affected with idiopathic epilepsy and fulfilled the inclusion criteria were recruited in the current study. Adherence to the treatment was evaluated during patients鈥 hospitalization in the Department of Neurology at Riyadh National Hospital, Riyadh, Saudi Arabia, between December 2011 and January 2014. The medication adherence has been assessed during semi-structured interviews with each patient and/or his parents using a multiple choice graded questionnaire. Results From the selected group of patients, only 94 patients (81.0%) fulfilled the inclusion criteria within the study period. Thirty six of respondents (38.3%) were non adherent to antiepileptic treatment. No statistical differences were found between males and females regarding their ages, age at diagnosis of epilepsy, mother age, epilepsy duration, family numbers, number of poor-adherents or seizure frequency. The most important factors that were significantly affecting patients鈥 adherence to the prescribed medications were age of mother, family number, number of administered drugs, the stability of parents鈥 marriage, family support, and seizure frequency as well as the regularity of the relationship between patients and their healthcare providers. Forgetfulness was the most common cause of non-adherence among this group of patients followed by inability to obtain medication and fear from side effects of drugs. Our results revealed also that the number of patients who felt to be stigmatized are significantly more in non-adherents group as compared to patients with a strong sense of normality (P <0.05). A positive relationship between adherence and the necessity and benefit scales at which patients have stronger belief in the necessity of medication for controlling illness was associated with good adherence. Conclusion The assessment of medication adherence among epileptic patients should be a routine part of the management process to improve the health care and quality of lives of those patients.
The aim of the study was to determine sociodemographic, biological epilepsy-specific, and adherence predictors of long-term pediatric seizure outcomes.This study is a prospective, longitudinal, observational study of antiepileptic drug (AED) adherence and seizure outcomes in children with newly diagnosed epilepsy. Patients were recruited from April 2006 to March 2009 and followed for 2 years. Objective, electronic monitors were used to assess AED adherence. Medical chart reviews assessed medical variables and seizure outcomes.Participants (n = 109) were 7.3 2.9 years of age, and 62% male. Four adherence trajectory groups were identified: severe early nonadherence (n = 10), variable nonadherence (n = 16), moderate nonadherence (n = 40), and high adherence (n = 43). Two seizure probability trajectory groups were identified: high seizure (n = 28) and low seizure probability (n = 81). Participants with recognizable syndromes were less likely to be a member of the high seizure probability group (b = -2.372; odds ratio [OR] = 0.093; 95% confidence interval [CI]OR = 0.015, 0.595); those with the presence of epileptiform discharges on EEG were more likely to be in the high seizure probability group (b = 1.649; OR = 5.203; 95% CIOR = 1.422, 19.037). Adherence trajectory group status was a significant predictor of seizure trajectory group status (partial max-rescaled R(2) = 0.13).Adherence trajectories and 2 biological epilepsy-specific variables explain a similar proportion of the variability in longitudinal seizure outcomes. The relationship between AED nonadherence and seizure outcomes is not linear. Early adherence interventions could change the course of seizure outcomes, particularly if variability in adherence was minimized postdiagnosis.
FATMAT,AYBEGULY.The effect of a modular education program related to children with epilepsy and their parents on disease management[J]. Pediatrics,2015,135(S1): S6-S7.
SHAMS ME,BARAKAT EA.Measuring the rate of therapeutic adherence among outpatients with T2DM in Egypt[J]. Saudi Pharm J,2010,18(4):225-232.
An improvement with the adherence to oral hypoglycemic agent(s) may be achieved through continuing patient education about diabetes, improvement of patients’ economical levels as well as a reduction in the cost of medication. Pharmaceutical companies have to be involved and pharmacists have to be payed for helping chronically ill patients to take their medicines correctly for improving clinical outcomes.
PASCHAL AM,RUSH SE,SADLERT.Factors associated with medication adherence in patients with epilepsy and recommendations for improvement[J]. Epilepsy Behav,2014,31:346-350.
Although it is one of the most common neurological disorders, epilepsy continues to be a highly stigmatized and disabling chronic condition. Healthy People 2020 aims for improvement in the health-related quality of life and well-being of Americans, including these medically vulnerable patients. Efforts to research and improve medication adherence in this population and others with chronic conditions are an important step towards this end. The purpose of this study was to investigate factors associated with adherence and to provide recommendations for improvement. A cross-sectional survey research design was used in a convenience sample of patients receiving treatment at a tertiary epilepsy center. Adherence was measured by self-reported missed/skipped medication doses and seizure frequencies and by the presence of intractable seizures as indicated in patients' medical charts. Analysis was conducted with SPSS 21.0 on the data collected from the returned mailed surveys. Among the sample of 180 patients, most had some education beyond high school, household incomes of varying amounts, and health insurance coverage. Most of the participants were unemployed. Clinical records showed that 46% had intractable seizures. About 66% missed taking their medication on a monthly basis, with “forgetfulness” being the primary reason. Adherence (seizure frequency) was associated with being employed ( P 02=02.028). Adherence (complying with medication treatment plan) was also associated with “medication reminders” ( P 02=02.002) and educational attainment ( P 02=02.008). The findings indicate a continued need to explore the complex issue of adherence. The findings also highlight the need for health education and other public health and medical professionals to design effective strategies to connect patients with employment opportunities and other resources. Efforts are also needed to help provide information and build skills among patients with epilepsy that would lead to improved medication adherence and management.
AL-AQEELS,AL-SABHAN J. Strategies for improving adherence to antiepileptic drug treatment in patients with epilepsy [J]. Cochrane Database Syst Rev,2011(1): CD008312.
Poor adherence to antiepileptic medications is associated with increased mortality and morbidity. In this review we focus on interventions designed to assist patients with adherence to antiepileptic medications. To determine the effectiveness of interventions aimed at improving adherence to antiepileptic medications in adults and children with epilepsy. We searched the Epilepsy Group's Specialised Register (24 June 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2) and electronic databases: MEDLINE (OVID) (1950 to June 2010); EMBASE (OVID) (1980 to 2010 Week 24); CINAHL (1982 to June 2010) and PsycINFO (22 June 2010), and the reference lists of relevant articles. Randomised or quasi-randomised controlled trials of adherence-enhancing interventions aimed at patients with clinical diagnosis of epilepsy (as defined in individual studies), of any age and of either gender, treated with antiepileptic drugs in a primary care, outpatient or other community setting. We screened titles and abstracts for eligibility. Two review authors independently extracted data and assessed each study according to the Cochrane criteria. The studies differed widely according to intervention and measures of adherence, therefore combining data was not appropriate. Six trials met our inclusion criteria: five targeted adult epileptic patients with a combined patient number of 222 and one targeted parents of children with epilepsy (n = 51). Follow-up time was generally short: from one to six months. Two main types of intervention were examined: educational and behavioural modification. Each study compared treatment with no intervention 'usual care'. None compared one intervention with another. Due to heterogeneity between studies in terms of interventions and the methods used to measure adherence, we did not pool the results. Education and counselling of patients with epilepsy have shown mixed success. Behavioural interventions such as the use of intensive reminders and 'implementation intention' interventions provided more positive effects on adherence. Intensive reminders and 'implementation intention' interventions appear promising in enhancing adherence to antiepileptic mediations, however we need more reliable evidence on their efficacy from carefully designed randomised controlled trials before a firm conclusion can be reached.
DIIORIOC,BAMPSY,WALKER ER,et al.Results of a research study evaluating WebEase,an online epilepsy self-management program[J]. Epilepsy Behav,2011,22(3): 469-474.
Abstract WebEase (Epilepsy Awareness, Support, and Education) is an online epilepsy self-management program to assist people with taking medication, managing stress, and improving sleep quality. The primary study aims were to determine if those who participated in WebEase demonstrated improvements in medication adherence, perceived stress, and sleep quality. Participants were randomized to a treatment (T) or waitlist control (WCL) group (n=148). At follow-up, participants in the T group reported higher levels of medication adherence than those in the WLC group. Analyses were also conducted comparing those who had completed WebEase modules with those who had not. Those who had completed at least some modules within the WebEase program reported higher levels of self-efficacy and a trend toward significance was observed for the grouptime interactions for medication adherence, perceived stress, self-management, and knowledge. The results highlight the usefulness of online tools to support self-management among people with epilepsy. Copyright 脗漏 2011 Elsevier Inc. All rights reserved.
LUA PL,NENI WS.A randomised controlled trial of an SMS-based mobile epilepsy education system[J]. J Telemed Telecare,2013,19(1):23-28.
We evaluated an epilepsy education programme based on text messaging (SMS). Epilepsy outpatients from three hospitals in Malaysia were randomised into two groups: intervention and control. Patients in the control group were supplied with printed epilepsy educational material while those in the intervention group also received text messages from the Mobile Epilepsy Educational System (MEES). A total of 136 patients completed the study (mean age 31 years; 91% Malay; 51% with an illness duration of more than 5 years). A between-group analysis showed that the awareness, knowledge and attitudes (AKA) about epilepsy did not significantly differ between the groups at baseline (P > 0.05). The intervention patients reported better AKA levels during follow-up compared to the control patients (P < 0.05). A within-group analysis showed that in intervention patients, there were significant improvements in all AKA domains with larger effect sizes (P < 0.01) while control patients also exhibited significant improvement in most domains except for Awareness but with smaller effect sizes. After controlling for possible confounding variables (age, gender, educational qualification, monthly income and baseline mean for each domain), the intervention group still reported significantly higher AKA than the control group particularly in Awareness (P < 0.001) and Total AKA (P = 0.003). There was also significantly better medication adherence and clinic attendance in the intervention group (P < 0.05). The results suggest that the addition of the MEES to conventional epilepsy education is effective in improving AKA.
Patients' perspectives on antiepileptic medication: relationships between beliefs about medicines and adherence among patients with epilepsy in UK primary care
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