Adherence to medicines and self-management of epilepsy: a community-based study.

This community-based survey of people with epilepsy who were divided into adherent and non-adherent groups used validated scales to determine factors associated with medicine non-adherence and self-management of epilepsy to identify those people at risk of poor self-management behavior or medicines non-adherence. Using demographic characteristics, it is possible to identify those people at risk during a regular epilepsy review. Adults with epilepsy were identified from general practices using clinical and drug searches with the diagnosis confirmed by case notes analysis. Four hundred thirty-eight people with epilepsy were divided into adherent and non-adherent groups using medication records and self-report of non-adherent behavior. Data were also collected on patient demographics, seizure activity and self-management behavior. Low self-management scores and recent seizures were associated with non-adherence. Young adults, those in education or employment, those living with others and those who had recent seizures were more likely to have low self-management scores.

Developing a method to identify medicines non-adherence in a community sample of adults with epilepsy.

The aim is to propose a simple way of identifying patients at risk of antiepileptic drug (AED) non-adherence during epilepsy review (a scheduled consultation to review the patient and their condition). The use of a multi-modal approach to the problem of non-adherence is necessary because of the limitations of existing methods. A mixed methodology was developed in a nested study using a case record review to calculate the medicine possession ratio (MPR) from the AED medication records of a community sample, a literature review and a consensus panel to develop a questionnaire to address how people manage their epilepsy, particularly medicine management, and how to collect information about non-adherence through stated findings in keeping with non-adherent behavior. Results show that a medicine record can be used to estimate the MPR (<80% indicates non-adherence) and that an open and non-confrontational consultation style can be fostered by using key questions within the consultation to identify those at risk of non-adherence.