Medicine possession ratio as proxy for adherence to antiepileptic drugs: prevalence, associations, and cost implications

Impact of prescription length supply policy on patient medication adherence in Thailand

BACKGROUND

Phramongkutklao Hospital is one of the largest military hospitals in Thailand. Beginning in 2016, an institutional policy was implemented in which medication prescription length was increased from 30 to 90 days. However, there have been no formal investigations into how this policy has impacted medication adherence among patients in hospitals. As such, this study evaluated how prescription length impacted medication adherence among dyslipidemia and type-2 diabetes patients who were treated at Phramongkutklao Hospital.

METHODS

This pre-post implementation study compared patients who received prescription lengths of 30 and 90 days based on information recorded in the hospital database between 2014 and 2017. Therein, we used the medication possession ratio (MPR) to estimate patient adherence. Focusing on patients with universal coverage insurance, we employed the difference-in-difference method to examine changes in adherence from before and after policy implementation, then conducted a logistic regression to test for associations between the predictors and adherence.

RESULTS

We analyzed data from a total of 2,046 patients, with equal amounts of 1,023 placed into the control group (no change to 90-day prescription length) and intervention group (change from 30 to 90-day prescription length). First, we found that increased prescription length was associated with 4% and 5% higher MPRs among dyslipidemia and diabetes patients in the intervention group, respectively. Second, we found that medication adherence was correlated with sex, comorbidities, history of hospitalization, and the number of prescribed medications.

CONCLUSION

Increasing the prescription length from 30 to 90 days improved medication adherence in both the dyslipidemia and type-2 diabetes patients. This shows that the policy change was successful for patients in the hospital considered for this study.

Adherence to anti-seizure medications and associated factors among children with epilepsy at tertiary Hospital in Southwest Ethiopia: a cross-sectional study

Background

Childhood epilepsy causes a tremendous burden for the child, the family, society as well as the healthcare system. Adherence to anti-seizure medications (ASMs) is a key to treatment success. Poor adherence has been considered as one of the main causes of unsuccessful treatment for epilepsy and presents a potential ongoing challenge for achieving a key therapeutic goal of seizure control.

Methods

A facility-based cross-sectional study design was conducted among children with epilepsy attending the Pediatrics neurology follow up clinic of Jimma Medical Center from June- 21 to September- 20, 2021. Data were collected by using a semi-structured pre-tested questionnaire. Epidata version 3.1 and SPSS version 26.0 were used for data entry and analysis respectively. Descriptive statistics and binary logistic regression analysis were employed. Adjusted odds ratios were used to ascertain effect sizes for any association between the dependent and associated variables while significance level at p-value of < 0.05 was determined using 95% confidence intervals.

Result

A total of 170 children with epilepsy were included in this study. About 54.7% were male and 44.7% were in age range of 10–17 years. The overall adherence to anti-seizure medications was 54.1%. Those caregivers who were married [AOR = 7.46 (95% CI = 1.46, 38.20)], those children with controlled seizure status [AOR = 3.64 (95% CI = 1.51, 8.78)], those who got appropriate health care [AOR = 7.08(95% CI = 2.91, 17.24)], those caregivers who had good knowledge [AOR = 5.20(95% CI = 2.60,14.83)]; and positive attitude [AOR = 2.57 (95% CI = 1.06, 6.28)] towards epilepsy were significantly associated with adherence to anti-seizure medications.

Conclusions

More than half of the children/adolescents having epilepsy were adherent to their anti-seizure medication(s). Children’s adherence to anti- seizure medications was influenced by current marital status of the parents/caregivers, controlled seizure status, getting appropriate healthcare in the hospital, caregiver’s knowledge; and attitude towards epilepsy. More efforts are required to scale up the provision of client-centered service (provision of appropriate health care delivery, focus on quality of treatment and providing health education/counseling to improve caregivers’ knowledge and attitude towards epilepsy) to improve children’s adherence status to their medication(s) and seizure control status.