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Vasey MJ, Tai XY, Thorpe J, Jones GD, Ashby S, Hallab A, Ding D, Andraus M, Dugan P, Perucca P, Costello DJ, French JA, O'Brien TJ, Depondt C, Andrade DM, Sengupta R, Datta A, Delanty N, Jette N, Newton CR, Brodie MJ, Devinsky O, Cross JH, Sander JW, Hanna J, Besag FMC, Sen A. The impact of COVID-19 on people with epilepsy: Global results from the coronavirus and epilepsy study. Epilepsia Open 2024; 9:1931-1947. [PMID: 39225433 PMCID: PMC11450608 DOI: 10.1002/epi4.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 07/25/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE To characterize the experience of people with epilepsy and aligned healthcare workers (HCWs) during the first 18 months of the COVID-19 pandemic and compare experiences in high-income countries (HICs) with non-HICs. METHODS Separate surveys for people with epilepsy and HCWs were distributed online in April 2020. Responses were collected to September 2021. Data were collected for COVID-19 infections, the effect of COVID-related restrictions, access to specialist help for epilepsy (people with epilepsy), and the impact of the pandemic on work productivity (HCWs). The frequency of responses for non-HICs and HICs were compared using non-parametric Chi-square tests. RESULTS Two thousand one hundred and five individuals with epilepsy from 53 countries and 392 HCWs from 26 countries provided data. The same proportion of people with epilepsy in non-HICs and HICs reported COVID-19 infection (7%). Those in HICs were more likely to report that COVID-19 measures had affected their health (32% vs. 23%; p < 0.001). There was no difference between non-HICs and HICs in the proportion who reported difficulty in obtaining help for epilepsy. HCWs in non-HICs were more likely to report COVID-19 infection than those in HICs (18% vs 6%; p = 0.001) and that their clinical work had been affected by concerns about contracting COVID-19, lack of personal protective equipment, and the impact of the pandemic on mental health (all p < 0.001). Compared to pre-pandemic practices, there was a significant shift to remote consultations in both non-HICs and HICs (p < 0.001). SIGNIFICANCE While the frequency of COVID-19 infection was relatively low in these data from early in the pandemic, our findings suggest broader health consequences and an increased psychosocial burden, particularly among HCWs in non-HICs. Planning for future pandemics should prioritize mental healthcare alongside ensuring access to essential epilepsy services and expanding and enhancing access to remote consultations. PLAIN LANGUAGE SUMMARY We asked people with epilepsy about the effects of COVID-19 on their health and healthcare. We wanted to compare responses from people in high-income countries and other countries. We found that people in high-income countries and other countries had similar levels of difficulty in getting help for their epilepsy. People in high-income countries were more likely to say that their general health had been affected. Healthcare workers in non-high-income settings were more likely to have contracted COVID-19 and have the care they deliver affected by the pandemic. Across all settings, COVID-19 associated with a large shift to remote consultations.
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Affiliation(s)
| | - Xin You Tai
- Nuffield Department of Clinical Neurosciences, Oxford Epilepsy Research GroupUniversity of OxfordOxfordUK
| | - Jennifer Thorpe
- Nuffield Department of Clinical Neurosciences, Oxford Epilepsy Research GroupUniversity of OxfordOxfordUK
| | - Gabriel Davis Jones
- Nuffield Department of Clinical Neurosciences, Oxford Epilepsy Research GroupUniversity of OxfordOxfordUK
| | | | - Asma Hallab
- Charité—Universitätsmedizin BerlinCorporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Biologie Intégrative et Physiologie – Neurosciences Cellulaires et Intégrées, Faculté des Sciences et IngénierieSorbonne UniversitéParisFrance
| | - Ding Ding
- Institute of NeurologyFudan University Huashan HospitalShanghaiChina
| | - Maria Andraus
- Department of Internal Medicine, Faculty of Medicine & Neurology and Neurophysiology Services, Deolindo Couto Institute of NeurologyUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrazil
| | - Patricia Dugan
- Department of NeurologyNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Piero Perucca
- Department of Medicine (Austin Health), Epilepsy Research CentreThe University of MelbourneMelbourneVictoriaAustralia
- Department of Neurology, Bladin‐Berkovic Comprehensive Epilepsy ProgramAustin HealthMelbourneVictoriaAustralia
- Department of Neuroscience, School of Translational Medicine, The Alfred HospitalMonash UniversityMelbourneVictoriaAustralia
- Departments of Medicine and NeurologyThe Royal Melbourne Hospital, The University of MelbourneMelbourneVictoriaAustralia
| | - Daniel J. Costello
- Epilepsy Service, Cork University Hospital & College of Medicine and HealthUniversity College CorkCorkIreland
| | | | - Terence J. O'Brien
- Department of Neuroscience, School of Translational Medicine, The Alfred HospitalMonash UniversityMelbourneVictoriaAustralia
| | - Chantal Depondt
- Department of Neurology, CUB Erasme HospitalHôpital Universitaire de Bruxelles—Université Libre de BruxellesBrusselsBelgium
| | - Danielle M. Andrade
- Division of Neurology, Adult Epilepsy Genetics Program, Toronto Western HospitalUniversity of TorontoTorontoOntarioCanada
| | | | | | - Norman Delanty
- School of Pharmacy and Biomolecular Sciences, Beaumont Hospital, FutureNeuro Research CentreRoyal College of Surgeons in IrelandDublinIreland
| | - Nathalie Jette
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Charles R. Newton
- Nuffield Department of Clinical Neurosciences, Oxford Epilepsy Research GroupUniversity of OxfordOxfordUK
- Department of PsychiatryUniversity of OxfordOxfordUK
| | | | - Orrin Devinsky
- Department of NeurologyNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - J. Helen Cross
- UCL NIHR BRC Great Ormond Street Institute of Child HealthLondonUK
- Young EpilepsyLingfieldUK
| | - Josemir W. Sander
- UCL Queen Square Institute of NeurologyLondonUK
- Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | | | - Frank M. C. Besag
- East London NHS Foundation TrustBedfordUK
- UCL School of PharmacyLondonUK
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Arjune Sen
- Nuffield Department of Clinical Neurosciences, Oxford Epilepsy Research GroupUniversity of OxfordOxfordUK
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Barnes JP, Dial H, Owens W, DeClercq J, Choi L, Shah NB, Zuckerman AD, Johnson K. Adherence and discontinuation of prescription cannabidiol for the management of seizure disorders at an integrated care center. Epilepsy Res 2024; 200:107300. [PMID: 38241756 DOI: 10.1016/j.eplepsyres.2024.107300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 12/21/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
OBJECTIVE Evaluate adherence, discontinuation rates, and reasons for non-adherence and discontinuation of prescription CBD during the 12-months post-initiation period at an integrated care center. METHODS This was a prospective study of patients prescribed CBD by a neurology clinic provider with initial prescription fulfillment through the center's specialty pharmacy from January 2019 through April 2020. Baseline demographics and reasons for non-adherence and/or discontinuation were collected from the electronic health record and pharmacy claims history was used to calculate adherence using proportion of days covered (PDC). Patients were included in the PDC analysis if they had at least 3 fills during the study period. Non-adherence was defined as a PDC < 0.8. Descriptive statistics were used to summarize data with categorical variables represented as frequencies and percentages and continuous variables as medians and interquartile ranges (IQRs). RESULTS We included 136 patients with a median age of 14 years (IQR 9 - 21). Most patients were white (n = 115, 85%), with a diagnosis of intractable epilepsy (n = 100, 74%). Among the 128 patients with 3 or more fills, the median PDC was 0.99 (IQR 0.95 - 1.00) with non-adherence seen in 6% (n = 8) of patients. The most common reason for non-adherence was side effects (n = 2, 25%). Prescription CBD was discontinued by 23% (n = 31) of patients with a median time to discontinuation of 117 days (IQR 68 - 216). The most common reason for discontinuation was major side effects (n = 12, 39%). The most common side effects leading to discontinuation were agitation/irritability (n = 4), mood changes (n = 4), aggressive behavior (n = 3), and increased seizure frequency (n = 3). CONCLUSION Adherence to prescription CBD at an integrated care center was high with approximately 94% of patients considered adherent. Providers and pharmacists may improve adherence and discontinuation rates by educating patients on the timeline of response, potential side effects, and potential for dose adjustments.
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Affiliation(s)
- J Paige Barnes
- Lipscomb University College of Pharmacy, Nashville, TN, United States
| | - Holly Dial
- Department of Pharmacy, Ascension Saint Thomas Midtown Hospital, Nashville, TN, United States
| | - Wendi Owens
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Josh DeClercq
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Leena Choi
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Nisha B Shah
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Autumn D Zuckerman
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Kayla Johnson
- Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, TN, United States.
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Khatooni M, Rahimi S, Bahrami M. The relationship between stress, anxiety, depression and medication adherence behavior in patients with epilepsy: A cross-sectional study. Epilepsy Behav 2024; 151:109616. [PMID: 38232557 DOI: 10.1016/j.yebeh.2023.109616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/24/2023] [Accepted: 12/27/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To investigate the relationships between stress, anxiety, and depression and medication adherence behavior in patients with epilepsy (PEW). METHODS A cross-sectional study design was conducted on 235 PEW in the Qazvin's Boo Ali Sian Hospital. Data collection tools included socio demographic and clinical data form, morisky medication adherence scale (MMAS-8), depression anxiety stress scales -21(DASS-21). We used adjusted multivariate logistic regression model for statistical analysis. RESULTS A considerable proportion of patients reported mild, moderate, severe and extremely severe symptoms of depression (177 [75/3%]), anxiety (169 [71.9 %]), and stress (158 [67.2 %]). However, 61/8% of the participant had proper medication adherence and 38/3% had poor medication adherence. The results of adjusted multivariate logistic regression showed that in patients who had severe and extremely severe depression and anxiety, the probability of poor medication adherence was higher (P < 0.05). The levels of stress were not significant predictors for medication adherence behavior (P > 0.05). CONCLUSION According to this study, severe and extremely severe depression and anxiety can be considered as an important predicting factor in the lack of adherence to antiepileptic medication. PRACTICE IMPLICATIONS Healthcare professionals can improve care of patients with PEW by considering patients' mental and psychological health problems in educational, counseling and supportive programs.
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Affiliation(s)
- Marzieh Khatooni
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Sara Rahimi
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
| | - Mahdie Bahrami
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
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Schönenberger N, Meyer-Massetti C. Risk factors for medication-related short-term readmissions in adults - a scoping review. BMC Health Serv Res 2023; 23:1037. [PMID: 37770912 PMCID: PMC10536731 DOI: 10.1186/s12913-023-10028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Hospital readmissions due to medication-related problems occur frequently, burdening patients and caregivers emotionally and straining health care systems economically. In times of limited health care resources, interventions to mitigate the risk of medication-related readmissions should be prioritized to patients most likely to benefit. Focusing on general internal medicine patients, this scoping review aims to identify risk factors associated with drug-related 30-day hospital readmissions. METHODS We began by searching the Medline, Embase, and CINAHL databases from their inception dates to May 17, 2022 for studies reporting risk factors for 30-day drug-related readmissions. We included all peer-reviewed studies, while excluding literature reviews, conference abstracts, proceeding papers, editorials, and expert opinions. We also conducted backward citation searches of the included articles. Within the final sample, we analyzed the types and frequencies of risk factors mentioned. RESULTS After deduplication of the initial search results, 1159 titles and abstracts were screened for full-text adjudication. We read 101 full articles, of which we included 37. Thirteen more were collected via backward citation searches, resulting in a final sample of 50 articles. We identified five risk factor categories: (1) patient characteristics, (2) medication groups, (3) medication therapy problems, (4) adverse drug reactions, and (5) readmission diagnoses. The most commonly mentioned risk factors were polypharmacy, prescribing problems-especially underprescribing and suboptimal drug selection-and adherence issues. Medication groups associated with the highest risk of 30-day readmissions (mostly following adverse drug reactions) were antithrombotic agents, insulin, opioid analgesics, and diuretics. Preventable medication-related readmissions most often reflected prescribing problems and/or adherence issues. CONCLUSIONS This study's findings will help care teams prioritize patients for interventions to reduce medication-related hospital readmissions, which should increase patient safety. Further research is needed to analyze surrogate social parameters for the most common drug-related factors and their predictive value regarding medication-related readmissions.
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Affiliation(s)
- N Schönenberger
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - C Meyer-Massetti
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Healthcare (BIHAM), University of Bern, Bern, Switzerland
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Crook CL, Margolis SA, Goldstein A, Davis JD, Gonzalez JS, Grant AC, Nakhutina L. Medication self-management in predominantly African American and Caribbean American people with epilepsy: The role of medication beliefs and epilepsy knowledge. Epilepsy Behav 2023; 146:109313. [PMID: 37544193 DOI: 10.1016/j.yebeh.2023.109313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Suboptimal medication adherence is common in people with epilepsy (PWE) and disproportionally prevalent among racially/ethnically diverse patients. Understanding reasons and risks of suboptimal adherence is critical to developing interventions that reduce negative health outcomes. This cross-sectional study characterized common barriers to medication self-management, prevalence of negative medication beliefs, and gaps in epilepsy knowledge among predominantly African American and Caribbean American PWE and examined their interrelationships. MATERIALS AND METHODS Sixty-three PWE (Age = 42.1 ± 13.2; 60% female; 79% Black; 19% Hispanic/Latino) completed validated self-report questionnaires about medication self-management, medication beliefs, and epilepsy knowledge. Correlations and t-tests examined interrelationships. RESULTS Four barriers to medication self-management were common, including not taking antiseizure medications at the same time every day, forgetting doses, not planning refills before running out, and spreading out doses when running low. More than half the sample believed medications were overused by prescribers. Nearly one-third believed medications were harmful, and nearly a quarter believed their antiseizure medications were minimally necessary with almost half reporting elevated concerns about negative consequences of antiseizure medications. Poorer medication self-management was associated with stronger beliefs that medications in general are harmful/overused by prescribers. Individuals who were "accepting" of their antiseizure medications (i.e., high perceived necessity, low concerns) were less likely to spread out time between doses when running low compared to non-accepting counterparts. Knowledge gaps related to the cause of seizures/epilepsy, chronicity of epilepsy treatment, and seizure semiology/diagnosis were common. Nevertheless, epilepsy knowledge was unrelated to medication self-management and medication beliefs. CONCLUSIONS In these PWE, the most prevalent reasons for suboptimal medication self-management were behaviorally mediated and potentially modifiable. Negative medication beliefs and misconceptions about epilepsy and its treatment were common. Results further suggest that interventions addressing negative medication beliefs will be more effective than knowledge-based psychoeducation alone to improve medication self-management in this patient population.
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Affiliation(s)
- Cara L Crook
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 222 Richmond St., Providence, RI 02903, USA; Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA
| | - Seth A Margolis
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 222 Richmond St., Providence, RI 02903, USA; Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA.
| | | | - Jennifer D Davis
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 222 Richmond St., Providence, RI 02903, USA; Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA
| | - Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave., Bronx, NY 10461, USA; Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461, USA
| | - Arthur C Grant
- SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11203, USA
| | - Luba Nakhutina
- SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11203, USA
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Bensken WP, Vaca GFB, Williams SM, Khan OI, Jobst BC, Stange KC, Sajatovic M, Koroukian SM. Disparities in adherence and emergency department utilization among people with epilepsy: A machine learning approach. Seizure 2023; 110:169-176. [PMID: 37393863 PMCID: PMC10528555 DOI: 10.1016/j.seizure.2023.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 07/04/2023] Open
Abstract
PURPOSE We used a machine learning approach to identify the combinations of factors that contribute to lower adherence and high emergency department (ED) utilization. METHODS Using Medicaid claims, we identified adherence to anti-seizure medications and the number of ED visits for people with epilepsy in a 2-year follow up period. We used three years of baseline data to identify demographics, disease severity and management, comorbidities, and county-level social factors. Using Classification and Regression Tree (CART) and random forest analyses we identified combinations of baseline factors that predicted lower adherence and ED visits. We further stratified these models by race and ethnicity. RESULTS From 52,175 people with epilepsy, the CART model identified developmental disabilities, age, race and ethnicity, and utilization as top predictors of adherence. When stratified by race and ethnicity, there was variation in the combinations of comorbidities including developmental disabilities, hypertension, and psychiatric comorbidities. Our CART model for ED utilization included a primary split among those with previous injuries, followed by anxiety and mood disorders, headache, back problems, and urinary tract infections. When stratified by race and ethnicity we saw that for Black individuals headache was a top predictor of future ED utilization although this did not appear in other racial and ethnic groups. CONCLUSIONS ASM adherence differed by race and ethnicity, with different combinations of comorbidities predicting lower adherence across racial and ethnic groups. While there were not differences in ED use across races and ethnicity, we observed different combinations of comorbidities that predicted high ED utilization.
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Affiliation(s)
- Wyatt P Bensken
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Guadalupe Fernandez-Baca Vaca
- Department of Neurology, University Hospitals Cleveland Medical Center, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Scott M Williams
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Omar I Khan
- Epilepsy Center of Excellence, Baltimore VA Medical Center, US Department of Veterans Affairs, Baltimore, MD, USA
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, NH, Lebanon, USA
| | - Kurt C Stange
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA; Center for Community Health Integration, Departments of Family Medicine & Community Health, and Sociology, Case Western Reserve University, Cleveland, OH, USA
| | - Martha Sajatovic
- Departments of Neurology and Psychiatry, University Hospitals Cleveland Medical Center, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Choi H, Wetmore JB, Camarillo IA, Misiewicz S, Siegel K, Chung WK, Leu CS, Phelan JC, Yang LH, Ottman R. Association of antiseizure medication adherence with illness perceptions in adults with epilepsy. Epilepsy Behav 2023; 145:109289. [PMID: 37315405 PMCID: PMC10527556 DOI: 10.1016/j.yebeh.2023.109289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE We assessed the relationship of epilepsy illness perceptions to antiseizure medication (ASM) adherence. METHODS Surveys were completed by 644 adult patients with epilepsy of unknown cause. We used the Morisky Medication Adherence Scale-8 (MMAS-8) to define "high" adherence (score = 8) and "low-medium" adherence (score < 8). We evaluated epilepsy illness perceptions using seven items from the Brief Illness Perception Questionnaire (BIPQ), each scored from 0-10, measuring participants' views of the overall effect of epilepsy on their lives, how long it would last, how much control they had over their epilepsy, the effectiveness of their treatment, level of concern about epilepsy, level of understanding of epilepsy, and emotional impact of epilepsy. We investigated the association of each BIPQ item with medication adherence using logistic regression models that controlled for potential confounders (age, race/ethnicity, income, and time since the last seizure). RESULTS One hundred forty-nine patients (23%) gave responses indicating high adherence. In the adjusted models, for each 1-unit increase in participants' BIPQ item scores, the odds of high adherence increased by 17% for understanding of their epilepsy (OR = 1.17, 95% CI 1.07-1.27, p < 0.001), decreased by 11% for overall life impact of epilepsy (OR = 0.89, 95% CI 0.82-0.97, p = 0.01) and decreased by 6% for emotional impact of epilepsy (OR = 0.94, 95% CI 0.86-0.99, p = 0.03). No other illness perception was associated with high adherence. Depression, anxiety, and stigma mediated the inverse relationships of high adherence to the overall life impact of epilepsy and the emotional impact of epilepsy. These measures did not mediate the relationship of high adherence to the perceived understanding of epilepsy. CONCLUSION These results indicate that a greater perceived understanding of epilepsy is independently associated with high ASM adherence. Programs aimed at improving patients' understanding of their epilepsy may help improve medication adherence.
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Affiliation(s)
- Hyunmi Choi
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
| | - John B Wetmore
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Itzel A Camarillo
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA.
| | - Sylwia Misiewicz
- Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA.
| | - Karolynn Siegel
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
| | - Cheng-Shiun Leu
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Jo C Phelan
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Lawrence H Yang
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA; School of Global Public Health, New York University, New York, NY, USA.
| | - Ruth Ottman
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA; Division of Translational Epidemiology and Mental Health Equity, New York State Psychiatric Institute, New York, NY, USA.
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Solomon Y, Teshome Y, Ejigu S, Bezabih M. Prevalence of anti-seizure medication nonadherence and its associated factors, among people with epilepsy in North Shewa, Ethiopia, 2021. Epilepsy Behav 2023; 145:109301. [PMID: 37336134 DOI: 10.1016/j.yebeh.2023.109301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Epilepsy is a worldwide neurologic illness, characterized by recurrent unprovoked epileptic seizures and can affect people of all age groups. Patients who are receiving drug therapy for chronic diseases, such as epilepsy, must fit complex medication regimens into their everyday routines. Managing medication schedules may pose a significant burden on patients' lives. Anti-seizure medication choices should therefore be tailored to patients' factors that may limit medication use. The study aimed to determine the prevalence and Predictors of anti-seizure medication nonadherence among patients with epilepsy. METHODOLOGY An institutional-based cross-sectional study was conducted among 352 people with epilepsy who were selected by systematic random sampling method at government hospitals in North Shewa Ethiopia. Data were collected by reviewing patients' charts and interviewing people with epilepsy by using structured and pretested questionnaires. Data obtained were encoded into EPI-INFO software and exported to SPSS version 25 for analysis. Logistic regression was employed to assess independent factors associated with medication non-adherence. RESULT The prevalence of anti-seizure medication non-adherence was 40%. Being female [AOR = 3.37, 95%, CI: 1.84, 6.18], Divorced [AOR = 9.13, 95%, CI: 1.80, 46.34], Being jobless [AOR = 7.33, 95%, CI: 3.24, 16.56], Perceived poor social support [AOR = 2.73, 95%, CI: 1.28, 5.82], perceived stigma [AOR = 5.07, 95%, CI: 2.40, 10.68], polytherapy [AOR = 2.23, 95%, CI: 1.06, 4.71], drug side effects[AOR = 6.03, 95%, CI: 3.17, 11.45], buying medications [AOR = 5.81, 95%, CI: 3.63,16.79] and duration of stay on treatment [AOR = 4.31, 95%, CI: 1.863, 9.97] were significant predictors of anti-seizure medication non-adherence. CONCLUSION Non-adherence to anti-seizure medication among people with epilepsy in the study area was relatively higher as compared with study reports from different parts of the country. Health and clinical, socio-economy, and patients' psychological mindset were among the determinant factors affecting the consistency of epilepsy treatment adherence. Enhanced professional, health education for patients as well as for society and financial support, are basic pillars to reduce the constraints of effective treatment.
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Affiliation(s)
- Yerukneh Solomon
- Department of Biomedical Sciences, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia.
| | - Yonas Teshome
- Department of Biomedical Sciences, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Solomon Ejigu
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Mihret Bezabih
- Department of Public Health, Arba Minch College of Health Sciences, Arba Minch, Ethiopia
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Versavel S, Subasinghe A, Johnson K, Golonski N, Muhlhausen J, Perry P, Sanchez R. Diversity, equity, and inclusion in clinical trials: A practical guide from the perspective of a trial sponsor. Contemp Clin Trials 2023; 126:107092. [PMID: 36702295 DOI: 10.1016/j.cct.2023.107092] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/15/2022] [Accepted: 01/17/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Considering diversity, equity, and inclusion (DEI) in clinical trials ensures that data collected for investigational treatments reflect the populations most likely to benefit from those therapies. Resources and recommendations regarding DEI were assembled by the trial sponsor to assist clinical trial development. METHODS A cross-disciplinary team from the sponsoring organization was assembled to inform trial planning and collate resources that promote DEI throughout the clinical trial life cycle. RESULTS Representatives from clinical operations, health economic outcomes research, medical affairs, patient advocacy, procurement, and research and development functional groups united together to implement DEI strategies in clinical trials. Planning strategies focus on eligibility, participant/patient engagement, feedback through patient advocacy organizations, and community interactions. Informed site, investigator, and vendor selection at trial startup supports efforts to recruit diverse target trial populations and engage underrepresented businesses; establishing relationships and demographic target-goal tracking should be maintained throughout trial management. Continued communication during trial closeout consolidates learnings and enhances partnerships with trial participants and patient advocacy organizations. The sponsoring organization continuously updates an internal library of resources to facilitate implementation of outlined strategies. CONCLUSIONS This first iteration of guidance intends to improve the representation of target populations who will ultimately benefit from investigational therapies; to assist sponsor clinical trial teams in developing recruitment and retention plans; and to ensure compliance with federal granting agencies. The sponsoring organization anticipates data from future clinical trials will help characterize the impact of these initiatives to ensure evidence-based practices are used in future clinical trials to enhance DEI.
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10
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Chatoo A, Lee S. Association of Coping Strategies and Medication Adherence: A Systematic Review. Innov Pharm 2022; 13:10.24926/iip.v13i3.4991. [PMID: 36627914 PMCID: PMC9815862 DOI: 10.24926/iip.v13i3.4991] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Medication adherence is difficult for most patients who take at least one medication. Poor drug adherence is a developing problem since it contributes to negative outcomes, prescription waste, increased healthcare expenses, and disease progression. Coping strategies are an important tool for managing a patient's condition because a patient's coping method influences how he or she perceives the situation and deals with the stress that comes with it, which can eventually affect adherence. Coping strategies are classified into five categories: problem-focused, emotion-focused, seeking understanding, support seeking, and problem avoidance. Objective: The goal of this study is to examine and illustrate the association of coping strategies on medication adherence. Method: A systematic review of PubMed/MEDLINE database was conducted in order to screen and select articles. A total of 15 studies were included where they were classified by endpoints. Endpoints that were considered are medication adherence, problem-solving/active coping strategy, emotion-focused coping strategy, seeking understanding coping strategy, support seeking coping strategy and problem avoidance coping strategy. The association of each coping strategy on medication adherence was then evaluated from each article assigned to every category of coping strategies to determine if it had a favorable, negative, or no impact on medication adherence. Results: Most studies which measured problem-solving/active coping strategy (78%) had a positive association on medication adherence, followed by studies which measured emotion-focused coping strategy (69%). Majority of the studies that evaluated for problem avoidance coping strategy (50%) showed a negative association on medication adherence and a small proportion of studies (30%) showed a positive association. Four(4) of the 5 coping strategies (problem-solving/active, emotion-focused, seeking understanding and support seeking) were found to have a greater number of studies showing positive association to medication adherence as opposed to problem avoidance. Conclusion: The findings may suggest that problem-solving and emotion-focused coping strategies can be useful to help people with chronic conditions improve their medication adherence. More study is needed to establish a link between coping strategies and medication adherence in patients, which will allow pharmacists and other healthcare professionals to deliver better interventions to patients and assess for medication nonadherence due to poor coping skills.
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Affiliation(s)
- Avinash Chatoo
- Touro College of Pharmacy;,Corresponding author: Avinash Chatoo PharmD Candidate 2023 Touro College of Pharmacy 230 W 125 Street, New York, NY 10027
| | - SuHak Lee
- University of Minnesota, College of Pharmacy
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11
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Mendorf S, Prell T, Schönenberg A. Detecting Reasons for Nonadherence to Medication in Adults with Epilepsy: A Review of Self-Report Measures and Key Predictors. J Clin Med 2022; 11:jcm11154308. [PMID: 35893399 PMCID: PMC9331129 DOI: 10.3390/jcm11154308] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
This review presents individual reasons for self-reported nonadherence in people with epilepsy (PWE). A literature search was performed on the PubMed/Medline and Scopus databases for studies published up to March 2022. Thirty-six studies were included using the following inclusion criteria: original studies on adults with epilepsy, use of subjective self-report adherence measurement methods, and publication in English. Data were extracted using a standardized data extraction table, including the year of publication, authors, cohort size, study design, adherence measurement method, and self-reported reasons for nonadherence. Self-reported reasons for nonadherence were grouped following the WHO model with the five dimensions of nonadherence. In addition, study characteristics and sociodemographic information are reported. Of the 36 included studies, 81% were observational. The average nonadherence rate was nearly 50%. Across all studies, patient-associated, therapy-associated, and circumstance-related factors were the most frequently reported dimensions of nonadherence. These factors include forgetfulness, presence of side-effects, and history of seizures. Regarding healthcare system factors, financial problems were the most reported reason for nonadherence. Stigmatization and quality of life were the most frequently cited factors influencing nonadherence in the disease- and circumstance-related dimensions. The results suggest that interventions for improving adherence should incorporate all dimensions of nonadherence.
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Affiliation(s)
- Sarah Mendorf
- Department of Neurology, University Hospital Jena, 07747 Jena, Germany
- Correspondence: ; Tel.: +49-3641-9323511
| | - Tino Prell
- Department of Geriatrics, University Hospital Halle, 06120 Halle, Germany; (T.P.); (A.S.)
| | - Aline Schönenberg
- Department of Geriatrics, University Hospital Halle, 06120 Halle, Germany; (T.P.); (A.S.)
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12
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von Gaudecker JR, Buelow JM, Miller WR, Tanner AL, Austin JK. Social determinants of health associated with epilepsy treatment adherence in the United States: A scoping review. Epilepsy Behav 2021; 124:108328. [PMID: 34628091 DOI: 10.1016/j.yebeh.2021.108328] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of this paper is to share the results of a scoping review in which we examined the social determinants of health (SDoH) that are associated with anti-seizure medication (ASM) treatment adherence among people living with epilepsy in the United States. METHODS Our review was informed by the methods of Arksey and O'Malley for a scoping review. A total of 3,826 articles were identified for reference through a literature search, of which 17 publications were deemed relevant to our scoping review. The final articles were mapped using the Epilepsy SDoH Conceptual Framework to identify gaps. FINDINGS Our review suggests that there are multidimensional associations of SDoH in ASM adherence. The SDoH were interrelated. Race/ethnicity and socioeconomic status appeared to have major associations with ASM adherence. Several gaps in the literature were identified, including inadequately exploring the effect that each SDoH has on treatment adherence, and the methods used for assessment. CONCLUSIONS Future longitudinal research to address the identified gaps would foster interventions that promote ASM adherence among vulnerable populations living with epilepsy.
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Affiliation(s)
| | | | - Wendy R Miller
- Indiana University, 600 Barnhill Drive, Indianapolis, USA
| | | | - Joan K Austin
- Indiana University, 600 Barnhill Drive, Indianapolis, USA
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13
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McCann ZH, Szaflarski M, Szaflarski JP. A feasibility study to assess social stress and social support in patients enrolled in a cannabidiol (CBD) compassionate access program. Epilepsy Behav 2021; 124:108322. [PMID: 34600280 PMCID: PMC8960472 DOI: 10.1016/j.yebeh.2021.108322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 01/12/2023]
Abstract
Cannabidiol (CBD) trials offer an opportunity to examine social factors that shape outcomes of patients with treatment-resistant epilepsy. Prior research of patients treated with CBD for epilepsy describes financial struggles of these patients/families and the association between socioeconomic status and patient-centered outcomes. However, social determinants of health in this population are still poorly understood, mainly due to data scarcity. This study aimed to establish feasibility of assessing social stress, social support, and religious participation and their associations with outcomes (perceived health, quality of life, and mood) in patients treated with CBD for epilepsy. Data were collected during 2015-2018 through structured face-to face interviews with patients/caregivers in a CBD compassionate access/research program in the southern United States. Adult (ages 19-63; n = 65) and pediatric (ages 8-19; n = 46) patients or their caregivers were interviewed at the time of enrollment in the study. Social stress was assessed with stressful life events, perceived stress, epilepsy-related discrimination, and economic stressors; social support with the Interpersonal Support Evaluation List [ISEL]-12; and religious participation with frequency of religious attendance. The results showed economic stressors to be associated with poor overall health, but no associations were noted between stress, support, and religious participation measures and quality of life or mood. Despite a robust data collection plan, completeness of the data was mixed. We discuss lessons learned and directions for future research and identify potential refinements to social data collection in people with treatment-resistant epilepsy during clinical trials.
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Affiliation(s)
- Zachary H McCann
- Department of Sociology, University of Alabama at Birmingham, USA.
| | | | - Jerzy P Szaflarski
- UAB Epilepsy Center and Departments of Neurology, Neurosurgery, and Neurobiology, USA
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14
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Eslami V, Kimberley Molina D, Ákos Szabó C. Definite SUDEP population in Bexar County, Texas: A 36-year data registry. Epilepsy Behav 2021; 121:108005. [PMID: 34052632 DOI: 10.1016/j.yebeh.2021.108005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Sudden unexplained death in epilepsy (SUDEP) is one of the leading causes of mortality in epilepsy. In this study, cases of definite SUDEP are reported for Bexar County from a 36-year period. METHODS Death reports by Bexar County Medical Examiner (BCME) from 1983 to 2018 were reviewed to identify cases with definite SUDEP. The findings were based upon investigators' reports, which included medical history, medication list, sleep position, time of death, and pathology reports. In addition to these potential risk factors, body mass indices (BMI), as well as heart, lung, and brain weights were compared between SUDEP victims with therapeutic vs subtherapeutic anti-seizure medication (ASM) levels. RESULTS Definite SUDEP was identified in 286 cases. The incidence of definite SUDEP was 0.51 ± 0.26/1000 person-years among PWE and 0.56 ± 0.29 per 100,000 person-years among the general population in Bexar County. The median age was 37 years old (interquartile range 27-48), and the majority were male (65%). While 171 (60%) people were prescribed at least one ASM, ASM levels were subtherapeutic in 239 cases (83.6%). Risk factors for SUDEP did not differ between SUDEP victims with therapeutic vs subtherapeutic ASM levels. While BMIs were only slightly increased in adherent vs nonadherent SUDEP victims, they were significantly associated with subtherapeutic ASM levels. Abnormal lung, heart, and brain weights were reported in 48 (16.8%), 67 (23.4%), and 43 (15.0%) SUDEP cases, respectively. SIGNIFICANCE This study is one of the largest autopsy-based registries of definite SUDEP. Subtherapeutic ASM levels measured in post-mortem blood samples suggest that nonadherence to ASM therapy was a leading risk factor for SUDEP. As BMI was elevated in this cohort, and obesity was significantly associated with subtherapeutic ASM levels, it may also be a risk factor for SUDEP. Case-controlled studies are needed to validate the specific role of obesity and related comorbidities in this population.
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Affiliation(s)
- Vahid Eslami
- Department of Neurology, University of Health Science Center at San Antonio, TX, United States
| | - D Kimberley Molina
- Bexar County's Medical Examiner's Office, San Antonio, TX, United States
| | - Charles Ákos Szabó
- Department of Neurology, University of Health Science Center at San Antonio, TX, United States; South Texas Comprehensive Epilepsy Center, San Antonio, TX, United States.
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15
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Wilder ME, Kulie P, Jensen C, Levett P, Blanchard J, Dominguez LW, Portela M, Srivastava A, Li Y, McCarthy ML. The Impact of Social Determinants of Health on Medication Adherence: a Systematic Review and Meta-analysis. J Gen Intern Med 2021; 36:1359-1370. [PMID: 33515188 PMCID: PMC8131473 DOI: 10.1007/s11606-020-06447-0] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medication adherence (MA) is critical to successful chronic disease management. It is not clear how social determinants of health (SDH) impact MA. We conducted a systematic review and meta-analysis to summarize the evidence on the relationship between SDH and MA. METHODS We conducted a systematic review of the literature using a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) format. A literature search was performed using three databases: PubMed, Scopus, and Cochrane Clinical Trials Register in December of 2018. Included studies were completed in the USA, included adults aged 18 years and older, measured at least one social determinant of health, and medication adherence was the primary outcome measure. Data from included full texts were independently extracted using a standardized data extraction form. We then conducted a meta-analysis and pooled the odds ratios from the included studies for each social determinant as well as for all SDH factors collectively. RESULTS A total of 3137 unduplicated abstracts were identified from our database searches. A total of 173 were selected for full text review after evaluating the abstract. A total of 29 articles were included for this systematic review. Economic-related SDH factors and MA were mostly commonly examined. The meta-analysis revealed a significant relationship between food insecurity (aOR = 0.56; 95% CI 0.42-0.7), housing instability (aOR = 0.64; 95% CI 0.44-0.93), and social determinants overall (aOR = 0.75; 95% CI 0.65-0.88) and medication adherence. DISCUSSION Food insecurity and housing instability most consistently impacted medication adherence. Although included studies were heterogenous and varied widely in SDH and MA measurements, adverse social determinants overall were significantly associated with lower MA. The relationship between SDH and MA warrants more attention and research by health care providers and policymakers.
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Affiliation(s)
- Marcee E Wilder
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA.
| | - Paige Kulie
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Caroline Jensen
- Anesthesiology Residency Program, Columbia University, New York, NY, USA
| | - Paul Levett
- Himmelfarb Health Sciences Library, George Washington University, Washington, DC, USA
| | - Janice Blanchard
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Luis W Dominguez
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Maria Portela
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Aneil Srivastava
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Yixuan Li
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Melissa L McCarthy
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA.,Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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16
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Thorpe J, Ashby S, Hallab A, Ding D, Andraus M, Dugan P, Perucca P, Costello D, French JA, O'Brien TJ, Depondt C, Andrade DM, Sengupta R, Delanty N, Jette N, Newton CR, Brodie MJ, Devinsky O, Helen Cross J, Sander JW, Hanna J, Sen A. Evaluating risk to people with epilepsy during the COVID-19 pandemic: Preliminary findings from the COV-E study. Epilepsy Behav 2021; 115:107658. [PMID: 33341393 PMCID: PMC7698680 DOI: 10.1016/j.yebeh.2020.107658] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/22/2020] [Accepted: 11/22/2020] [Indexed: 01/21/2023]
Abstract
The COVID-19 pandemic has caused global anguish unparalleled in recent times. As cases rise, increased pressure on health services, combined with severe disruption to people's everyday lives, can adversely affect individuals living with chronic illnesses, including people with epilepsy. Stressors related to disruption to healthcare, finances, mental well-being, relationships, schooling, physical activity, and increased isolation could increase seizures and impair epilepsy self-management. We aim to understand the impact that COVID-19 has had on the health and well-being of people with epilepsy focusing on exposure to increased risk of seizures, associated comorbidity, and mortality. We designed two online surveys with one addressing people with epilepsy directly and the second for caregivers to report on behalf of a person with epilepsy. The survey is ongoing and has yielded 463 UK-based responses by the end of September 2020. Forty percent of respondents reported health changes during the pandemic (n = 185). Respondents cited a change in seizures (19%, n = 88), mental health difficulties (34%, n = 161), and sleep disruption (26%, n = 121) as the main reasons. Thirteen percent found it difficult to take medication on time. A third had difficulty accessing medical services (n = 154), with 8% having had an appointment canceled (n = 39). Only a small proportion reported having had discussions about epilepsy-related risks, such as safety precautions (16%, n = 74); mental health (29%, n = 134); sleep (30%, n = 140); and Sudden Unexpected Death in Epilepsy (SUDEP; 15%, n = 69) in the previous 12 months. These findings suggest that people with epilepsy are currently experiencing health changes, coupled with inadequate access to services. Also, there seems to be a history of poor risk communication in the months preceding the pandemic. As the UK witnesses a second COVID-19 wave, those involved in healthcare delivery must ensure optimal care is provided for people with chronic conditions, such as epilepsy, to ensure that avoidable morbidity and mortality is prevented during the pandemic, and beyond.
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Affiliation(s)
- Jennifer Thorpe
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, UK,SUDEP Action, 18 Newbury Street, Wantage, Oxfordshire OX12 8DA. UK
| | - Samantha Ashby
- SUDEP Action, 18 Newbury Street, Wantage, Oxfordshire OX12 8DA. UK
| | - Asma Hallab
- Department of Nuclear Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Ding Ding
- Institute of Neurology, Fudan University Huashan Hospital, Shanghai, China
| | - Maria Andraus
- Department of Internal Medicine, Neurology Service, Epilepsy Program, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patricia Dugan
- Department of Neurology, NYU Grossman School of Medicine, USA
| | - Piero Perucca
- Department of Neuroscience, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Australia & Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Daniel Costello
- Epilepsy Service, Cork University Hospital & College of Medicine and Health, University College Cork, Ireland
| | | | - Terence J. O'Brien
- Department of Neuroscience, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Australia & Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Chantal Depondt
- Department of Neurology, Hôpital Erasme – Université Libre de Bruxelles, Brussels, Belgium
| | - Danielle M. Andrade
- Adult Epilepsy Genetics Program, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | | | - Norman Delanty
- Beaumont Hospital, and School of Pharmacy and Biomolecular Sciences, FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nathalie Jette
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Charles R. Newton
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, UK,University Department of Psychiatry, University of Oxford, UK
| | - Martin J. Brodie
- Epilepsy Unit, West Glasgow Ambulatory Care Hospital-Yorkhill, Glasgow, UK
| | - Orrin Devinsky
- Department of Neurology, NYU Grossman School of Medicine, USA
| | - J. Helen Cross
- UCL NIHR BRC Great Ormond Street Institute of Child Health, London, UK,Young Epilepsy, St Pier's Lane, Dormansland, Lingfield RH7 6P, UK
| | - Josemir W. Sander
- UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
| | - Jane Hanna
- SUDEP Action, 18 Newbury Street, Wantage, Oxfordshire OX12 8DA. UK
| | - Arjune Sen
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, UK.
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17
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Vásquez E, O’Malley I, Cruz-Gonzalez M, Velásquez E, Alegría M. The Impact of Social Support on Treatment Participation and Completion in a Disability Prevention Intervention for Older Adults. J Aging Health 2021; 33:557-564. [PMID: 33729038 PMCID: PMC9923629 DOI: 10.1177/0898264321999897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives: This study evaluates the role of emotional and instrumental social support on treatment participation and completion using the Positive Minds-Strong Bodies (PMSB) disability prevention program. Methods: Data from a multisite randomized controlled trial of the PMSB program for older adults (≥60 years) with physical impairment and mild to severe depression and/or anxiety were used. Participants were randomly assigned to receive 10 sessions of cognitive behavior therapy (CBT) plus 36 sessions of group exercise or usual care. Results: Adjusting for covariates, higher levels of emotional social support at baseline were associated with increased odds of completing the recommended number of CBT sessions (6 or more, OR = 2.58, p = .030), attending 5.56 more exercise sessions (p = .006), and increased odds of completing the recommended exercise sessions (25 or more, OR = 2.37, p = .047). Discussion: Emotional social support appears to increase dosage in a disability prevention program.
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Affiliation(s)
- Elizabeth Vásquez
- Department of Epidemiology & Biostatistics, School of Public Health, University at Albany (SUNY), Rensselaer, NY, USA
| | - Isabel O’Malley
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Esther Velásquez
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA,Department of Medicine, Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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18
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Sunny AA, Iyer RS, Kumaran SG, Bunshaw NG, Shanmugham K, Govindaraj U. Affordability, availability and tolerability of anti-seizure medications are better predictors of adherence than beliefs: Changing paradigms from a low resource setting. Seizure 2020; 83:208-215. [PMID: 33227659 DOI: 10.1016/j.seizure.2020.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/11/2020] [Accepted: 11/07/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Anti-seizure medication (ASM) non-adherence contributes to treatment gap and increases mortality and morbidity associated with epilepsy. Beliefs about medications are considered better predictors of ASM non-adherence than clinico-demographic factors. We aimed to look into ASM non-adherence rates among adults with epilepsy (AWE), identify the contributing barriers and determine whether medication beliefs were more powerful predictors than clinico-demographic factors. METHODS This was a cross-sectional study of AWE receiving ASMs. Participants (n = 304) were assessed by validated questionnaires, for non-adherence (8-item Morisky Medication Adherence Scale) and perceptions of ASMs (Beliefs about Medicines Questionnaire) along with clinico-demographic details. RESULTS Our group with high literacy and low-income had a high non-adherence rate (55 %) despite having positive beliefs (Mean necessity-concern differential [NCD] = 2.86). Among the beliefs, ASM non-adherence was significantly associated with ASM-concern (t = 4.23, p < 0.001) and NCD (t = -4.11, p < 0.001). Stepwise multiple linear regression analysis showed that non-adherence was significantly associated with per-capita income (β -0.215, p < 0.001), ASM side effects (β 0.177, p = 0.001), high seizure frequency (β 0.167, p = 0.002), ASM availability (β -0.151, p = 0.004), ASM costs (β -0.134, p = 0.013 and NCD (β -0.184, p = 0.001). NCD accounted for 2.9 % of the variance in non-adherence whereas the other clinico-demographic variables together accounted for 14.6 %. CONCLUSION We describe a paradigm shift in AWE with high non-adherence to ASMs, wherein clinico-demographic variables emerge as better predictors of non-adherence than beliefs. High literacy facilitates the perception of need for ASMs whereas costs and side effects hamper adherence.
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Affiliation(s)
- Anita Ann Sunny
- Department of Neurology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Rajesh Shankar Iyer
- Department of Neurology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
| | - Soumya Gopalan Kumaran
- Department of Neurology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Nadiya Grace Bunshaw
- Department of Neurology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Karthikeyan Shanmugham
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Uma Govindaraj
- Department of Statistics, PSG College of Arts & Science, Coimbatore, Tamil Nadu, India
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19
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Abd Wahab ES, Al Omar M, Altabakha MMAM. Adherence to Antiepileptic Drugs among Patients Attending the Neuro Spinal Hospital in the United Arab Emirates. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2020; 12:499-507. [PMID: 33679099 PMCID: PMC7909063 DOI: 10.4103/jpbs.jpbs_367_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/20/2020] [Accepted: 05/29/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Adherence to antiepileptic drugs (AEDs) is an integral component of epilepsy management. There are no previous data in the United Arab Emirates (UAE). Objectives: The aim of this study was to assess the prevalence of AED adherence among patients attending the Neuro Spinal Hospital in UAE and to identify the predictors of nonadherence. Materials and Methods: A cross-sectional study was conducted between April 2018 and May 2019, and included consecutive patients with epileptic who were receiving AEDs for at least 6 months. A validated interviewer-administered questionnaire was used. Adherence was assessed by four-item Morisky’s Medication Adherence Scale with a score between 0 and 4. Patients were considered adherent or nonadherent for a score of zero, or 1 and more, respectively. Chi-square test, binary, and multiple logistic regression analysis were used. Results: The study included 315 respondents, 70.8% (n = 223) were adherent, the rest were nonadherent. The most common factor affecting adherence was forgetfulness. Lower education level and having a seizure within the last 6 months were significant risk of nonadherence (odds ratio [OR] 95% confidence interval [CI] = 2.6 (1.2–5.8) and 2.5 (1.3–5.2), respectively), whereas levetiracetam intake reduces the risk of nonadherence (OR: 0.5 [0.2–0.9]). Conclusions: The prevalence of AED adherence was 70.8%. Education level and having a seizure in the last 6 months were significant predictors of nonadherence, whereas levetiracetam intake reduces the risk of nonadherence.
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Affiliation(s)
- Enas S Abd Wahab
- Department of Pharmacy, Neuro Spinal Hospital, Dubai, United Arab Emirates
| | - Muaed Al Omar
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Moawia M A M Altabakha
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
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Pirri S, Lorenzoni V, Turchetti G. Scoping review and bibliometric analysis of Big Data applications for Medication adherence: an explorative methodological study to enhance consistency in literature. BMC Health Serv Res 2020; 20:688. [PMID: 32709237 PMCID: PMC7379348 DOI: 10.1186/s12913-020-05544-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 07/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medication adherence has been studied in different settings, with different approaches, and applying different methodologies. Nevertheless, our knowledge and efficacy are quite limited in terms of measuring and evaluating all the variables and components that affect the management of medication adherence regimes as a complex phenomenon. The study aim is mapping the state-of-the-art of medication adherence measurement and assessment methods applied in chronic conditions. Specifically, we are interested in what methods and assessment procedures are currently used to tackle medication adherence. We explore whether Big Data techniques are adopted to improve decision-making procedures regarding patients' adherence, and the possible role of digital technologies in supporting interventions for improving patient adherence and avoiding waste or harm. METHODS A scoping literature review and bibliometric analysis were used. Arksey and O'Malley's framework was adopted to scope the review process, and a bibliometric analysis was applied to observe the evolution of the scientific literature and identify specific characteristics of the related knowledge domain. RESULTS A total of 533 articles were retrieved from the Scopus academic database and selected for the bibliometric analysis. Sixty-one studies were identified and included in the final analysis. The Morisky medication adherence scale (36%) was the most frequently adopted baseline measurement tool, and cardiovascular/hypertension disease, the most investigated illness (38%). Heterogeneous findings emerged from the types of study design and the statistical methodologies used to assess and compare the results. CONCLUSIONS Our findings reveal a lack of Big Data applications currently deployed to address or measure medication adherence in chronic conditions. Our study proposes a general framework to select the methods, measurements and the corpus of variables in which the treatment regime can be analyzed.
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Affiliation(s)
- Salvatore Pirri
- Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy
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21
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Siqueira HH, Dalbem JS, Schiavini M, Silva PE, Costa TBP, Leite PHSC, Koeche B, Diesel M, Scolari LP, Wolf P, Walz R, Lin K. Self-reported adherence among people with epilepsy in Brazil. Epilepsy Behav 2020; 103:106498. [PMID: 31653605 DOI: 10.1016/j.yebeh.2019.106498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/09/2019] [Accepted: 08/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nonadherence rates among people with epilepsy (PWE) are widely variable, ranging from 26% to 95.4%. We aimed to identify nonadherence in Brazil, its determinant factors, its impact on patients' management, and to compare it with other chronic nonparoxysmal diseases. METHODS A multicenter observational case-control study was conducted between March 2015 and October 2016, and 153 subjects were included. Subjects' clinical-epidemiological data were surveyed with the Morisky-Green test (MGT), Brief Medication Questionnaire (BMQ), and the Liverpool adverse events profile (LAEP). RESULTS One hundred three PWE and 50 controls with other, nonparoxysmal chronic conditions were interviewed; both groups were matched according to age and socioeducational level. People with epilepsy were aged 36.4 ± 13.9 (range 18-67), 55% were women, mean age at epilepsy onset was 18.1 ± 15.5 years, 51.5% had pharmacoresistant epilepsy, and 48.5% were on monotherapy. 74.8% of patients and 70.0% controls were nonadherent to treatment according to MGT (p = 0.58); and barrier of recall (BMQ) was associated with nonadherence in 78% of PWE and 76% of controls (p = 0.84). Binary logistic regression analysis revealed LAEP (OR 1.05; 95%CI = 1.01-1.09; p = 0.03) and self-reported frequency of forgetfulness on the last three months (OR 19.13; 95%CI = 2.40-152.28; p < 0.01) as the main factors associated with nonadherence. Nonadherent subjects did not have more seizures and did not need emergency treatment more often than adherent ones. CONCLUSION Three of four PWE were not fully adherent to their treatment. Adherence assessment should be routine in all outpatient visits as well as interventions aimed to improving it. Adverse events are important predictors of adherence, and they should be considered when choosing the initial treatment of epilepsy.
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Affiliation(s)
- Heloise Helena Siqueira
- Medical Sciences Graduation Program, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Neurology Division, Hospital Geral Universitário, Cuiabá, MT, Brazil.
| | - Juliane Salter Dalbem
- Medical Sciences Graduation Program, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil
| | - Marcel Schiavini
- Neurology Division, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil
| | - Paulo Eduardo Silva
- Neurology Division, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil
| | | | | | - Bruna Koeche
- Neurology Division, Hospital Geral Universitário, Cuiabá, MT, Brazil
| | - Marcelo Diesel
- Neurology Division, Hospital Geral Universitário, Cuiabá, MT, Brazil
| | | | - Peter Wolf
- Medical Sciences Graduation Program, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Neurology Division, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Danish Epilepsy Centre, Dianalund, Denmark
| | - Roger Walz
- Medical Sciences Graduation Program, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Neurology Division, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Center for Applied Neurosciences (CeNAp), Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil
| | - Katia Lin
- Medical Sciences Graduation Program, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Neurology Division, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Center for Applied Neurosciences (CeNAp), Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil
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Dolgin K. The SPUR Model: A Framework for Considering Patient Behavior. Patient Prefer Adherence 2020; 14:97-105. [PMID: 32021121 PMCID: PMC6970605 DOI: 10.2147/ppa.s237778] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/18/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Medication nonadherence is a global problem that requires urgent attention. Roughly half of all drugs that are prescribed for chronic treatments are not taken by the patients in question. Initiatives designed to support patients and help them modify their behavior are enhanced by personalization, and a number of profiling tools exist to help customize such interventions. Most of these tools were originally designed as paper-based questionnaires, but the growth of digital adherence technologies (DATs) illuminate the need for the development of digital profiling systems that can interact with fully automated patient interfaces. OBJECTIVE The objective of this study was to examine existing frameworks from medicine, psychology, sociology, consumer behavior, and economics to elaborate a comprehensive, quantitative profiling approach that can be used to drive the customization of patient support initiatives. RESULTS Building primarily on Icek Ajzen's Theory of Planned Behavior (TPB), the Health Belief Model (HBM) was used to inform the beliefs about behavior posited in the TPB, while incorporating established factors regarding self-efficacy in the "control" elements of the TPB and selected social and psychological factors in the other constituents of the model. The resulting SPUR (Social, Psychological, Usage, Rational) framework represents a holistic, profiling tool with detailed, quantitative outputs that describe a patient's behavioral risks and the drivers of that risk. CONCLUSION An interactive, digital questionnaire built around SPUR represents a potentially useful tool for those desirous of building interactive digital support programs for patients with chronic diseases.
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Moura LMVR, Magliocco B, Ney JP, Cheng EM, Esper GJ, Hoch DB. Implementation of quality measures and patient-reported outcomes in an epilepsy clinic. Neurology 2019; 93:e2032-e2041. [PMID: 31666351 PMCID: PMC7978483 DOI: 10.1212/wnl.0000000000008548] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/11/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To see if systematic collection of patient-reported epilepsy quality measures can identify opportunities to improve care, and to examine the associations between these measures and physical and mental health. METHODS We developed a patient-reported questionnaire for medication adherence, seizure frequency, medication side effects, and driving that included the Patient-Reported Outcome Measurement Information System-10 (PROMIS-10) (physical and mental health). We offered it to all adult patients seen twice in an epilepsy clinic (January 2017-January 2018). The questionnaire was available on the web as well as a tablet provided at appointment check-in. We used the first completed questionnaire to explore the relationship between patient-reported care quality and measures of physical and mental health. RESULTS A total of 610 unique patients (15% of the total encounters) completed a survey. Respondents were comparable to nonrespondents. Respondents reported gaps in care or opportunities for quality improvement in 48.4% (n = 295) of the encounters. Of patients who reported at least 1 seizure per month over the previous 3 months, 55.2% (n = 100) reported problems with adherence, 30.0% (n = 131) reported having problems believed to be adverse reactions to anticonvulsants, and 15.2% (n = 41) reported driving. In addition, respondents who reported either seizures over the recent 3 months, nonadherence to treatment due to cost, or anticonvulsant-associated adverse effects had consistently worse physical and mental health (all p < 0.05). CONCLUSIONS Systematic collection of epilepsy quality measures endorsed by the American Academy of Neurology can identify opportunities for quality improvement. Measures of epilepsy care quality predict outcomes that matter to patients.
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Affiliation(s)
- Lidia M V R Moura
- From the Department of Neurology (L.M.V.R.M., D.B.H.), Massachusetts General Hospital, Boston; American Academy of Neurology (B.M.), Minneapolis, MN; Department of Neurology (J.P.N.), Boston University, MA; Department of Neurology (E.M.C.), David Geffen School of Medicine, University of California, Los Angeles; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA.
| | - Brandon Magliocco
- From the Department of Neurology (L.M.V.R.M., D.B.H.), Massachusetts General Hospital, Boston; American Academy of Neurology (B.M.), Minneapolis, MN; Department of Neurology (J.P.N.), Boston University, MA; Department of Neurology (E.M.C.), David Geffen School of Medicine, University of California, Los Angeles; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - John P Ney
- From the Department of Neurology (L.M.V.R.M., D.B.H.), Massachusetts General Hospital, Boston; American Academy of Neurology (B.M.), Minneapolis, MN; Department of Neurology (J.P.N.), Boston University, MA; Department of Neurology (E.M.C.), David Geffen School of Medicine, University of California, Los Angeles; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - Eric M Cheng
- From the Department of Neurology (L.M.V.R.M., D.B.H.), Massachusetts General Hospital, Boston; American Academy of Neurology (B.M.), Minneapolis, MN; Department of Neurology (J.P.N.), Boston University, MA; Department of Neurology (E.M.C.), David Geffen School of Medicine, University of California, Los Angeles; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - Gregory J Esper
- From the Department of Neurology (L.M.V.R.M., D.B.H.), Massachusetts General Hospital, Boston; American Academy of Neurology (B.M.), Minneapolis, MN; Department of Neurology (J.P.N.), Boston University, MA; Department of Neurology (E.M.C.), David Geffen School of Medicine, University of California, Los Angeles; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - Daniel B Hoch
- From the Department of Neurology (L.M.V.R.M., D.B.H.), Massachusetts General Hospital, Boston; American Academy of Neurology (B.M.), Minneapolis, MN; Department of Neurology (J.P.N.), Boston University, MA; Department of Neurology (E.M.C.), David Geffen School of Medicine, University of California, Los Angeles; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
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Mroueh L, Boumediene F, Jost J, Ratsimbazafy V, Preux PM, Salameh P, Al-Hajje A. Self-reported attitudes about medication in Lebanese people with epilepsy. Epilepsy Behav 2019; 98:80-87. [PMID: 31301454 DOI: 10.1016/j.yebeh.2019.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Epilepsy is a common worldwide neurological disorder. For people with epilepsy (PWE), adherence and attitudes towards medication is a crucial step to improve efficacy of prescribed treatment and to prevent seizures. OBJECTIVES The first aim of this study was to evaluate attitudes towards antiepileptic medications in Lebanese population. Secondary aims were to assess factors affecting attitudes and associated with epilepsy control. MATERIAL AND METHODS A cross-sectional study was conducted in outpatient neurology clinics located in Beirut-Lebanon. Data were collected using a structured questionnaire. Self-report of medication taking behaviors were assessed using the abbreviated (4 items) Morisky Medication Adherence Scale (MMAS-4). Epilepsy was considered as controlled if the patient had no seizures in the last 6 months. RESULTS Among 250 PWE recruited in this study, male-to-female ratio was 0.87 (116/134), and 50.8% were married. Mean duration of epilepsy was 13.7 ± 12.8 years. Valproate was the most common antiepileptic drug (AED) used followed by levetiracetam and carbamazepine. About 60.8% of the population presented partial epilepsy. Uncontrolled epilepsy was present in more than half of participants (55.2%), with only 32.4% had positive attitudes to their medication. Positive attitudes towards antiepileptic increased in people who found that their treatment was efficacious (odds ratio (OR) = 4.9; 95% confidence interval (CI): 1.2-20.0; p = 0.03), who had controlled epilepsy (OR = 3.4; 95%CI 1.6-7.1; p = 0.001), and who were diagnosed as PWE between the age of 12-20 years (OR = 3.1; 95%CI 1.1-8.4; p = 0.03). Oppositely, these attitudes decreased in participants who felt their treatment as an economic burden (OR = 0.2; 95%CI 0.1-0.4; p ≪ 0.001), and in people with depression (OR = 0.4; 95%CI 0.2-0.9; p = 0.04). Controlled epilepsy was higher in people who contacted a neurologist if seizure occurred, in people with positive attitudes, and after a long duration of disease, but it decreased if patient did not follow neurologist's instructions in fasting period. CONCLUSIONS Lebanese PWE were less likely to have positive attitudes towards medication, which may lead to poor epilepsy control. Depression and economic burden were the major factors that decreased these attitudes. Identifying factors affecting attitudes to medication and leading to controlled epilepsy may help clinicians to elaborate educational programs to optimize medication adherence.
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Affiliation(s)
- Lara Mroueh
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000 Limoges, France; Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Beirut, Lebanon.
| | - Farid Boumediene
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000 Limoges, France
| | - Jeremy Jost
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000 Limoges, France; CHU Limoges, Department of Pharmacy, 87000 Limoges, France
| | - Voa Ratsimbazafy
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000 Limoges, France; CHU Limoges, Department of Pharmacy, 87000 Limoges, France
| | - Pierre-Marie Preux
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000 Limoges, France
| | - Pascale Salameh
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Beirut, Lebanon
| | - Amal Al-Hajje
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Beirut, Lebanon
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McGee RE, Sajatovic M, Quarells RC, Johnson EK, Liu H, Spruill TM, Fraser RT, Janevic M, Escoffery C, Thompson NJ. Depression and quality of life among African Americans with epilepsy: Findings from the Managing Epilepsy Well (MEW) Network integrated database. Epilepsy Behav 2019; 94:301-306. [PMID: 30975571 PMCID: PMC7430521 DOI: 10.1016/j.yebeh.2019.02.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 11/18/2022]
Abstract
Depression and worse quality of life (QOL) are significantly associated with epilepsy. However, limited descriptive data on depression and quality of life among African Americans with epilepsy are available. This study sought to describe the prevalence of depression among African Americans with epilepsy participating in self-management studies and to examine the relationship between depression and QOL. Using data from the Managing Epilepsy Well (MEW) research network, a subgroup of African Americans with epilepsy were selected for the analytic sample. Descriptive statistics indicated the prevalence of depression (Patient Health Questionnaire-9 [PHQ-9]) and reports of epilepsy-specific QOL (Quality of Life in Epilepsy-10 [QOLIE-10]) in the sample. Multiple linear regression examined the relationship between depression and QOL while controlling for sociodemographic characteristics and seizure frequency. The prevalence of depression (PHQ-9 ≥; 10) was 47.7%. Quality of life was the only variable significantly associated with depressive symptoms in multivariable analyses, suggesting that depressive symptoms have a stronger relationship with QOL than seizure frequency. With the high levels of depression and the significant relationship with QOL, regular screening of depression is needed among African Americans with epilepsy. Self-management programs that improve mood may also play an important role in improving the lives of African Americans with epilepsy.
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Affiliation(s)
- Robin E McGee
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA, 30322, United States of America.
| | - Martha Sajatovic
- Case Western Reserve University, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH 44106, United States of America.
| | - Rakale C Quarells
- Morehouse School of Medicine, 720 Westview Dr. SW, Atlanta, GA 30310, United States of America.
| | - Erika K Johnson
- University of Washington, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98104, United States of America.
| | - Hongyan Liu
- Case Western Reserve University, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH 44106, United States of America
| | - Tanya M Spruill
- New York University School of Medicine, 550 First Avenue, New York, NY 10016, United States of America.
| | - Robert T Fraser
- University of Washington, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98104, United States of America.
| | - Mary Janevic
- University of Michigan, 1415 Washington Heights, Ann Arbor, MI, United States of America.
| | - Cam Escoffery
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA, 30322, United States of America.
| | - Nancy J Thompson
- Emory University, Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA, 30322, United States of America.
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Saengow VE, Chancharoenchai P, Saartying W, Pimpa W, Chotichanon N, Lewsirirat T, Srisantisuk P. Epilepsy video animation: Impact on knowledge and drug adherence in pediatric epilepsy patients and caregivers. Clin Neurol Neurosurg 2018; 172:59-61. [DOI: 10.1016/j.clineuro.2018.06.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
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Begley C, Shegog R, Liu H, Tatsuoka C, Spruill TM, Friedman D, Fraser RT, Johnson EK, Bamps YA, Sajatovic M. Correlates of epilepsy self-management in MEW Network participants: From the Centers for Disease Control and Prevention Managing Epilepsy Well Network. Epilepsy Behav 2018; 85:243-247. [PMID: 29853255 DOI: 10.1016/j.yebeh.2018.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/14/2018] [Accepted: 04/16/2018] [Indexed: 12/14/2022]
Abstract
While self-management (S-M) skills of people living with epilepsy (PWE) are increasingly recognized as important for daily functioning and quality of life, there is limited information on overall skill levels, specific areas needing improvement, or associated correlates. The purpose of this study was to provide evidence on the S-M skills of PWE and identify the demographic and clinical correlates that could be used in targeting interventions. Data were derived from the Managing Epilepsy Well (MEW) research network database containing epilepsy S-M data on 436 PWE participating in five studies conducted recently throughout the U.S. Common data elements included sociodemographics, clinical condition, and S-M behaviors covering five domains. Descriptive statistics and multivariate regression analyses found significant variation in total and domain-specific S-M skill levels and the associated characteristics of individuals. The findings from this national sample were remarkably consistent across sites and with existing theory and prior empirical studies indicating that competencies in information and lifestyle management were significantly lower than medication, safety, and seizure management. Self-management behavior levels were higher for females and those with less education, but lower in those with depression and lower quality of life. There were no significant differences by age, race/ethnicity, marital status, or seizure frequency after adjusting for other characteristics.
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Affiliation(s)
- Charles Begley
- Department of Management, Policy, and Community Health, University of Texas School of Public Health, Houston, United States.
| | - Ross Shegog
- Department of Health Promotion and Behavioral Science, University of Texas School of Public Health, Houston, United States
| | - Hongyan Liu
- Department of Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Curtis Tatsuoka
- Department of Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Tanya M Spruill
- Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Daniel Friedman
- Department of Neurology, New York University School of Medicine, New York, NY, United States
| | - Robert T Fraser
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Erica K Johnson
- Health Promotion Research Center, University of Washington, Seattle, WA, United States
| | - Yvan A Bamps
- Department of Neurosurgery, School of Medicine Emory University, United States
| | - Martha Sajatovic
- Department of Psychiatry & of Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center University Hospitals Cleveland Medical Center, Cleveland, OH, United States
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Tao L, Zhang X, Duan Z, Wang Y, Liu J, Hou H, Fang Q. Sexual dysfunction and associated factors in Chinese Han women with epilepsy. Epilepsy Behav 2018; 85:150-156. [PMID: 29940378 DOI: 10.1016/j.yebeh.2018.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/28/2018] [Accepted: 06/01/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Women with epilepsy (WWE) are believed to be at risk of sexual dysfunction (SD) and face many sexual challenges because of multiple factors. This study aimed to assess the factors associated with SD in Chinese Han WWE. METHODS This cross-sectional study examined 112 married WWE in the Affiliated Hospital of Yangzhou University with focal (FE) or generalized epilepsy (GE) on antiepileptic drugs (AEDs), and 120 healthy controls without epilepsy, all of Chinese Han nationality. Data collection tools included the Chinese version of Female Sexual Function Index (FSFI), the Chinese version of Zung Self-Rating Anxiety Scale (SAS), the Chinese version of the Zung Self-Rating Depression Scale (SDS), the Chinese version of the revised Morisky Medication Adherence Scale (MMAS-8), and the Chinese version of the National Hospital Seizure Severity Scale (NHS3). Chi-square test, t-test, one-way analysis of variance (ANOVA), and binary logistic regression were used for statistical analysis. RESULTS A high rate (70.5%) of SD was detected in WWE, with 24.2% in controls. Sexual dysfunction affected all dimensions: desire (85.7%), arousal (56.3%), lubrication (47.3%), orgasm (66.1%), satisfaction (58.9%), and pain (41.1%). Elevated rates of anxiety (40.2%) and depression (33%) and poor medication adherence (31.3%) were also found in WWE. Binary logistic regression found that poor economic status (odds ratio (OR) = 13.904, 95% confidence interval (CI): 2.025-95.472, P = 0.007 and OR = 6.350, 95% CI: 1.323-30.477, P = 0.021), anxiety (OR = 1.222, 95% CI: 1.055-1.415, P = 0.007), and poor medication adherence (OR = 0.297, 95% CI: 0.124-0.707, P = 0.006) were associated with SD. CONCLUSIONS The associated factors of SD in Chinese Han WWE are multifactorial. The WWE have higher levels of anxiety, poor family economic status, and poor medication adherence. Medical professionals should not only better control seizures but also evaluate and improve patients' sexual function so as to improve the quality of life of WWE.
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Affiliation(s)
- Lihong Tao
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu 215006, China; Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Xinjiang Zhang
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Zuowei Duan
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Yingge Wang
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Jiangbing Liu
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Hongling Hou
- Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225012, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, Jiangsu 215006, China.
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Ernawati I, Islamiyah WR, Sumarno. How to Improve Clinical Outcome of Epileptic Seizure Control Based on Medication Adherence? A Literature Review. Open Access Maced J Med Sci 2018; 6:1174-1179. [PMID: 29983823 PMCID: PMC6026415 DOI: 10.3889/oamjms.2018.235] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/11/2018] [Accepted: 05/19/2018] [Indexed: 11/09/2022] Open
Abstract
Anti-Epileptic Drugs (AEDs) are the main therapy for epilepsy to prevent seizures. Non-adherence situation plays an important factor in the failure of seizure control. Such a condition may generate several impacts on clinical, social, and economic aspect. Several methods are used to measure adherence in epilepsy patients, including direct and indirect measurement. The direct measure involves measurement of drug levels in hair or body fluids such as blood and saliva. Whereas, indirect measure involves the non-biological tools, for example, a self-report measure, pill counts, appointment attendance, medication refills, and seizure frequency. Numerous factors may affect adherence in epilepsy patients, such as age, sex, and seizure aetiology, seizure sites, which are categorised as irreversible factors and hardly to be improved. However, there are factors that can be influenced to improve adherence such as patient knowledge, medication, cultural, health care professionals, and national health policies, which are related to treatment and education factor which is associated with behaviour to be likely adherence.
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Affiliation(s)
- Iin Ernawati
- Faculty of Pharmacy, Airlangga University, Gubeng, Surabaya, East Java, Indonesia
| | | | - Sumarno
- Department of Clinical Pharmacy, Faculty of Pharmacy, Airlangga University, Gubeng, Surabaya, East Java, Indonesia
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Abstract
Adherence to medications is dependent upon a variety of factors, including individual characteristics of the patient, the patient's family and culture, interactions with healthcare providers, and the healthcare system itself. Because of its association with worse outcomes, poor medication adherence is considered a potential contributor to disparities in health outcomes observed for various conditions across racial and ethnic groups. While there are no simple answers, it is clear that patient, provider, cultural, historical, and healthcare system factors all play a role in patterns of medication use. Here, we provide an overview of the interface between culture and medication adherence for chronic conditions; discuss medication adherence in the context of observed health disparities; provide examples of cultural issues in medication adherence at the individual, family, and healthcare system/provider level; review potential interventions to address cultural issues in medication use; and provide recommendations for future work.
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Abstract
Adherence to medications is dependent upon a variety of factors, including individual characteristics of the patient, the patient's family and culture, interactions with healthcare providers, and the healthcare system itself. Because of its association with worse outcomes, poor medication adherence is considered a potential contributor to disparities in health outcomes observed for various conditions across racial and ethnic groups. While there are no simple answers, it is clear that patient, provider, cultural, historical, and healthcare system factors all play a role in patterns of medication use. Here, we provide an overview of the interface between culture and medication adherence for chronic conditions; discuss medication adherence in the context of observed health disparities; provide examples of cultural issues in medication adherence at the individual, family, and healthcare system/provider level; review potential interventions to address cultural issues in medication use; and provide recommendations for future work.
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Affiliation(s)
- Elizabeth L McQuaid
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA.
- Department of Pediatrics, Alpert Medical School, Brown University, Providence, RI, USA.
- Bradley/Hasbro Children's Research Center, 1 Hoppin Street, Providence, RI, USA.
| | - Wendy Landier
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Farrukh MJ, Makmor-Bakry M, Hatah E, Tan HJ. Use of complementary and alternative medicine and adherence to antiepileptic drug therapy among epilepsy patients: a systematic review. Patient Prefer Adherence 2018; 12:2111-2121. [PMID: 30349205 PMCID: PMC6188960 DOI: 10.2147/ppa.s179031] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To identify the use pattern of complementary and alternative medicine (CAM) and its impact on antiepileptic drug (AED) adherence among patients with epilepsy. METHOD Potential studies were identified through a systematic search of Scopus, Science Direct, Google Scholar, and PubMed. The keywords used to identify relevant articles were "adherence," "AED," "epilepsy," "non-adherence," and "complementary and alternative medicine." An article was included in the review if the study met the following criteria: 1) conducted in epilepsy patients, 2) conducted in patients aged 18 years and above, 3) conducted in patients prescribed AEDs, and 4) patients' adherence to AEDs. RESULTS A total of 3,330 studies were identified and 30 were included in the final analysis. The review found that the AED non-adherence rate reported in the studies was between 25% and 66%. The percentage of CAM use was found to be between 7.5% and 73.3%. The most common reason for inadequate AED therapy and higher dependence on CAM was the patients' belief that epilepsy had a spiritual or psychological cause, rather than primarily being a disease of the brain. Other factors for AED non-adherence were forgetfulness, specific beliefs about medications, depression, uncontrolled recent seizures, and frequent medication dosage. CONCLUSION The review found a high prevalence of CAM use and non-adherence to AEDs among epilepsy patients. However, a limited number of studies have investigated the association between CAM usage and AED adherence. Future studies may wish to explore the influence of CAM use on AED medication adherence.
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Affiliation(s)
| | - Mohd Makmor-Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia,
| | - Ernieda Hatah
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia,
| | - Hui Jan Tan
- Faculty of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
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Wang S, Chen C, Jin B, Yang L, Ding Y, Guo Y, Chen Y, Wang S, Ding M. The association of psychosocial variables with adherence to antiepileptic drugs in patients with temporal lobe epilepsy. Epilepsy Behav 2017; 77:39-43. [PMID: 29107200 DOI: 10.1016/j.yebeh.2017.09.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/15/2017] [Accepted: 09/22/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The aim of this study was to explore the association between psychosocial factors and adherence to antiepileptic drugs (AEDs) in patients with temporal lobe epilepsy (TLE). METHODS This cross-sectional study was conducted with 123 individuals with TLE, admitted to our epilepsy center from December 2015 to May 2017. The participants completed standardized self-report questionnaires measuring medication adherence, anxiety, depression, and family and social support. Adherence was measured by the 8-item Morisky Medication Adherence Scale (MMAS), and logistic regression was used to examine statistically significant associations of different variables with adherence. RESULTS We found a 33.3% rate of poor AED adherence. Moderate-to-severe anxiety (odds ratio (OR)=2.851, 95% confidence interval (CI)=1.138-7.144, P=0.025) and the presence of hippocampal sclerosis (OR=3.098, 95% CI=1.259-7.620, P=0.014) were positively associated with poor adherence to antiepileptic drugs. Social support (OR=0.925, 95% CI=0.863-0.990, P=0.025) was negatively associated with poor adherence. Neither depression nor family support was associated with adherence. CONCLUSION One-third of patients with TLE were prone to poor AED adherence, especially individuals with hippocampal sclerosis. Intervention approaches designed to improve AED adherence in patients with TLE should focus on psychosocial factors.
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Affiliation(s)
- Shan Wang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Cong Chen
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bo Jin
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Linglin Yang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yao Ding
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yi Guo
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yi Chen
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuang Wang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Meiping Ding
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Josephson CB, Gonzalez-Izquierdo A, Denaxas S, Fitzpatrick NK, Sajobi TT, Engbers JDT, Patten S, Jette N, Wiebe S. Serotonin reuptake inhibitors and mortality in epilepsy: A linked primary-care cohort study. Epilepsia 2017; 58:2002-2009. [PMID: 28944447 DOI: 10.1111/epi.13904] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Preliminary evidence suggests that serotonin reuptake inhibitor (SRI) use may increase postictal respiratory drive and prevent death. We sought to determine whether SRIs are associated with improved all-cause and possible seizure-specific mortality in patients with epilepsy. METHODS Patients with epilepsy and a random 10:1 sample without epilepsy were extracted from The ClinicAl research using LInked Bespoke studies and Electronic health Records (CALIBER) resource. The hazard ratio (HR) of all-cause and possible seizure-specific mortality, treating SRI use as a time-varying covariate, was determined using the date of a second SRI prescription as exposure and in discrete 6-month periods over the entire duration of follow-up. We used Cox regression and competing risk models with Firth correction to calculate the HR. We controlled for age, sex, depression, comorbidity, (Charlson comorbidity index) and socioeconomic status (Index of Multiple Deprivation). RESULTS We identified 2,718,952 eligible patients in CALIBER, of whom 16,379 (0.60%) had epilepsy. Median age and follow-up were 44 (interquartile range [IQR] 29-61]) and 6.4 years (IQR 2.4-10.4 years), respectively, and 53% were female. A total of 2,178 patients (13%) had at least two SRI prescriptions. Hazard of all-cause mortality was significantly elevated following a second prescription for an SRI (HR 1.64 95% confidence interval [95% CI] 1.44-1.86; p < 0.001). The HR was similar in 163,778 age, sex, and general practitioner (GP) practice-matched controls without epilepsy. Exposure to an SRI was not associated with seizure-related death (HR 1.08, 95% CI 0.59-1.97; 0.796). SIGNIFICANCE There is no evidence in this large population-based cohort that SRIs protect against all-cause mortality or seizure-specific mortality. Rather, SRI use was associated with increased mortality, irrespective of epilepsy, which is probably due to various factors associated with the use of antidepressants. Larger studies with systematically collected clinical data are needed to shed further light on these findings.
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Affiliation(s)
- Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Arturo Gonzalez-Izquierdo
- Farr Institute of Health Informatics Research, London, United Kingdom.,Institute of Health Informatics, University College London, London, United Kingdom
| | - Spiros Denaxas
- Farr Institute of Health Informatics Research, London, United Kingdom.,Institute of Health Informatics, University College London, London, United Kingdom
| | - Natalie K Fitzpatrick
- Farr Institute of Health Informatics Research, London, United Kingdom.,Institute of Health Informatics, University College London, London, United Kingdom
| | - Tolulope T Sajobi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.,Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Scott Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Nathalie Jette
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.,Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Chinnaiyan S, Narayana S, Nanjappa VP. Adherence to Antiepileptic Therapy in Adults. J Neurosci Rural Pract 2017; 8:417-420. [PMID: 28694623 PMCID: PMC5488564 DOI: 10.4103/jnrp.jnrp_392_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Epilepsy is a neurological disorder affecting 70 million worldwide. The high incidence of relapse can be attributed to nonadherence, thus increasing the incidence of refractory epilepsy to 10%-20%. AIMS This study was planned to determine rate of adherence and factors affecting adherence using Antiepileptic Adherence Questionnaire and Baseline Adherence Questionnaire. MATERIALS AND METHODS A cross-sectional, questionnaire-based study was carried out at a rural hospital from May to September 2015. Patients of either gender aged 18-60 years, diagnosed with epilepsy were interviewed after they consented. Patient details, responses to questionnaires were collected and analyzed using descriptive statistics. RESULTS Among the participants, 67.8% were males and 32.2% were females with the mean age of 38.3 ± 13.9 years. The response rate was 75% (90/120). The majority were literate (64.4%) and employed (58.9%). The duration of disease was <5 years in most individuals; 50% were highly, 21.1% moderately, and 28.9% nonadherent to treatment. Among the highly adherent, 66.7% never skipped medications because they had knowledge of the disease and treatment. More than 97% were satisfied with the social support, and 89% expressed that their family and friends reminded them to take medications. Patients who were nonadherent to treatment attributed it to the lack of knowledge of the disease (57%) and treatment (96%). Reasons for nonadherence were patients assumed drug was harmful, felt cured of the disease, and wanted to avoid side effects. CONCLUSION Nearly, 70% expressed the lack of satisfactory support from the social circle. We observed that nearly seventy percent epileptic patients were moderate-highly adherent. Nonadherence was attributed to patient feeling cured of disease and assuming medications to be harmful. Counseling of patients will help in adherence to treatment.
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Affiliation(s)
- Sowmya Chinnaiyan
- Department of Pharmacology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
| | - Sarala Narayana
- Department of Pharmacology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
| | - Venkatarathnamma Puttappa Nanjappa
- Department of Medicine, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
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Ebong IM, Lopez MR, Kanner AM, Wallace DM. The relationship between mood disorder and insomnia depends on race in US veterans with epilepsy. Epilepsy Behav 2017; 70:80-86. [PMID: 28411520 DOI: 10.1016/j.yebeh.2017.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/02/2017] [Indexed: 01/29/2023]
Abstract
PURPOSE Few data exist on race, medical/psychiatric comorbidities, and insomnia symptoms in US veterans with epilepsy. Our aims were to examine 1) whether insomnia symptom prevalence was different between Black and White veterans and 2) whether predictors of insomnia symptoms varied by race. METHODS This retrospective, cross-sectional study included veterans evaluated in an epilepsy clinic over the course of 1.5years. Individuals completed standardized assessments for epilepsy and sleep complaints. Insomnia criteria were met by 1) report of difficulty with sleep initiation, maintenance, or premature awakenings accompanied by daytime impairment or 2) sedative-hypnotic use on most days of the month. Demographics, medical/psychiatric comorbidities, and medications were determined per electronic medical record review. Hierarchical multivariable logistic regression analyses were performed to determine if race, medical/mental health comorbidities, and the potential interaction of race with each comorbid condition were associated with insomnia. RESULTS Our sample consisted of 165 veterans (32% Black). The unadjusted prevalence of insomnia was not different between Black and White veterans (42% vs 39%, p=0.68). In adjusted analyses, the association between mood disorder and insomnia varied by race. Depressed White veterans had over 11-times higher predicted odds of insomnia (OR 11.4, p<0.001) than non-depressed White veterans, while depressed Black veterans had 4-times higher predicted odds of insomnia (OR 4.1, p=0.06) than non-depressed Black veterans. Although mood disorder diagnosis was associated with insomnia for both racial groups, White veterans had a stronger association between mood disorder diagnosis and insomnia than Black veterans. CONCLUSIONS The relationship between mood disorder diagnosis and insomnia was stronger for White than Black veterans with epilepsy. Future studies are needed to explore mental health symptoms and psychosocial determinants of insomnia with larger samples of minority individuals with epilepsy.
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Affiliation(s)
- Ima M Ebong
- Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, United States; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Maria R Lopez
- Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, United States; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Andres M Kanner
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Douglas M Wallace
- Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, United States; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States.
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DIY CBT for Comorbidities in Epilepsy. Epilepsy Curr 2017; 17:144-146. [DOI: 10.5698/1535-7511.17.3.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Sajatovic M, Tatsuoka C, Welter E, Friedman D, Spruill TM, Stoll S, Sahoo SS, Bukach A, Bamps YA, Valdez J, Jobst BC. Correlates of quality of life among individuals with epilepsy enrolled in self-management research: From the US Centers for Disease Control and Prevention Managing Epilepsy Well Network. Epilepsy Behav 2017; 69:177-180. [PMID: 28139451 PMCID: PMC6205501 DOI: 10.1016/j.yebeh.2016.12.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/12/2016] [Indexed: 11/29/2022]
Abstract
RATIONALE Epilepsy is a chronic neurological condition that causes substantial burden on patients and families. Quality of life may be reduced due to the stress of coping with epilepsy. For nearly a decade, the Centers for Disease Control (CDC) Prevention Research Center's Managing Epilepsy Well (MEW) Network has been conducting research on epilepsy self-management to address research and practice gaps. Studies have been conducted by independent centers across the U.S. Recently, the MEW Network sites, collaboratively, began compiling an integrated database to facilitate aggregate secondary analysis of completed and ongoing studies. In this preliminary analysis, correlates of quality of life in people with epilepsy (PWE) were analyzed from pooled baseline data from the MEW Network. METHODS For this analysis, data originated from 6 epilepsy studies conducted across 4 research sites and comprised 459 PWE. Descriptive comparisons assessed common data elements that included gender, age, ethnicity, race, education, employment, income, seizure frequency, quality of life, and depression. Standardized rating scales were used for quality of life (QOLIE-10) and for depression (Patient Health Questionnaire, PHQ-9). RESULTS While not all datasets included all common data elements, baseline descriptive analysis found a mean age of 42 (SD 13.22), 289 women (63.0%), 59 African Americans (13.7%), and 58 Hispanics (18.5%). Most, 422 (92.8%), completed at least high school, while 169 (61.7%) were unmarried, divorced/separated, or widowed. Median 30-day seizure frequency was 0.71 (range 0-308). Depression at baseline was common, with a mean PHQ-9 score of 8.32 (SD 6.04); 69 (29.0%) had depression in the mild range (PHQ-9 score 5-9) and 92 (38.7%) had depression in the moderate to severe range (PHQ-9 score >9). Lower baseline quality of life was associated with greater depressive severity (p<.001), more frequent seizures (p<.04) and lower income (p<.05). CONCLUSIONS The MEW Network Integrated Database offers a unique opportunity for secondary analysis of data from multiple community-based epilepsy research studies. While findings must be tempered by potential sample bias, i.e. a relative under-representation of men and relatively small sample of some racial/ethnic subgroups, results of analyses derived from this first integrated epilepsy self-management database have potential to be useful to the field. Associations between depression severity and lower QOL in PWE are consistent with previous studies derived from clinical samples. Self-management efforts that focus on mental health comorbidity and seizure control may be one way to address modifiable factors that affect quality of life in PWE.
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Affiliation(s)
- Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Department of Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
| | - Curtis Tatsuoka
- Department of Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Elisabeth Welter
- Department of Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Daniel Friedman
- Department of Neurology, New York University School of Medicine, New York, New York
| | - Tanya M. Spruill
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Shelley Stoll
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, Michigan
| | - Satya S. Sahoo
- Department of Epidemiology and Biostatistics, of Neurology, & of Electrical Engineering and Computer Science Department, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Ashley Bukach
- Department of Psychiatry and Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Yvan A. Bamps
- Senior Research Project Coordinator, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Joshua Valdez
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Barbara C. Jobst
- Professor, Department of Neurology, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, New Hampshire
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Adherence to antiepileptic drugs among diverse older Americans on Part D Medicare. Epilepsy Behav 2017; 66:68-73. [PMID: 28038389 PMCID: PMC5297256 DOI: 10.1016/j.yebeh.2016.10.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Older minority groups are more likely to have poor AED adherence. We describe adherence to antiepileptic drugs (AEDs) among older Americans with epilepsy. METHODS In retrospective analyses of 2008-2010 Medicare claims for a 5% random sample of beneficiaries augmented by minority representation, epilepsy cases in 2009 were those with ≥1 claim with ICD-9345.x or ≥2 with 780.3x, and ≥1 AED. New-onset cases had no such claims or AEDs in the year before the 2009 index event. We calculated the Proportion of Days Covered (PDC) (days with ≥1 AED over total follow-up days) and used logistic regression to estimate associations of non-adherence (PDC <0.8) with minority group adjusting for covariates. RESULTS Of 36,912 epilepsy cases (19.2% White, 62.5% African American (AA), 11.3% Hispanic, 5.0% Asian and 2% American Indian/Alaskan Native), 31.8% were non-adherent (range: 24.1% Whites to 34.3% AAs). Of 3706 new-onset cases, 37% were non-adherent (range: 28.7% Whites to 40.5% AAs). In adjusted analyses, associations with minority group were significant among prevalent cases, and for AA and Asians vs. Whites among new cases. Among other findings, beneficiaries from high-poverty ZIP codes were more likely to be non-adherent than their counterparts, and those in cost-sharing drug benefit phases were less likely to be non-adherent than those in deductible phases. CONCLUSION About a third of older adults with epilepsy have poor AED adherence; minorities are more likely than Whites. Investigations of reasons for non-adherence, and interventions to promote adherence, are needed with particular attention to the effect of cost-sharing and poverty.
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O' Rourke G, O' Brien JJ. Identifying the barriers to antiepileptic drug adherence among adults with epilepsy. Seizure 2016; 45:160-168. [PMID: 28063375 DOI: 10.1016/j.seizure.2016.12.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/07/2016] [Accepted: 12/11/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To identify the barriers to antiepileptic drug (AED) adherence among adults with epilepsy (AWE). The impact of AED non-adherence on quality of life (QoL) was also examined. METHOD Systematic design (SR) study. A search strategy was undertaken with no time limits, for articles published in English, in MEDLINE, CINANL, PsycINFO, EMBASE, Cochrane databases and grey literature sources. Eligibility criteria included participants with epilepsy over 18 years, who were prescribed AEDs. Adherence had to be defined and adherence assessment measurements identified. A screening process was undertaken to select eligible studies. Eight studies met the inclusion criteria and were included in a quantitative synthesis. Quality of evidence was conducted using the EBL critical appraisal checklist and assessing risk of bias within individual studies. RESULTS Across the included studies a high prevalence of non-adherence was identified. AED non-adherence was associated with specific beliefs about medications, being depressed or anxious, poor medication self-administration management, uncontrolled recent seizures, frequent medication dosage times, poor physician-patient relationship and perceived social support. Additionally, AED non-adherence impacted negatively on QoL as a result of poor seizure control. CONCLUSION Although included studies were of good quality, risk of biases reduced the generalisability of results. Findings suggested that comprehensive adherence assessments should routinely be performed. Recommendations for future research include the use of longitudinal research designs and a follow up SR to include the 16-18-year-old population.
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Antiepileptic Drug Nonadherence and Its Predictors among People with Epilepsy. Behav Neurol 2016; 2016:3189108. [PMID: 28053370 PMCID: PMC5178347 DOI: 10.1155/2016/3189108] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/16/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction. Antiepileptic drugs are effective in the treatment of epilepsy to the extent that about 70% of people with epilepsy can be seizure-free, but poor adherence to medication is major problem to sustained remission and functional restoration. The aim of this study was to assess the prevalence and associated factors of antiepileptic drug nonadherence. Methods. Cross-sectional study was conducted on 450 individuals who were selected by systematic random sampling method. Antiepileptic drug nonadherence was measured by Morisky Medication Adherence Scale (MMAS) and logistic regression was used to look for significant associations. Result. The prevalence of AEDs nonadherence was 37.8%. Being on treatment for 6 years and above [AOR = 3.47, 95% CI: 1.88, 6.40], payment for AEDs [AOR = 2.76, 95% CI: 1.73, 4.42], lack of health information [AOR = 2.20, 95% CI: 1.41,3.43], poor social support [AOR = 1.88, 95%, CI: 1.01, 3.50], perceived stigma [AOR = 2.27, 95% CI: 1.45, 3.56], and experience side effect [AOR = 1.70, 95% CI: 1.06, 2.72] were significantly associated with antiepileptic drug nonadherence. Conclusion. More than one-third of people with epilepsy were not compliant with their AEDs. Giving health information about epilepsy and its management and consequent reduction in stigma will help for medication adherence.
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Moura LM, Schwamm EL, Moura Junior V, Seitz MP, Hoch DB, Hsu J, Schwamm LH. Patient-reported financial barriers to adherence to treatment in neurology. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:685-694. [PMID: 27895506 PMCID: PMC5117903 DOI: 10.2147/ceor.s119971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective Many effective medical therapies are available for treating neurological diseases, but these therapies tend to be expensive and adherence is critical to their effectiveness. We used patient-reported data to examine the frequency and determinants of financial barriers to medication adherence among individuals treated for neurological disorders. Patients and methods Patients completed cross-sectional surveys on iPads as part of routine outpatient care in a neurology clinic. Survey responses from a 3-month period were collected and merged with administrative sources of demographic and clinical information (eg, insurance type). We explored the association between patient characteristics and patient-reported failure to refill prescription medication due to cost in the previous 12 months, termed here as “nonadherence”. Results The population studied comprised 6075 adults who were presented between July and September 2015 for outpatient neurology appointments. The mean age of participants was 56 (standard deviation: 18) years, and 1613 (54%) were females. The patients who participated in the surveys (2992, 49%) were comparable to nonparticipants with respect to gender and ethnicity but more often identified English as their preferred language (94% vs 6%, p<0.01). Among respondents, 9.8% (n=265) reported nonadherence that varied by condition. These patients were more frequently Hispanic (16.7% vs 9.8% white, p=0.01), living alone (13.9% vs 8.9% cohabitating, p<0.01), and preferred a language other than English (15.3% vs 9.4%, p=0.02). Conclusion Overall, the magnitude of financial barriers to medication adherence appears to vary across neurological conditions and demographic characteristics.
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Affiliation(s)
| | | | | | | | | | - John Hsu
- Mongan Institute for Health Policy, Massachusetts General Hospital; Department of Medicine and Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Treatment non-adherence in pseudo-refractory epilepsy. Epilepsy Res 2016; 122:1-6. [DOI: 10.1016/j.eplepsyres.2016.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 12/10/2015] [Accepted: 02/02/2016] [Indexed: 01/16/2023]
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Guo Y, Ding XY, Lu RY, Shen CH, Ding Y, Wang S, Tang YL, Ding MP. Depression and anxiety are associated with reduced antiepileptic drug adherence in Chinese patients. Epilepsy Behav 2015. [PMID: 26209942 DOI: 10.1016/j.yebeh.2015.06.042] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the association of depression and anxiety with adherence to antiepileptic drugs (AEDs) in Chinese patients with epilepsy. METHODS A total of 184 Chinese patients with epilepsy, and without cognitive impairment, underwent psychometric tests: the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Adherence to antiepileptic drugs was measured by the eight-item Morisky Medication Adherence Scale (MMAS-8). Data on patients' demographic characteristics, disease characteristics, and treatment characteristics were also collected. RESULTS The MMAS-8 indicated that 39.7% of the patients had low adherence, 34.2% had moderate adherence, and 26.1% had high adherence. Demographic, disease, and treatment characteristics were not significantly different between the low adherence group and the moderate-to-high adherence group. Thirty-six (19.6%) patients had moderate-to-severe depression according to the BDI, and 47 (25.5%) patients were considered anxious according to the BAI. A significant difference in depression scores was found between the low adherence group and the moderate-to-high adherence group (χ(2)=13.625, P<0.001). We also found a significant difference in anxiety scores between the two groups (χ(2)=8.331, P=0.004). Pearson's correlations indicated that depression scores (r=-0.281, P<0.001) and anxiety scores (r=-0.255, P<0.001) were negatively correlated with adherence. Negative correlations were found between BDI scores and items 2, 7, and 8 of the MMAS-8 (P<0.05); negative correlations were also found between BAI scores and items 3 and 6-8 (P<0.05). CONCLUSION Depression and anxiety were associated with reduced antiepileptic drug adherence in Chinese patients. Addressing depression and anxiety among patients with epilepsy may help improve adherence to AEDs.
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Affiliation(s)
- Yi Guo
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiao-Yan Ding
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ru-Yi Lu
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chun-Hong Shen
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yao Ding
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuang Wang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ye-Lei Tang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Mei-Ping Ding
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Chapman SCE, Horne R, Eade R, Balestrini S, Rush J, Sisodiya SM. Applying a perceptions and practicalities approach to understanding nonadherence to antiepileptic drugs. Epilepsia 2015. [PMID: 26215092 DOI: 10.1111/epi.13097] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Nonadherence to antiepileptic drugs (AEDs) is a common cause of poor seizure control. This study examines whether reported adherence to AEDs is related to variables identified in the National Institute for Health and Clinical Excellence (NICE) Medicines Adherence Guidelines as being important to adherence: perceptual factors (AED necessity beliefs and concerns), practical factors (limitations in capability and resources), and perceptions of involvement in treatment decisions. METHODS This was a cross-sectional study of people with epilepsy receiving AEDs. Participants completed an online survey hosted by the Epilepsy Society (n = 1,010), or as an audit during inpatient admission (n = 118). Validated questionnaires, adapted for epilepsy, assessed reported adherence to AEDs (Medication Adherence Report Scale [MARS]), perceptions of AEDs (Beliefs about Medicines Questionnaire [BMQ]), and patient perceptions of involvement in treatment decisions (Treatment Empowerment Scale [TES]). RESULTS Low adherence was related to AED beliefs (doubts about necessity: t(577) = 3.90, p < 0.001; and concerns: t(995) = 3.45, p = 0.001), reported limitations in capability and resources (t(589) = 7.78, p < 0.001), and to perceptions of a lack of involvement in treatment decisions (t(623) = 4.48, p < 0.001). In multiple logistic regression analyses, these factors significantly (p < 0.001) increased variance in reported adherence, above that which could be explained by age and clinical variables (seizure frequency, type, epilepsy duration, number of AEDs prescribed). SIGNIFICANCE Variables identified in the NICE Medicines Adherence Guidelines as potentially important factors for adherence were found to be related to adherence to AEDs. These factors are potentially modifiable. Interventions to support optimal adherence to AEDs should be tailored to address doubts about AED necessity and concerns about harm, and to overcome practical difficulties, while engaging patients in treatment decisions.
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Affiliation(s)
- Sarah C E Chapman
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, United Kingdom
| | - Rob Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, United Kingdom
| | - Rona Eade
- Epilepsy Society, Chalfont St. Peter, Bucks, United Kingdom
| | - Simona Balestrini
- Epilepsy Society, Chalfont St. Peter, Bucks, United Kingdom.,Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom.,Neuroscience Department, Polytechnic University of Marche, Ancona, Italy
| | - Jennifer Rush
- Epilepsy Society, Chalfont St. Peter, Bucks, United Kingdom
| | - Sanjay M Sisodiya
- Epilepsy Society, Chalfont St. Peter, Bucks, United Kingdom.,Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom
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