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Bosveld MH, Smits AGM, Mertens HJMM, Zandvoort MJJMV, Mook WNKAV, Bokhoven MAV. Patients and informal caregivers in the lead: a qualitative study on the experiences of patients, informal caregivers, and healthcare professionals with involvement in treatment, e-health and self-management programs. BMC Health Serv Res 2024; 24:713. [PMID: 38858686 PMCID: PMC11165740 DOI: 10.1186/s12913-024-11156-z] [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: 01/03/2024] [Accepted: 05/31/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND A significant proportion of patients and informal caregivers favor an active role in decisions concerning their health. Simultaneously, governments aim to shift treatment from a professional care setting to a community setting, in light of an ageing population, a decreasing number of health workers and allocation of scarce resources. This transition of care solicits patients' and informal caregivers' ability to self-manage. Therefore, the Maastricht University Medical Centre + has established the Academy for Patients and Informal caregivers. The aim is to proactively and professionally support patients and their informal caregivers to enhance their self-management. For that, the Academy offers activities in three categories: (1) instruction of nursing techniques, (2) training of e-health competencies and (3) the provision of self-management programs. Both patients with an episodic care need, as well as patients and informal caregivers with chronic illness, are eligible to participate in the Academy's activities. However, little is known about the experience of these interventions from the perspective of patients, informal caregivers and healthcare professionals. METHODS We conducted semi-structured interviews with 15 patients, 8 informal caregivers and 19 health care professionals who either participated in, referred to or received patients from the Academy. Topics revolved around self-management and the Quadruple aim, covering topics such as patient experiences, healthcare costs, health and well-being of the population and improving work life for health professionals. Data were analyzed using thematic analysis. RESULTS Patients and caregivers experienced an increase in the ability to manage health needs independently, leading to increased mental well-being and self-efficacy. They felt recognized as partners in care, although managing illness needs came with its own burdens. Health care professionals indicated that they felt assured of the quality, uniformity and availability of activities due to its central organization, with instruction nurses finding greater meaning in their work. On the level of health care systems, participants in this study mentioned a decrease in use of formal healthcare, whilst enabling a more equitable division of care. CONCLUSION Stakeholders' experiences with the Academy for Patients and Informal caregivers indicate that participation contributes to development of self-management, whilst also improving working conditions, reducing the appeal to formal care and advancing equity in healthcare. The burden for patients and informal caregivers is to be considered in future developments.
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Affiliation(s)
- Matthijs H Bosveld
- Care and Public Health Research Institute (CAPHRI; department of Family Medicine), Maastricht University, Maastricht, The Netherlands.
- School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
| | - Anne G M Smits
- Care and Public Health Research Institute (CAPHRI; department of Family Medicine), Maastricht University, Maastricht, The Netherlands
| | - Helena J M M Mertens
- Maastricht University Medical Centre+ (board of directors), Maastricht, The Netherlands
| | | | - Walther N K A van Mook
- Maastricht University Medical Centre+ (department of Intensive Care), School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Marloes A van Bokhoven
- Care and Public Health Research Institute (CAPHRI; department of Family Medicine), Maastricht University, Maastricht, The Netherlands
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Long L, Reynolds SS, Lewis LS, Webb MA, Epley C, Maturu S. Evaluation of a Seizure Action Plan in an Adult Epilepsy Center. Neurol Clin Pract 2024; 14:e200275. [PMID: 38586237 PMCID: PMC10997209 DOI: 10.1212/cpj.0000000000200275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/10/2024] [Indexed: 04/09/2024]
Abstract
Background Seizure action plans (SAPs) provide valuable information for patients to manage seizure emergencies, but are underutilized in adult epilepsy centers. The purpose of this project was to implement a structured SAP for adult patients with epilepsy. Methods A pre/postimplementation design was used. Provider SAP utilization rates were analyzed over a 16-week period. A pre and postimplementation survey assessed participant perceived impact of the SAP on knowledge and comfort associated with managing seizure emergencies. Provider barriers and facilitators were also assessed. Results Average provider SAP utilization rate was 51.45%. A total of 204 participants completed the surveys, which showed a significant increase in knowledge and comfort for all items, p < 0.001. At postsurvey analysis, 98% of participants felt that all patients with epilepsy should have a SAP regardless of seizure burden. Discussion Implementing a structured SAP increased provider utilization and patient and care partner knowledge and comfort of managing seizure emergencies.
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Affiliation(s)
- Lucretia Long
- The Ohio State University Wexner Medical Center (LL, CE, SM), Columbus; Duke University (RSS, LSL, MAW), Durham, NC
| | - Staci S Reynolds
- The Ohio State University Wexner Medical Center (LL, CE, SM), Columbus; Duke University (RSS, LSL, MAW), Durham, NC
| | - Lisa S Lewis
- The Ohio State University Wexner Medical Center (LL, CE, SM), Columbus; Duke University (RSS, LSL, MAW), Durham, NC
| | - Michelle A Webb
- The Ohio State University Wexner Medical Center (LL, CE, SM), Columbus; Duke University (RSS, LSL, MAW), Durham, NC
| | - Crystal Epley
- The Ohio State University Wexner Medical Center (LL, CE, SM), Columbus; Duke University (RSS, LSL, MAW), Durham, NC
| | - Sarita Maturu
- The Ohio State University Wexner Medical Center (LL, CE, SM), Columbus; Duke University (RSS, LSL, MAW), Durham, NC
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Al-Aqeel S. Nonadherence to antiseizure medications: what have we learned and what can be done next? Expert Rev Pharmacoecon Outcomes Res 2024:1-8. [PMID: 38676921 DOI: 10.1080/14737167.2024.2349191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/25/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Nonadherence to antiseizure medications (ASMs) is associated with increased mortality, morbidity, health care utilization, and costs. AREAS COVERED This article reviewed 18 randomized controlled trials published between Jan 2010 and Feb 2024 on Medication Adherence Enhancing Intervention (MAEI) for people with epilepsy. The adequacy of reporting intervention development process was assessed using the GUIDance for the rEporting of intervention Development (GUIDED). The adequacy of the intervention description was assessed using the Template for Intervention Description and Replication (TIDieR) checklist. The interventions were categorized as educational (n = 7), behavioral (n = 5), or mixed (n = 6). The impact of MAEIs on adherence is mixed with majority of studies either reporting no difference between intervention and control groups (n = 6) or improvement in the intervention group (n = 7). The shortcomings in the reporting of MAEIs development, MAEIs description, and MAEIs impact measurement were discussed. EXPERT OPINION Future research needs to accomplish the following tasks: 1) develop and test valid epilepsy-specific self-report measures for assessing adherence; 2) optimize intervention design; and 3) increase transparency in reporting all stages of research.
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Affiliation(s)
- Sinaa Al-Aqeel
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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4
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Goh SL, Harding KE, Lewis AK, Taylor NF, Carney PW. Self-management strategies for people with epilepsy: An overview of reviews. Epilepsy Behav 2024; 150:109569. [PMID: 38071829 DOI: 10.1016/j.yebeh.2023.109569] [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: 08/07/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE This overview of systematic reviews aimed to appraise evidence regarding self-management strategies on health-related quality of life, self-efficacy, medication compliance, seizure status and psychosocial outcomes compared to usual care for people with epilepsy. METHODS Databases were searched until September 2022 using MeSH terms included OVID Medline, Embase and Cochrane. Following application of eligibility criteria, data were extracted and quality of articles was assessed using the AMSTAR2 checklist. A narrative synthesis of evidence included certainty of evidence evaluated using a Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS The 12 selected reviews contained three meta-analyses and 91 unique primary studies. One review considered only epilepsy with intellectual disability and three considered paediatrics. Interventions included technologically-based interventions, small group discussion, or counselling and educational programs. There was high certainty evidence to suggest self-management is associated with improvement in health-related quality of life and moderate certainty evidence to suggest improvement in depression symptoms. There was low certainty evidence to suggest a modest reduction in negative health events and a minimal increase in the satisfaction with life. There was no evidence of benefit favouring self-management on measures of adherence epilepsy self-management, perception of self-efficacy, medication adherence or seizure status. SIGNIFICANCE Despite high certainty evidence to suggest that self-management strategies for people with epilepsy improve health-related quality of life, benefits have not been demonstrated for outcomes that would be expected to be associated with these improvements, such as seizure status. These results provide support for self-management strategies to supplement usual care for people with epilepsy.
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Affiliation(s)
- Sarah L Goh
- Monash Health, Clayton, VIC 3168, Australia; Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia
| | - Katherine E Harding
- Allied Health Clinical Research Office, Eastern Health, 5 Arnold Street, Box Hill, VIC 3128, Australia; La Trobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia
| | - Annie K Lewis
- Allied Health Clinical Research Office, Eastern Health, 5 Arnold Street, Box Hill, VIC 3128, Australia; La Trobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, 5 Arnold Street, Box Hill, VIC 3128, Australia; La Trobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia
| | - Patrick W Carney
- Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia; Department of Neurosciences, Eastern Health, 5 Arnold St, Box Hill, VIC 3128, Australia; The Florey Institute for Neuroscience and Mental Health, Melbourne Brain Centre, Burgundy Street, Heidelberg, VIC 3084, Australia.
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5
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Fontaine S, Gautier L, Diependaele AS, Hamieh M, Morello R, Guillouët S, Bertran F. Impact of educational actions on the quality of life of patients with epilepsy: A randomised controlled trial. Epilepsy Res 2023; 192:107128. [PMID: 37027966 DOI: 10.1016/j.eplepsyres.2023.107128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/08/2023] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
INTRODUCTION Epilepsy is a common and disabling disease for patients and their families. The care of these patients is no longer limited to the simple control of seizures, but considers, in a more global way, their quality of life (QOL). Improving the QOL is precisely one of the main objectives of therapeutic education. The aim of this study was to evaluate the impact of educational actions on the global QOL of patients with epilepsy. MATERIALS AND METHODS This study was carried out between October 2016 and August 2018. 80 patients were included over 18 years old with an epileptic condition diagnosed for at least 6 months and treated in the University Hospital of Caen Normandy in France. They were randomised to either the control group with usual care or the experimental group with the group educational sessions. The overall score for the QOLIE-31 survey was assessed from the inclusion (M0) and 6 months late. RESULTS At the M0 mark, the score of the control group (58.1 ± 12.3) was significantly lower than that of the experimental group (61.1 ± 14.3). After 6 months, the overall QOL score, was significantly higher for the experimental group compared to the control group (p = 0.002). In the experimental group, the overall score went from 61.1 ± 14.3-69 ± 14.2 and in the control group it went from 58.1 ± 12.3-58 ± 16.2. DISCUSSION The quality-of-life overall score for patients having participated in educational actions provided by epilepsy specialist nurses improved significantly. Complementary research is necessary to assess the sustainability of these effects and interactions with the caregivers.
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Rabiei DL, Lotfizadeh DM, Karimi Z, Masoudi DR. The effects of self-management education and support on self-efficacy, self-esteem, and quality of life among patients with epilepsy. Seizure 2022; 102:96-104. [DOI: 10.1016/j.seizure.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 09/11/2022] [Accepted: 09/30/2022] [Indexed: 10/31/2022] Open
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Willems LM, Hochbaum M, Frey K, Schulz J, Menzler K, Langenbruch L, Kovac S, Immisch I, von Podewils F, Hamacher M, Siebenbrodt K, Rosenow F, Reese JP, Strzelczyk A. Multicenter, cross-sectional study of the costs of illness and cost-driving factors in adult patients with epilepsy. Epilepsia 2022; 63:904-918. [PMID: 35192210 DOI: 10.1111/epi.17174] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/02/2022] [Accepted: 01/12/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study was undertaken to quantify epilepsy-related costs of illness (COI) in Germany and identify cost-driving factors. METHODS COI were calculated among adults with epilepsy of different etiologies and severities. Multiple regression analysis was applied to determine any epilepsy-related and sociodemographic factors that serve as cost-driving factors. RESULTS In total, 486 patients were included, with a mean age of 40.5 ± 15.5 years (range = 18-83 years, 58.2% women). Mean 3-month COI were estimated at €4911, €2782, and €2598 for focal, genetic generalized, and unclassified epilepsy, respectively. The mean COI for patients with drug-refractory epilepsy (DRE; €7850) were higher than those for patients with non-DRE (€4720), patients with occasional seizures (€3596), or patients with seizures in remission for >1 year (€2409). Identified cost-driving factors for total COI included relevant disability (unstandardized regression coefficient b = €2218), poorer education (b = €2114), living alone (b = €2612), DRE (b = €1831), and frequent seizures (b = €2385). Younger age groups of 18-24 years (b = -€2945) and 25-34 years (b = -€1418) were found to have lower overall expenditures. A relevant disability (b = €441), DRE (b = €1253), frequent seizures (b = €735), and the need for specialized daycare (b = €749) were associated with higher direct COI, and poorer education (b = €1969), living alone (b = €2612), the presence of a relevant disability (b = €1809), DRE (b = €1831), and frequent seizures (b = €2385) were associated with higher indirect COI. SIGNIFICANCE This analysis provides up-to-date COI data for use in further health economics analyses, highlighting the high economic impacts associated with disease severity, disability, and disease-related loss of productivity among adult patients with epilepsy. The identified cost drivers could be used as therapeutic and socioeconomic targets for future cost-containment strategies.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University and University Hospital Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maja Hochbaum
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University and University Hospital Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Katharina Frey
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University and University Hospital Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Juliane Schulz
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Katja Menzler
- Epilepsy Center Hessen and Department of Neurology, Philipps University Marburg, Marburg (Lahn), Germany
| | - Lisa Langenbruch
- Epilepsy Center Münster-Osnabrück, Department of Neurology, Institute of Translational Neurology, University of Münster, Münster, Germany.,Department of Neurology, Osnabrück Hospital, Osnabrück, Germany
| | - Stjepana Kovac
- Epilepsy Center Münster-Osnabrück, Department of Neurology, Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Ilka Immisch
- Epilepsy Center Hessen and Department of Neurology, Philipps University Marburg, Marburg (Lahn), Germany
| | - Felix von Podewils
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Mario Hamacher
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Kai Siebenbrodt
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University and University Hospital Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University and University Hospital Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jens-Peter Reese
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University and University Hospital Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
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8
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Chen HF, Tsai YF, Fan JY, Chen MC, Hsi MS, Hua MS. Evaluation of a self-management intervention for adults with epilepsy in Taiwan: A longitudinal randomized controlled trial. Epilepsy Behav 2021; 117:107845. [PMID: 33621815 DOI: 10.1016/j.yebeh.2021.107845] [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: 12/11/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Epilepsy is a neurological disease that causes recurrent seizures and can have a significant impact on a person's quality of life (QOL). A self-management intervention (SMI) can allow adults with epilepsy to modify behaviors in order to manage their seizures and evaluate the impact of medication and treatments on their daily lives. The purpose of this study was to investigate the effects of a SMI for adults with epilepsy. METHODS This was a longitudinal randomized controlled trial. Adults with epilepsy between the age of 20 and 65 years were recruited from a medical center in northern Taiwan. Participants were assigned to an intervention group (IG) or control group (CG) through simple randomization. Data regarding demographic and clinical characteristics were collected at baseline (T0). In addition, participants answered nine validated self-report questionnaires, which were used as outcome measures. Following collection of baseline data, the CG received routine monthly counseling over the next 3 months. The IG received the routine monthly counseling, as well as individual face-to-face health counseling on self-management 1 h/month and remote counseling via the phone or computer network at least twice per month. After the first month (T1) and at the end of the third (T2) and sixth months (T3) participants answered the nine questionnaires again. Differences in outcomes between the IGs and CGs were analyzed by comparing scores for the nine outcome variables at T0 with scores at T1, T2, and T3 with generalized estimating equations. RESULTS A total of 210 adults agreed to participate in the study; however, only 155 participants completed the questionnaires for all three time points: 75 in the CG and 80 in the IG. The mean age of the 155 participants was 39.6 years (SD = 10.9). There was no significant difference between demographic or clinical variables between the two groups. The only difference in baseline scores (T0) among the nine self-report questionnaires was in epilepsy knowledge, measured with the Epilepsy Knowledge Profile questionnaire, which were significantly higher for the CG (mean = 32.28, SD = 3.92) than the IG (mean = 23.01, SD = 2.79) (p < 0.001). Generalized estimating equations (GEE) analysis showed scores decreased significantly at T3 from baseline for the CG for epilepsy knowledge and QOL (p < 0.001). Improvements in scores for sleep quality, anxiety, depression, self-efficacy, coping, and social support did not differ between groups. Classification of the IG by gender showed a significantly greater increase for males compared with females from baseline to T3 for epilepsy knowledge (p < 0.001). If we further classified the IGs by seizure frequency, participants with a seizure frequency of ≥1 per year had a more significant increase in epilepsy knowledge and increase in QOL compared with participants with a seizure frequency of <1 per year at T3 compared with T0. CONCLUSION The lack of improvement in health-related quality of life (HRQoL) following the SMI may indicate that additional time is required to change behaviors that impact this variable for patients with epilepsy. Additional research should focus on variables associated with medication compliance, epilepsy knowledge, medicine symptom distress, self-efficacy, anxiety, and HRQoL.
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Affiliation(s)
- Hsiu-Fang Chen
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan; Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Yun-Fang Tsai
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan; School of Nursing, Chang Gung University, Tao-Yuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.
| | - Jun-Yu Fan
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan; Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Min-Chi Chen
- Graduate Institute of Biomedical Sciences, Chang Gung University, Tao-Yuan, Taiwan
| | - Mo-Song Hsi
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Mau-Sun Hua
- Department of Psychology, National Taiwan University, Taipei, Taiwan
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Hansen OA, Harboe L, Døssing MK, Kjeldsen MJ, Beier CP. Safety and feasibility of an intensive epilepsy nurse-based treatment course. Seizure 2021; 86:35-40. [PMID: 33517240 DOI: 10.1016/j.seizure.2021.01.004] [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: 12/04/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine safety, feasibility and patient satisfaction of an epilepsy nurse-based treatment course with frequent contacts and changes of anti-epileptic treatment provided by supervised anti-epileptic drug (AED) prescribing epilepsy nurses. METHODS Regular prescheduled clinical contacts with a neurologist to adjust AED treatment were largely substituted by on-demand contacts with epilepsy nurses with the delegated right to adapt AED within predefined limits. To secure safety, electronic medical files of patients with 6 or more contacts with epilepsy nurses were retrospectively analysed for clinical characteristics, safety measures and seizure frequency before/after the intensive treatment course and patients were asked to complete a questionnaire about treatment satisfaction. RESULTS Between January 1st 2016 and 31st December 2018, 2721 patients were treated by epilepsy nurses (2561 ambulatory controls, 8690 phone contacts). 617 patients received an intensive treatment course (six or more contacts in the observation period, range: 6-65) with an average length of 24.3 months. The average number of AED tried was 3.4. In patients with ongoing seizures (n = 310), 165 (53.2 %) reported an improvement of seizure frequency by 50 % or more. Seizure frequency fell from 4.4 to 2.4 days with seizures/months (p < 0.001). The epilepsy-related hospitalization rate was 0.86/patient; 27 episodes with status epilepticus occurred in 21 patients, three hospitalizations were due to severe side effects. There were no fatal complications. No hospitalization was related to the intensive treatment course by prescribing epilepsy nurses. The overall patients' satisfaction was high. CONCLUSION Intensive epilepsy treatment facilitated by epilepsy nurses was safe and associated with high patient accept and improvement of seizure frequency.
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Affiliation(s)
| | - Line Harboe
- Department of Neurology, Odense University Hospital, Denmark
| | | | - Marianne Juel Kjeldsen
- Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - Christoph Patrick Beier
- Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark.
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Chan HY, Leenen LA, Wijnen BF, van der Putten IM, Evers SM, Hjm Majoie M, van Heugten CM. ZMILE, a multicomponent self-management intervention for adults with epilepsy: Rationale and description of the intervention. Clin Rehabil 2020; 35:629-638. [PMID: 33225721 PMCID: PMC8076840 DOI: 10.1177/0269215520975327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective: In this paper, we aim to provide a comprehensive description of the multicomponent self-management intervention for adults with epilepsy, ZMILE. Rationale or theory: Acquiring self-management skills has been shown to play a vital role in enabling patients with epilepsy overcoming (health-related) struggles in daily life and coping with limitations their condition poses on them. ZMILE is a course consisting of education (to increase concordance to treatment), goal-setting (proactive coping), and self-monitoring. Resources needed: The course is guided by two nurse practitioners and each patient is allowed to bring one family member or friend. Self-monitoring plays an important role and can be done through e-Health tools or written diaries. Processes involved: During and after the course, patients are required to work toward a personally defined goal using a five-step approach by means of pro-active coping. Moreover, patients are expected to use self-monitoring tools to reflect on their own behavior and identify ways to optimize medication intake when required. Quantification: ZMILE is provided in an outpatient setting over five weekly group sessions and one booster session. From the start, patients are encouraged to set individual goals. Each group session will have a different theme but part of every session is reflecting on personal goals and to learn from eachother. Conclusions: The ZMILE-intervention has been evaluated and may be a promising intervention in terms of effectiveness and feasibility for adults with epilepsy, relatives, and professionals. We present the adapted version which can be implemented in clinical practice.
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Affiliation(s)
- Hoi Yau Chan
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Loes Am Leenen
- Department of Research and Development, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands
| | - Ben Fm Wijnen
- Center of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.,Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ingeborg M van der Putten
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Silvia Maa Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Center of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Marian Hjm Majoie
- Department of Research and Development, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands.,MHeNS, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands.,School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Neurology, Academic Centre for Epileptology, Epilepsy Centre Kempenhaeghe & Maastricht University Medical Centre, The Netherlands
| | - Caroline M van Heugten
- MHeNS, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neurosciences, Maastricht University, Maastricht, The Netherlands
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Al-Aqeel S, Gershuni O, Al-Sabhan J, Hiligsmann M. Strategies for improving adherence to antiepileptic drug treatment in people with epilepsy. Cochrane Database Syst Rev 2020; 10:CD008312. [PMID: 33089492 PMCID: PMC8092477 DOI: 10.1002/14651858.cd008312.pub4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Poor adherence to antiepileptic medication is associated with increased mortality, morbidity and healthcare costs. In this review, we focus on interventions designed and tested in randomised controlled trials (RCTs) and quasi-RCTs to assist people with adherence to antiepileptic medication. This is an update of a Cochrane review first published in 2011, and last updated in 2017. OBJECTIVES To determine the effectiveness of interventions aimed at improving adherence to antiepileptic medication in adults and children with epilepsy. SEARCH METHODS For the latest update, we searched the following databases on 18 February 2020: Cochrane Register of Studies (CRS Web), MEDLINE, CINAHL Plus and PsycINFO. CRS Web includes RCTs or quasi-RCTs from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), CENTRAL, and the Specialized Registers of Cochrane Review Groups including Epilepsy. We also searched the reference lists of relevant articles. SELECTION CRITERIA RCTs and quasi-RCTs of adherence-enhancing interventions aimed at people with a clinical diagnosis of epilepsy (as defined in individual studies), of any age and treated with antiepileptic drugs in a primary care, outpatient or other community setting. DATA COLLECTION AND ANALYSIS All review authors independently assessed lists of potentially relevant citations and abstracts. At least two review authors independently extracted data and performed a quality assessment of each study according to the Cochrane tool for assessing risk of bias. We graded the level of evidence for each outcome according to GRADE. The studies differed widely according to the type of intervention and measures of adherence; therefore combining data was not appropriate. MAIN RESULTS We included 20 studies reporting data on 2832 participants. Thirteen studies targeted adults with epilepsy, one study included participants of all ages, one study included participants older than two years, one recruited pediatric patients aged between 1 month to 15 years, one study targeted caregivers of children with epilepsy, one targeted adolescents and caregivers, and two studies targeted families of children with epilepsy. We identified three ongoing studies. Follow-up time was generally short in most studies, ranging from 1 to 12 months. The studies examined three main types of interventions: educational interventions, behavioural interventions and mixed interventions. All but three studies compared treatment with usual care or 'no intervention'. Due to heterogeneity between studies in terms of interventions, methods used to measure adherence and the way the studies were reported, we did not pool the results and these findings were inappropriate to be included in a meta-analysis. Education and counselling of participants with epilepsy had mixed success (moderate-certainty evidence). Behavioural interventions such as the use of intensive reminders provided more favourable effects on adherence (moderate-certainty evidence). The effect on adherence to antiepileptic drugs described by studies of mixed interventions showed improved adherence in the intervention groups compared to the control groups (high-certainty evidence). Eleven studies described seizure frequency or seizure severity or both, with four of them, reporting improved adherence and decreased seizure frequency in the intervention groups (moderate-certainty evidence). Findings related to self-efficacy and quality of life were mixed, with no clear pattern across types of intervention. AUTHORS' CONCLUSIONS Behavioural interventions such as intensive reminders and the use of mixed interventions demonstrate some positive results, however, we need more reliable evidence on their efficacy, derived from carefully-designed RCTs before we can draw a firm conclusion. None of the newly included studies have provided additional information that would lead to significant changes in our conclusions.
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Affiliation(s)
- Sinaa Al-Aqeel
- Department of Clinical Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Olga Gershuni
- Department of International Health, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Jawza Al-Sabhan
- Department of Clinical Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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12
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Pandey DK, Dasgupta R, Levy J, Wang H, Serafini A, Habibi M, Song W, Shafer PO, Loeb JA. Enhancing epilepsy self-management and quality of life for adults with epilepsy with varying social and educational backgrounds using PAUSE to Learn Your Epilepsy. Epilepsy Behav 2020; 111:107228. [PMID: 32599431 PMCID: PMC7319931 DOI: 10.1016/j.yebeh.2020.107228] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE People with epilepsy (PWE) come from a wide variety of social backgrounds and educational skillsets, making self-management (SM) education for improving their condition challenging. Here, we evaluated whether a mobile technology-based personalized epilepsy SM education intervention, PAUSE to Learn Your Epilepsy (PAUSE), improves SM measures such as self-efficacy, epilepsy SM behaviors, epilepsy outcome expectations, quality of life (QOL), and personal impact of epilepsy in adults with epilepsy. METHODS Recruitment for the PAUSE study occurred from October 2015 to March 2019. Ninety-one PWE were educated using an Internet-enabled computer tablet application that downloads custom, patient-specific educational programs from Epilepsy.com. Validated self-reported questionnaires were used for outcome measures. Participants were assessed at baseline (T0), the first follow-up at completion of the PWE-paced 8-12-week SM education intervention (T1), and the second follow-up at least 3 months after the first follow-up (T2). Multiple linear regression was used to assess within-subject significant changes in outcome measures between these time points. RESULTS The study population was diverse and included individuals with a wide variety of SM educational needs and abilities. The median time for the first follow-up assessment (T1) was approximately 4 months following the baseline (T0) and 8 months following baseline for the second follow-up assessment (T2). Participants showed significant improvement in all SM behaviors, self-efficacy, outcome expectancy, QOL, and personal impact of epilepsy measures from T0 to T1. Participants who scored lower at baseline tended to show greater improvement at T1. Similarly, results showed that participant improvement was sustained in the majority of SM measures from T1 to T2. CONCLUSION This study demonstrated that a mobile technology-based personalized SM intervention is feasible to implement. The results provide evidence that epilepsy SM behavior and practices, QOL, outcome expectation for epilepsy treatment and management, self-efficacy, and outcome expectation and impact of epilepsy significantly improve following a personalized SM education intervention. This underscores a greater need for a pragmatic trial to test the effectiveness of personalized SM education, such as PAUSE to Learn Your Epilepsy, in broader settings specifically for the unique needs of the hard-to-reach and hard-to-treat population of PWE.
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Affiliation(s)
- Dilip K. Pandey
- Neurology and Rehabilitation, University of Illinois College of Medicine, University of Illinois Chicago, 912 S. Wood St, Chicago, IL 60612, USA,Corresponding author at: 174N NPI (MC 796), 912 S Wood St, Chicago, IL 60612, USA
| | - Raktima Dasgupta
- Health Policy and Administration, School of Public Health, University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL 60612, USA
| | - Jessica Levy
- Neurology and Rehabilitation, University of Illinois College of Medicine, University of Illinois Chicago, 912 S. Wood St, Chicago, IL 60612, USA
| | - Heng Wang
- Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL 60612, USA
| | - Anna Serafini
- Neurology and Rehabilitation, University of Illinois College of Medicine, University of Illinois Chicago, 912 S. Wood St, Chicago, IL 60612, USA
| | - Mitra Habibi
- Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, 833 S. Wood St., Chicago, IL 60612, USA
| | - Woojin Song
- Neurology and Rehabilitation, University of Illinois College of Medicine, University of Illinois Chicago, 912 S. Wood St, Chicago, IL 60612, USA
| | - Patricia O. Shafer
- Epilepsy Foundation, 8301 Professional Place West, Landover, MD 20785, USA
| | - Jeffrey A. Loeb
- Neurology and Rehabilitation, University of Illinois College of Medicine, University of Illinois Chicago, 912 S. Wood St, Chicago, IL 60612, USA
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13
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Lee SA, Kim SJ. Self-efficacy in seizure management differentially correlated with quality of life in persons with epilepsy depending on seizure recurrence and felt stigma. Seizure 2020; 81:91-95. [DOI: 10.1016/j.seizure.2020.07.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 01/06/2023] Open
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Michaelis R, Tang V, Nevitt SJ, Wagner JL, Modi AC, LaFrance WC, Goldstein LH, Gandy M, Bresnahan R, Valente K, Donald KA, Reuber M. Psychological treatments for people with epilepsy. Cochrane Database Syst Rev 2020; 8:CD012081. [PMID: 35653266 PMCID: PMC8409429 DOI: 10.1002/14651858.cd012081.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Given the significant impact epilepsy may have on the health-related quality of life (HRQOL) of individuals with epilepsy and their families, there is increasing clinical interest in evidence-based psychological treatments, aimed at enhancing psychological and seizure-related outcomes for this group. This is an updated version of the original Cochrane Review published in Issue 10, 2017. OBJECTIVES To assess the impact of psychological treatments for people with epilepsy on HRQOL outcomes. SEARCH METHODS For this update, we searched the following databases on 12 August 2019, without language restrictions: Cochrane Register of Studies (CRS Web), which includes randomized or quasi-randomized controlled trials from the Specialized Registers of Cochrane Review Groups including Epilepsy, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid, 1946 to 09 August 2019), and PsycINFO (EBSCOhost, 1887 onwards), and from PubMed, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (ICTRP). We screened the references from included studies and relevant reviews, and contacted researchers in the field for unpublished studies. SELECTION CRITERIA We considered randomized controlled trials (RCTs) and quasi-RCTs for this review. HRQOL was the main outcome. For the operational definition of 'psychological treatments', we included a broad range of skills-based psychological treatments and education-only interventions designed to improve HRQOL, seizure frequency and severity, as well as psychiatric and behavioral health comorbidities for adults and children with epilepsy. These psychological treatments were compared to treatment as usual (TAU), an active control group (such as social support group), or antidepressant pharmacotherapy. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 36 completed RCTs, with a total of 3526 participants. Of these studies, 27 investigated skills-based psychological interventions. The remaining nine studies were education-only interventions. Six studies investigated interventions for children and adolescents, three studies investigated interventions for adolescents and adults, and the remaining studies investigated interventions for adults. Based on satisfactory clinical and methodological homogeneity, we pooled data from 11 studies (643 participants) that used the Quality of Life in Epilepsy-31 (QOLIE-31) or other QOLIE inventories (such as QOLIE-89 or QOLIE-31-P) convertible to QOLIE-31. We found significant mean changes for the QOLIE-31 total score and six subscales (emotional well-being, energy and fatigue, overall QoL, seizure worry, medication effects, and cognitive functioning). The mean changes in the QOLIE-31 total score (mean improvement of 5.23 points, 95% CI 3.02 to 7.44; P < 0.001), and the overall QoL score (mean improvement of 5.95 points, 95% CI 3.05 to 8.85; P < 0.001) exceeded the threshold of minimally important change (MIC: total score: 4.73 points; QoL score: 5.22 points), indicating a clinically meaningful postintervention improvement in HRQOL. We downgraded the certainty of the evidence provided by the meta-analysis due to serious risks of bias in some of the included studies. Consequently, these results provided moderate-certainty evidence that psychological treatments for adults with epilepsy may enhance overall HRQOL. AUTHORS' CONCLUSIONS Implications for practice: Skills-based psychological interventions improve HRQOL in adults and adolescents with epilepsy. Adjunctive use of skills-based psychological treatments for adults and adolescents with epilepsy may provide additional benefits in HRQOL when these are incorporated into patient-centered management. We judge the evidence to be of moderate certainty. IMPLICATIONS FOR RESEARCH Investigators should strictly adhere to the CONSORT guidelines to improve the quality of reporting on their interventions. A thorough description of intervention protocols is necessary to ensure reproducibility. When examining the effectiveness of psychological treatments for people with epilepsy, the use of standardized HRQOL inventories, such as the Quality of Life in Epilepsy Inventories (QOLIE-31, QOLIE-31-P, and QOLIE-89) would increase comparability. Unfortunately, there is a critical gap in pediatric RCTs and RCTs including people with epilepsy and intellectual disabilities. Finally, in order to increase the overall quality of RCT study designs, adequate randomization with allocation concealment and blinded outcome assessment should be pursued. As attrition is often high in research that requires active participation, an intention-to-treat analysis should be carried out. Treatment fidelity and treatment competence should also be assessed. These important dimensions, which are related to 'Risk of bias' assessment, should always be reported.
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Affiliation(s)
- Rosa Michaelis
- Department of Neurology Gemeinschaftskrankenhaus Herdecke, University of Witten/Herdecke, Herdecke, Germany
| | - Venus Tang
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hospital Authority, Hong Kong
- Department of Clinical Psychology, Prince of Wales Hospital, Hospital Authority, Hong Kong
| | - Sarah J Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Janelle L Wagner
- College of Nursing, Medical University of South Carolina, Charleston, USA
| | - Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA
| | - William Curt LaFrance
- Departments of Psychiatry and Neurology, Brown University, Providence, Rhode Island, USA
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Milena Gandy
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Rebecca Bresnahan
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Kette Valente
- Faculty of Medicine, University of São Paulo (HCFMUSP), Sao Paulo, Brazil
| | - Kirsten A Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
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15
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Engelen MM, van Dulmen S, Puijk-Hekman S, Vermeulen H, Nijhuis-van der Sanden MW, Bredie SJ, van Gaal BG. Evaluation of a Web-Based Self-Management Program for Patients With Cardiovascular Disease: Explorative Randomized Controlled Trial. J Med Internet Res 2020; 22:e17422. [PMID: 32706708 PMCID: PMC7414414 DOI: 10.2196/17422] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/09/2020] [Accepted: 04/12/2020] [Indexed: 12/26/2022] Open
Abstract
Background Web-based self-management programs have the potential to support patients with cardiovascular disease (CVD) in their self-management (eg, by focusing on behavior change and improving physical activity). The intervention mapping framework was used to develop a web-based program called Vascular View. The Vascular View program contained 6 modules (coping with CVD, setting boundaries, lifestyle, healthy nutrition, being physically active, interaction with health professionals) aiming to increase self-management behavior by tailoring to the perceived problems and (support) needs of patients after CVD. Objective The aim was to test the effectiveness of Vascular View before embarking on a full-scale randomized clinical trial (RCT) by evaluating the potential effectiveness and effect sizes of the Vascular View program and identifying outcome measures most likely to capture the potential benefits. Methods An explorative RCT was performed. Both control and intervention groups received care as usual and, in addition, the intervention group received 12 months of access to a web-based self-management program. Assessment occurred at baseline, 6 months, and 12 months. Outcome measures included general patient-reported outcome measurements: Illness Perception Questionnaire (IPQ), Rand-36, Patient Activation Measure, and patient self-efficacy. Module-specific patient-reported outcome measurements were Beliefs about Medicines Questionnaire, International Physical Activity Questionnaire, Dutch Healthy Diet Index, Fagerström Test for Nicotine Dependence (FTND), Alcohol Use Disorders Identification Test, and Perceived Efficacy in Patient-Physician Interaction. Linear mixed models for repeated measures using intention-to-treat and per-protocol analysis were applied to study differences between the patients in the intervention and control groups. Floor and ceiling effects were explored to give insight into the outcome measures most likely to capture the potential benefits. Results A total of 105 patients in the control group and 103 patients in the intervention group participated in the study. A positive direction of change between baseline and 12 months was shown for most outcome measurements in favor of the intervention group, of which 2 out of 10 outcomes showed a significant effect: attribution of cause of the disease to risk factors and immunity factors (IPQ) and dependency of nicotine (FTND). Floor and ceiling effects were seen in the IPQ, Rand-36, and the self-efficacy questionnaire. Conclusions No conclusion for the efficacy of the Vascular View program or selection of outcome measurements can be taken yet. A process evaluation will be conducted to gain thorough insight into the working elements of the program, patient needs in eHealth, and the use of the program by patients. This can determine for whom web-based self-management programs will work and help to adapt the program. Trial Registration Dutch Trial Register NTR5412; https://www.trialregister.nl/trial/5303 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.6352
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Affiliation(s)
- Marscha M Engelen
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands
| | - Sandra van Dulmen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands.,Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Saskia Puijk-Hekman
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands
| | - Hester Vermeulen
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands.,Institute of Nursing, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, Netherlands
| | | | - Sebastian Jh Bredie
- Department of Internal Medicine, Radboud university medical center, Nijmegen, Netherlands
| | - Betsie Gi van Gaal
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands.,Institute of Nursing, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, Netherlands
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16
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Lewinski AA, Shapiro A, Gierisch JM, Goldstein KM, Blalock DV, Luedke MW, Gordon AM, Bosworth HB, Drake C, Lewis JD, Sinha SR, Husain AM, Tran TT, Van Noord MG, Williams JW. Barriers and facilitators to implementation of epilepsy self-management programs: a systematic review using qualitative evidence synthesis methods. Syst Rev 2020; 9:92. [PMID: 32334641 PMCID: PMC7183113 DOI: 10.1186/s13643-020-01322-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/06/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Epilepsy affects nearly 50 million people worldwide. Self-management is critical for individuals with epilepsy in order to maintain optimal physical, cognitive, and emotional health. Implementing and adopting a self-management program requires considering many factors at the person, program, and systems levels. We conducted a systematic review of qualitative and mixed-methods studies to identify facilitators and barriers that impact implementation and adoption of self-management programs for adults with epilepsy. METHODS We used established systematic review methodologies for qualitative and mixed-methods studies. We included studies addressing facilitators (i.e., factors that aided) or barriers (i.e., factors that impeded) to implementation and adoption of self-management interventions for adults with epilepsy. We conducted a narrative thematic synthesis to identify facilitators and barriers. RESULTS The literature search identified 2700 citations; 13 studies met eligibility criteria. Our synthesis identified five themes that categorize facilitators and barriers to successful implementation epilepsy self-management: (1) relevance, intervention content that facilitates acquisition of self-management skills; (2) personalization, intervention components that account for the individual's social, physical, and environmental characteristics; (3) intervention components, components and dosing of the intervention; (4) technology considerations, considerations that account for individual's use, familiarity with, and ownership of technology; and (5) clinician interventionist, role and preparation of the individual who leads intervention. We identified facilitators in 11 of the 13 studies and barriers in 11 of the 13 studies and classified these by social-ecological level (i.e., patient/caregiver, program, site/system). CONCLUSION Identification of facilitators and barriers at multiple levels provides insight into disease-specific factors that influence implementation and adoption of self-management programs for individuals with epilepsy. Our findings indicate that involving individuals with epilepsy and their caregivers in intervention development, and then tailoring intervention content during the intervention, can help ensure the content is relevant to intervention participants. Our findings also indicate the role of the clinician (i.e., the individual who provides self-management education) is important to intervention implementation, and key issues with clinicians were identified as barriers and opportunities for improvement. Overall, our findings have practical value for those seeking to implement and adopt self-management interventions for epilepsy and other chronic illnesses. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number is CRD42018098604.
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Affiliation(s)
- Allison A Lewinski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.
| | - Abigail Shapiro
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Jennifer M Gierisch
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Karen M Goldstein
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Dan V Blalock
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Matthew W Luedke
- Department of Neurology, Duke University Medical Center, Durham, NC, USA.,Neurodiagonostic Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Adelaide M Gordon
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Hayden B Bosworth
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.,School of Nursing, Duke University, Durham, NC, USA.,Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Connor Drake
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Center for Personalized Health Care, Duke University School of Medicine, Durham, NC, USA
| | - Jeffrey D Lewis
- Department of Neurology, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - Saurabh R Sinha
- Department of Neurology, Duke University Medical Center, Durham, NC, USA.,Neurodiagonostic Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Aatif M Husain
- Department of Neurology, Duke University Medical Center, Durham, NC, USA.,Neurodiagonostic Center, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Neuroscience Medicine, Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Tung T Tran
- Department of Neurology, Duke University Medical Center, Durham, NC, USA.,Neurodiagonostic Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | | | - John W Williams
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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17
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Elsayed MA, El-Sayed NM, Badi S, Ahmed MH. Factors affecting adherence to antiepileptic medications among Sudanese individuals with epilepsy: A cross-sectional survey. J Family Med Prim Care 2019; 8:2312-2317. [PMID: 31463248 PMCID: PMC6691456 DOI: 10.4103/jfmpc.jfmpc_405_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Nonadherence to medication is widespread in epilepsy and other chronic diseases. Studies reporting adherence to antiepileptic medications are very limited in African countries. Adherence reports from low income African countries are few in contrast to multiple studies from high-income countries. Therefore, the aim of this study is to measure the level of adherence to antiepileptic medication in Sudanese population. Methods: A descriptive cross-sectional study of 96 individuals with epilepsy recruited from neurology outpatient clinics in three tertiary centers in Sudan. Data were collected by using a structured questionnaire containing Morisky Medication Adherence Scale-4 (MMAS-4) and Belief about Medication Questionnaire and analyzed by statistical package of social sciences. Results: About 35% of patients were estimated to be nonadherent. Most of the patients (93%) acknowledged their need for antiepileptic drugs. However, 35% had high concern score. Adherence is affected by attitude toward antiepileptic drugs (AEDs) and presence of side effects to AEDs. The relation between side effects and adherence was significant (P value 0.000). Furthermore, there was a statistically insignificant relation between the number of drugs used and adherence (P value 0.002). There was a significant relation between adherence, necessity mean score, concern mean score, and necessity concern differential P value 0.000 for all. Conclusion: Nonadherence to antiepileptic medication was reported in almost in one third of individuals in this cohort. There were statistically significant associations between nonadherence and both side effects and number of medications used in the treatment of epilepsy. Therefore, family physician should always check compliance with antiepileptic medication. Patient's education about adherence to medication through family physician may in part decrease the recurrence of epileptic seizures. Further research is needed to explore ways to increase adherence with AEDs in a low resource country like Sudan.
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Affiliation(s)
- Muaz A Elsayed
- Department of Neurology, Faculty of Medicine, Omdurman Islamic University, Omdurman Teaching Hospital, Khartoum, Sudan
| | | | - Safaa Badi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Omdurman Islamic University, Khartoum, Sudan
| | - Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eagelstone, Milton Keynes, Buckinghamshire, UK
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18
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Wang Z, Zhang Y, Xin Y, Guo W, Zhuang L, Hu X, Gao X. Is self-management effective for improving the quality of life in adult epileptics? A systematic review and meta-analysis of randomized controlled trials. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.100926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Luedke MW, Blalock DV, Goldstein KM, Kosinski AS, Sinha SR, Drake C, Lewis JD, Husain AM, Lewinski AA, Shapiro A, Gierisch JM, Tran TT, Gordon AM, Van Noord MG, Bosworth HB, Williams JW. Self-management of Epilepsy: A Systematic Review. Ann Intern Med 2019; 171:117-126. [PMID: 31261386 DOI: 10.7326/m19-0458] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although self-management is recommended for persons with epilepsy, its optimal strategies and effects are uncertain. PURPOSE To evaluate the components and efficacy of self-management interventions in the treatment of epilepsy in community-dwelling persons. DATA SOURCES English-language searches of MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL in April 2018; the MEDLINE search was updated in March 2019. STUDY SELECTION Randomized and nonrandomized comparative studies of self-management interventions for adults with epilepsy. DATA EXTRACTION An investigator assessed study characteristics; intervention details, including 6 components of self-management; and outcomes, which were verified by a second reviewer. Risk of bias (ROB) was assessed independently by 2 investigators. DATA SYNTHESIS 13 randomized and 2 nonrandomized studies (2514 patients) evaluated self-management interventions. Interventions were delivered primarily in group settings, used a median of 4 components, and followed 2 general strategies: 1 based on education and the other on psychosocial therapy. Education-based approaches improved self-management behaviors (standardized mean difference, 0.52 [95% CI, 0.0 to 1.04]), and psychosocial therapy-based approaches improved quality of life (mean difference, 6.64 [CI, 2.51 to 10.77]). Overall, self-management interventions did not reduce seizure rates, but 1 educational intervention decreased a composite of seizures, emergency department visits, and hospitalizations. LIMITATION High ROB in most studies, incomplete intervention descriptions, and studies limited to English-language publications. CONCLUSION There is limited evidence that self-management strategies modestly improve some patient outcomes that are important to persons with epilepsy. Overall, self-management research in epilepsy is limited by the range of interventions tested, the small number of studies using self-monitoring technology, and uncertainty about components and strategies associated with benefit. PRIMARY FUNDING SOURCE U.S. Department of Veterans Affairs. (PROSPERO: CRD42018098604).
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Affiliation(s)
- Matthew W Luedke
- Duke University Medical Center and Durham Veterans Affairs Medical Center, Durham, North Carolina (M.W.L., S.R.S., A.A.L., A.S., T.T.T., A.M.G.)
| | - Dan V Blalock
- Durham Veterans Affairs Medical Center and Duke University School of Medicine, Durham, North Carolina (D.V.B., K.M.G., J.M.G., J.W.W.)
| | - Karen M Goldstein
- Durham Veterans Affairs Medical Center and Duke University School of Medicine, Durham, North Carolina (D.V.B., K.M.G., J.M.G., J.W.W.)
| | | | - Saurabh R Sinha
- Duke University Medical Center and Durham Veterans Affairs Medical Center, Durham, North Carolina (M.W.L., S.R.S., A.A.L., A.S., T.T.T., A.M.G.)
| | - Connor Drake
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (C.D.)
| | - Jeffrey D Lewis
- Uniformed Services University School of Medicine, Bethesda, Maryland (J.D.L.)
| | - Aatif M Husain
- Duke University Medical Center, Durham Veterans Affairs Medical Center, and Duke University, Durham, North Carolina (A.M.H.)
| | - Allison A Lewinski
- Duke University Medical Center and Durham Veterans Affairs Medical Center, Durham, North Carolina (M.W.L., S.R.S., A.A.L., A.S., T.T.T., A.M.G.)
| | - Abigail Shapiro
- Duke University Medical Center and Durham Veterans Affairs Medical Center, Durham, North Carolina (M.W.L., S.R.S., A.A.L., A.S., T.T.T., A.M.G.)
| | - Jennifer M Gierisch
- Durham Veterans Affairs Medical Center and Duke University School of Medicine, Durham, North Carolina (D.V.B., K.M.G., J.M.G., J.W.W.)
| | - Tung T Tran
- Duke University Medical Center and Durham Veterans Affairs Medical Center, Durham, North Carolina (M.W.L., S.R.S., A.A.L., A.S., T.T.T., A.M.G.)
| | - Adelaide M Gordon
- Duke University Medical Center and Durham Veterans Affairs Medical Center, Durham, North Carolina (M.W.L., S.R.S., A.A.L., A.S., T.T.T., A.M.G.)
| | - Megan G Van Noord
- Durham Veterans Affairs Medical Center, Durham, North Carolina; University of California, Davis, Davis, California (M.G.V.)
| | - Hayden B Bosworth
- Durham Veterans Affairs Medical Center, Duke University School of Medicine, and Duke University, Durham, North Carolina (H.B.B.)
| | - John W Williams
- Durham Veterans Affairs Medical Center and Duke University School of Medicine, Durham, North Carolina (D.V.B., K.M.G., J.M.G., J.W.W.)
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