Strategies for improving adherence to antiepileptic drug treatment in patients with epilepsy

Al-Aqeel, Sinaa; Al-sabhan, Jawza

doi:10.1002/14651858.cd008312.pub2

Cited by 33 publications

(14 citation statements)

References 59 publications

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“…Following the title and abstract screening, 12 articles were screened for eligibility, four of which were included into the epilepsy quantitative meta-review [162][163][164][165] ( Figure 30). All four were Cochrane reviews published between 2008 and 2011.…”

Section: Systematic Reviews Identifiedmentioning

confidence: 99%

“…Al-aqueel and Al-sabhan's 162 review of interventions to improve adherence to antiepileptic medication report promising findings from a single study. An implementation intention intervention (which involves the completion of a simple worksheet by patients, linking the intention of taking medication with a particular time, place and other routine activity) was found to be effective in enhancing medication adherence.…”

Section: Medication Adherencementioning

confidence: 99%

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A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

344

451

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BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Systematic Reviews Identifiedmentioning

confidence: 99%

Section: Medication Adherencementioning

confidence: 99%

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

344

451

View full text Add to dashboard Cite

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“…The studies showed that compared to controls, people who form implementation intentions in the form of if-then plans achieve better outcomes on medication adherence in epilepsy and stroke [51,65], physical capacity in chronic back pain (when combined with Mental Contrasting & Cognitive Behavioural Therapy) [60], but not physical activity in obese older adults. The study by Brown et al [51] was also included in a recent systematic review of behavioural change strategies aimed at improving adherence to antiepileptic medications in adults and children with epilepsy [67]. Strategies reviewed included implementation intentions, motivational interviewing, and intensive reminders and concluded that only implementation intentions and intensive reminders were promising in enhancing adherence to antiepileptic medications [67].…”

Section: Discussionmentioning

confidence: 99%

Bridging the gap between goal intentions and actions: a systematic review in patient populations

Kersten¹,

McCambridge²,

Kayes³

et al. 2014

Disability and Rehabilitation

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Purpose: To evaluate the evidence for the effectiveness of if-then implementation intentions (if-then plans) in adult patient populations. Outcomes of interest included adherence, goal pursuit and physical health outcomes.Method: Keywords were used to search electronic databases without date or language restrictions (up to 30/4/14). Studies were included if they 1) concerned a patient population; 2) used if-then plans as a sole intervention or as part of treatment, therapy or rehabilitation; 3) if they were randomised controlled trials. The PEDro scale was used to evaluate study quality. Guidance as set out by the Cochrane Collaboration was used. Two reviewers independently extracted data, discrepancies were discussed and if required referred to a third reviewer.Results: 18 of 2,141 articles were identified as potentially relevant and four studies of people with epilepsy, chronic back pain, stroke and obesity met the inclusion criteria. People who form if-then plans achieved better outcomes on epilepsy and stroke medication adherence and physical capacity than controls. Conclusions:Of the four studies that used an if-then plan only one, with people with epilepsy, looked at the intervention as a stand-alone strategy. Further research needs to explore if this simple approach improves rehabilitation outcomes and is a helpful and feasible strategy for people experiencing disabilities.

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“…The Cochrane review noted that the studies included differed widely according to intervention and measures of adherence and combining data in a meta-analysis was not deemed to be appropriate [13]. The review also highlighted methodological limitations increasing the risk of bias, and limitations in reporting that reduce transparency.…”

Section: Study Selectionmentioning

confidence: 99%

“…A Cochrane review of trials of adherence-enhancing interventions for epilepsy [13] identified behavioural interventions, such as the use of intensive reminders (e.g. prescription refill and appointment-keeping reminders) [14], and implementation intention interventions (where patients note when and where they intend to take their AEDs, and what they would be doing at the moment they will take their medications) [15], to provide more positive effects on adherence than interventions based on education and counselling.…”

Section: Introductionmentioning

confidence: 99%

Economic evaluation of a behavior-modifying intervention to enhance antiepileptic drug adherence

Plumpton

Brown

Reuber

et al. 2015

Epilepsy & Behavior

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Between 35% and 50% of patients with epilepsy are reported not to be fully adherent to their medication schedule. We aimed to conduct an economic evaluation of strategies for improving adherence to antiepileptic drugs. Based on the findings of a systematic review, we identified an implementation-intention intervention (specifying when, where and how to act) which was tested in a trial that closely resembled current clinical management of patients with epilepsy, and which measured adherence with an objective and least biased method. Using patient-level data, trial patients were matched to those recruited to the Standard And New Antiepileptic Drugs trial, according to their clinical characteristics and adherence. Generalised linear models were used to adjust cost and utility in order to estimate the incremental cost per quality-adjusted life-year (QALY) gained from the perspective of the National Health Service in the UK. The mean cost of the intervention group, £1,340 (95% CI £1,132, £1,688) was marginally lower than that of the control group representing standard care £1,352 (95% CI £1,132, £1,727). QALYs in the intervention group were higher than the control, 0.75 (95% CI 0.70, 0.79), compared with 0.74 (95% CI 0.68, 0.79), U"T that the intervention is cost effective at a threshold of £20,000 per QALY is 94%. Our analysis lends support to the cost-effectiveness of a self-directed, implementation-intention intervention for improving adherence to antiepileptic drugs. However, as with any modeling dependent on limited data on efficacy, there is considerable uncertainty surrounding the clinical effectiveness of the intervention which would require a substantive trial for a more definitive conclusion.

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Strategies for improving adherence to antiepileptic drug treatment in patients with epilepsy

Cited by 33 publications

References 59 publications

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Bridging the gap between goal intentions and actions: a systematic review in patient populations

Economic evaluation of a behavior-modifying intervention to enhance antiepileptic drug adherence

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