Factors influencing medication adherence after epilepsy surgery

Abstract

Aim. In drug‐responsive epilepsy patients, treatment non‐compliance is a major factor in seizure recurrence, but adherence to prescribed regimens following epilepsy surgery has not been examined. We measured adherence to prescribed antiepileptic drugs (AEDs) after epilepsy surgery and investigated factors influencing treatment non‐compliance. Methods. Postsurgical epilepsy patients (n=214) were monitored for 18.1±8.1 months. Adherence was measured using the Medication Possession Ratio (MPR) self‐report questionnaire, with MPR<0.8 defined as non‐adherence. Results. According to the MPR, 58 patients (27.1%) were non‐adherent after surgery. There were no differences in demographic and clinical variables, such as age (p=0.057, t =−1.925), duration of illness (p=0.597, t=0.530), gender ratio (p=0.714, χ2=0.134), and place of residence (urban vs. rural; p=0.874, χ2=0.025), between adherent and non‐adherent patients. Moreover, adherence was not related to surgical outcome as evaluated by the Engel classification (p=0.635, χ2=1.628) or to the types of AEDs after surgery (p=0.165, χ2=6.530). The most common reasons for non‐adherence were seizure‐free status for an extended period (26.5%), forgetfulness (19.1%), and an inability to buy the drugs locally (18.6%). Conclusion. Adherence to AEDs is improved after epilepsy surgery compared to presurgical estimates, but is still a common and serious problem. Targeted postsurgical management programs and communication strategies are necessary to improve adherence to AEDs after epilepsy surgery.

Detecting Reasons for Nonadherence to Medication in Adults with Epilepsy: A Review of Self-Report Measures and Key Predictors

“…Most of the 36 studies used a cross-sectional design ( n = 24). The others were one each of a longitudinal [ 47 ], retrospective [ 30 ], and community-based [ 22 ] nature. Two studies did not specify the observational design used [ 33 , 48 ], whereas seven provided no information about the study design [ 8 , 20 , 24 , 28 , 32 , 37 , 49 ].…”

“…The following adherence measurement methods were each used in a single study: Adherence Assessment Questionnaire (AAQ) [ 31 ], which assesses patient-related factors (e.g., forgetfulness, intentional modifications, and psychosocial stress) and therapy-associated factors (e.g., side effects); Epilepsy Self-Management Scale (ESMS) [ 49 ], which assesses patient-related factors, therapy-associated factors, and healthcare system factors (e.g., financial problems); Knobel Brief Adherence Questionnaire (KBAQ) [ 24 ], which assesses patient-related factors (e.g., forgetfulness) and therapy-associated factors (e.g., side effects); Malaysian Medication Adherence Scale (MALMAS) [ 35 ], which is derived from the MMAS and assesses patient-associated factors (e.g., forgetting and modifying due to an improvement in wellbeing) and therapy-associated factors (e.g., side-effects); MARS-5 [ 47 ], which assesses patient-related factors to investigate intentional nonadherence Medication Compliance Questionnaire (MCQ) [ 58 ], which assesses patient-related factors (e.g., forgetfulness and psychosocial stress) and therapy-associated factors (e.g., side-effects); Medication Possession Ratio Self-report Questionnaire (MPR) [ 30 ], which provides theming of patient-related factors (e.g., forgetting), beliefs about medication, fear of side-effects, and healthcare-related factors (e.g., costs). …”

“…Medication Possession Ratio Self-report Questionnaire (MPR) [ 30 ], which provides theming of patient-related factors (e.g., forgetting), beliefs about medication, fear of side-effects, and healthcare-related factors (e.g., costs).…”

“…The same principle is applied in the AAQ, which contains eight questions [ 31 ]. For MPR, participants with scores ≥0.8 are considered adherent, whereas those with scores <0.8 are considered nonadherent, with 0.8 being the medication quotient taken to medication prescribed [ 30 ]. Chapman et al [ 49 ] classified participants as adherent or nonadherent using a combination of ESMS and MPR.…”

“…Another dimension of nonadherence involves patient-related factors. These include anxiety [ 29 ], forgetfulness [ 8 , 24 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ], stress [ 21 ], knowledge about the disease and treatment [ 25 , 38 ], and medication beliefs [ 40 ].…”