Assessing adherence-based quality measures in epilepsy

Goodman, Michael J.; Durkin, Michael J.; Forlenza, Jamie; Ye, Xiangyang; Brixner, Diana I.

doi:10.1093/intqhc/mzs017

Cited by 16 publications

(17 citation statements)

References 14 publications

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“…[6, 8, 9] Non-adherence to AEDs may be especially problematic in the older population. Older patients are at heightened risk for adverse drug effects that could contribute to AED non-adherence [12].…”

Section: Discussionmentioning

confidence: 99%

“…Using the available data on the start date of prescriptions and the number of days the prescriptions were for, we calculated the number of days with at least one AED as the period from the start of the first AED to the last AED in the follow-up excluding any days in between with no AED prescriptions. Non-adherence was defined as a PDC < 0.80 [9]. …”

Section: Methodsmentioning

confidence: 99%

“…Previous studies have reported that 20–60% of adults with epilepsy are non-adherent to their prescribed AED therapy [6, 8, 9]. Some demographic groups may be more likely to have poor adherence and suffer its consequences.…”

Section: Introductionmentioning

confidence: 99%

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Adherence to antiepileptic drugs among diverse older Americans on Part D Medicare

Piper

Richman

Faught

et al. 2017

Epilepsy & Behavior

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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-9 345.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 3,706 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 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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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Adherence to antiepileptic drugs among diverse older Americans on Part D Medicare

Piper

Richman

Faught

et al. 2017

Epilepsy & Behavior

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“…It can lead to increased medical resource utilization and health-care costs along with increased the risk of death. [6]…”

Section: Introductionmentioning

confidence: 99%

Adherence to Antiepileptic Therapy in Adults

Chinnaiyan

Sarala

Nanjappa

2017

Journal of Neurosciences in Rural Practice

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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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“…Duration of topiramate therapy was dichotomized as ≤60 days vs. >60 days. In addition, the medication possession ratio [MPR calculated as: (sum of days supplied) ÷ (days of follow-up)] was categorized using cutoff of 0.90 to determine whether different levels of adherence modified the effect of topiramate use [21]. …”

Section: Methodsmentioning

confidence: 99%

Topiramate Use Does Not Reduce Flares of Inflammatory Bowel Disease

et al. 2014

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Background Additional medications are needed for inflammatory bowel disease (IBD), as existing therapies are incompletely effective and can be costly and toxic. Preclinical studies suggest that topiramate (an anticonvulsant) may have disease-modifying properties in IBD, but its efficacy in humans is unknown. Aim To evaluate whether topiramate use is associated with clinical benefit in IBD patients. Methods We conducted a retrospective cohort study using administrative claims data from the MarketScan databases. Persons with IBD were identified between 2000 and 2010. New users of topiramate were compared with users of other anticonvulsant and anti-migraine medications. The primary outcome was a new prescription for an oral steroid (≥14 days). Secondary outcomes included initiation of biologic agents, abdominal surgery, and hospitalization. Cox proportional hazard modeling was used to adjust for potential confounders. Results We identified 773 new users of topiramate and 956 users of comparator drugs. After adjusting for potential confounders, topiramate use was not associated with the primary outcome of steroid prescriptions (HR 1.14, 95% CI 0.74, 1.73). Results did not differ significantly by IBD subtype. There was no difference between topiramate users and users of comparator drugs with respect to post-exposure initiation of biologic agents (HR 0.93, 95% CI 0.35, 2.52), abdominal surgery (HR 1.22, 95% CI 0.70, 2.12), or hospitalization (HR 0.78, 95% CI 0.49, 1.26). Conclusion In this large US administrative claims study, topiramate use was not associated with markers of IBD flares. These results cast doubt on whether topiramate may be an effective adjunct to current IBD therapy.

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Assessing adherence-based quality measures in epilepsy

Abstract: All the adherence measures defined non-adherent groups that were associated with negative outcomes in epilepsy.

Cited by 16 publications

References 14 publications

Adherence to antiepileptic drugs among diverse older Americans on Part D Medicare

Adherence to antiepileptic drugs among diverse older Americans on Part D Medicare

Adherence to Antiepileptic Therapy in Adults

Topiramate Use Does Not Reduce Flares of Inflammatory Bowel Disease

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