Antiepileptic Drug Nonadherence and Its Predictors among People with Epilepsy

Getnet, Asmamaw; Woldeyohannes, Solomon Meseret; Bekana, Lulu; Mekonen, Tesfa; Fekadu, Wubalem; Menberu, Melak; Yimer, Solomon; Assaye, Adisu; Belete, Amsalu; Belete, Habte

doi:10.1155/2016/3189108

Cited by 75 publications

(98 citation statements)

References 31 publications

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“…27 The pragmatic approach of clinicians in Rwanda that is focused on seizure reduction is also reflected in the limited availability of clinical data on seizure type and syndromic classification in our population. Up to 46.1% of the 166 PwE at T2 had stopped their medication without the consent of their treating clinicians.…”

Section: Discussionmentioning

confidence: 99%

“…Adequate ways of communicating medical information will need to be created and a one-fits-all format will probably not apply. 27 The pragmatic approach of clinicians in Rwanda that is focused on seizure reduction is also reflected in the limited availability of clinical data on seizure type and syndromic classification in our population. Indeed, up to 80% of seizures were classified as generalized tonic-clonic seizure (GTCS), which is unexpectedly high when compared to other series in developed countries, in which 51%-64% of seizures are reported to be focal.…”

Section: Discussionmentioning

confidence: 99%

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An ambispective cohort study on treatment outcomes of patients with epilepsy in a tertiary epilepsy center in Rwanda and recommendations for improved epilepsy care

Steenkiste

Sebera²,

Nsanzabaganwa³

et al. 2019

Epilepsia Open

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Summary Objective Because outcome data inform and drive healthcare decisions and improvement of patient care, this study aimed to gain a deep understanding of sociodemographic profiles and treatment outcomes of newly presenting and recently diagnosed persons living with epilepsy (PwE) at a tertiary epilepsy center in Rwanda. Methods In June 2016 (T1), as a first stage of this single‐center cohort study, an ambispective chart review was conducted on baseline sociodemographic and disease characteristics of PwE using a structured questionnaire. Missing data were obtained by phone interview. In 2017, follow‐up data were collected by phone interview on treatment outcomes after 15‐months (T2). Results Of 406 PwE screened, 235 were included at T1 and outcomes on 166 PwE were obtained at T2. More than 70% were <20 years of age, with a male preponderance. A high number of patients were aged ≥20 years, were single (67.4%), unemployed (41.5%), and had no formal education or primary level education (53.9%), possibly reflecting stigma. A mean delay in diagnosis since first seizure increased with age at first seizure, amounting to 3 years for patients aged ≥20 years. At T2, 69.6% of 166 patients who could be contacted reported no seizures in the previous month. Valproate monotherapy was the most frequently prescribed treatment. At T2, 47% had discontinued treatment, which was often not recommended by a physician, despite medical insurance coverage in >90% of patients. Only 19% reported an adverse event. Marked and partial improvement in quality of life (QoL) was reported by, respectively, 50.9% and 32.7% of patients. Significance Encouraging results on improved seizure control and QoL were observed at follow‐up. The treatment gap remains high due to loss to follow‐up and treatment discontinuation. In this article, we discuss needs and recommendations for improving patient care, requiring concerted efforts of stakeholders at all levels of the healthcare system.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

An ambispective cohort study on treatment outcomes of patients with epilepsy in a tertiary epilepsy center in Rwanda and recommendations for improved epilepsy care

Steenkiste

Sebera²,

Nsanzabaganwa³

et al. 2019

Epilepsia Open

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“…Furthermore, a disease duration less than 10 years [58], an advanced disease [58], and the presence of comorbidities [39], in particular depression [16], contributed to nonadherence. Patients' experiences with side effects [66] or a lack of symptom control [61] and low satisfaction with health care [67] had shown to affect adherence. Likewise, patients were more often nonadherent if they expressed concerns about drug treatment [39] or felt stigmatized by the disease [66].…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…Patients' experiences with side effects [66] or a lack of symptom control [61] and low satisfaction with health care [67] had shown to affect adherence. Likewise, patients were more often nonadherent if they expressed concerns about drug treatment [39] or felt stigmatized by the disease [66]. Similarly, further attitudes like low acceptance of the disease [58] and a lack of interest in drug treatment [68] reduced adherence, as well as otherwise lacking knowledge of disease and drug treatment [61].…”

Section: Patient Characteristicsmentioning

confidence: 99%

Individual factors increasing complexity of drug treatment—a narrative review

Schmidt

Wurmbach

Lampert

et al. 2020

Eur J Clin Pharmacol

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Purpose Complexity of drug treatment is known to be a risk factor for administration errors and nonadherence promoting higher healthcare costs, hospital admissions and increased mortality. Number of drugs and dose frequency are parameters often used to assess complexity related to the medication regimen. However, factors resulting from complex processes of care or arising from patient characteristics are only sporadically analyzed. Hence, the objective of this review is to give a comprehensive overview of relevant, patient-centered factors influencing complexity of drug treatment. Methods A purposeful literature search was performed in MEDLINE to identify potential complexity factors relating to the prescribed drug (i.e. dosage forms or other product characteristics), the specific medication regimen (i.e. dosage schemes or additional instructions), specific patient characteristics and process characteristics. Factors were included if they were associated to administration errors, nonadherence and related adverse drug events detected in community dwelling adult patients. Results Ninety-one influencing factors were identified: fourteen in "dosage forms", five in "product characteristics", twelve in "dosage schemes", nine in "additional instructions", thirty-one in "patient characteristics" and twenty in "process characteristics". Conclusions Although the findings are limited by the non-systematic search process and the heterogeneous results, the search shows the influence of many factors on the complexity of drug treatment. However, to evaluate their relevance for individual patients, prospective studies are necessary.

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“…Adherence is defined as "the extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen." 11 Adherence has been studied in many chronic illnesses, such as HIV infection, 12 hypertension, 13 diabetes, 14 epilepsy, 15 multiple sclerosis 16 and psychiatric disorders. 17 Overall, an average adherence of only 50% is indicated by the World Health Organization among patients with chronic diseases.…”

mentioning

confidence: 99%