Abstract
Background and aim
Adherence to treatment is a critical component of epilepsy management. This study examines whether addressing antiepileptic drug (AED) side effects at every visit is associated with increased patient-reported medication adherence.
Patients and methods
This study identified 243 adults with epilepsy who were seen at two academic outpatient neurology settings and had at least two visits over a 3-year period. Demographic and clinical characteristics were abstracted. Evidence that AED side effects were addressed was measured through 1) phone interview (patient-reported) and 2) medical records abstraction (physician-documented). Medication adherence was assessed using the validated Morisky Medication Adherence Scale-4. Complete adherence was determined as answering “no” to all questions.
Results
Sixty-two (25%) patients completed the interviews. Participants and nonparticipants were comparable with respect to demographic and clinical characteristics; however, a smaller proportion of participants had a history of drug-resistant epilepsy than nonparticipants (17.7% vs 30.9%, P=0.04). Among the participants, evidence that AED side effects were addressed was present in 48 (77%) medical records and reported by 51 (82%) patients. Twenty-eight (45%) patients reported complete medication adherence. The most common reason for incomplete adherence was missed medication due to forgetfulness (n=31, 91%). There was no association between addressing AED side effects (neither physician-documented nor patient-reported) and complete medication adherence (P=0.22 and 0.20).
Discussion and conclusion
Among patients with epilepsy, addressing medication side effects at every visit does not appear to increase patient-reported medication adherence.
Supplementary materials
Table S1 Demographic and clinical characteristics of high and low medication adherence groups
Table S2 Demographic and clinical characteristics of medication adherence groups (MMAS ordinal categories)
Acknowledgments
The authors acknowledge Hui Zheng, PhD, for statistical consultation through the Harvard Catalyst Biostatistical Consulting Program, funded by the National Institutes of Health.
The study was funded by a 2015 Clinical Research Fellowship sponsored by the American Brain Foundation. The funding body had no role in the design of the study, in collection, analysis, and interpretation of data, and in writing the manuscript.
Author contributions
Lidia MVR Moura helped create the study concept and design and was involved in ethics institutional review board documentation, acquisition of data, analysis and interpretation of data, and critical revision of manuscript for intellectual content. Thiago S Carneiro helped in acquisition, analysis, and interpretation of data, and critical revision of manuscript for intellectual content. John Hsu and Andrew J Cole critically revised the manuscript for intellectual content. Barbara G Vickrey helped create the study concept and design and aided in analysis and interpretation of data, and critical revision of manuscript for intellectual content. Daniel B Hoch helped create the study concept and design and aided in acquisition, analysis, and interpretation of data, and critical revision of manuscript for intellectual content. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.
Disclosure
Lidia MVR Moura was the recipient of a 2015 Clinical Research Fellowship sponsored by the American Brain Foundation. John Hsu receives grant funding from NIH (1R01 CA16 4023-04, 2P01AG032952-06A1, R01 HD075121-04, and R01 MH104560-02). Barbara G Vickrey receives funding from NINDS, California Community Foundation, and UniHealth Foundation. The other authors report no conflicts of interest in this work.