An Evaluation of Medication Adherence and Self-Managment Techniques in Patients with Epilepsy

Abstract

RATIONALE: Comprehensive treatment of epilepsy involves many facets including self-management behaviors. The most common self-management strategy is adherence to an Antiepileptic Drug (AED) regimen. Controlling other non-drug related factors, such as management of information, concern for personal safety, management of the seizures themselves, and lifestyle issues may play an equal or greater role in the overall success of epilepsy therapy than does adherence to patients’ medication regimen. The purpose of this study was to determine the relationship between the self-management behaviors and clinical outcomes.

METHODS: Adult epilepsy patients whom were able complete the surveys by themselves and had been taking AED therapy for at least 6 months were recruited from The Ohio State University Medical Center’s outpatient epilepsy clinic for this cross-sectional, descriptive study. We used two previously-validated surveys to assess various self-management behaviors. Morisky’s four-item self-reported adherence measure (not epilepsy-specific) and DiIorio’s 38-item scale that assesses frequency of use of epilepsy self-management practices were administered to a convenience sample of patients. We also collected clinical (seizure activity, number of AEDs and presence of toxicity) and demographic information. The response to the Morisky questions provides a score ranging from 1 to 4. A score of 0 or 1 categorizes the patient in the low medication-taking behavior group, a score of 2 or 3 is medium and 4 is high medication-taking behavior. On the Epilepsy Self-Management scale (ESMS), each item is rated on a 5-point scale ranging from 1=Never to 5=Always. Higher sores indicate more frequent use of self-management strategies. In addition, this scale can be divided into 5 subscales that address patient management of medication, information, safety, seizure and lifestyle. Patients were grouped into three categories based on their seizure frequency (seizure-free, <1 seizure per week and >1 seizure per week).

RESULTS: A sample of fifty patients (23 women) was recruited from the Medical Center’s Comprehensive Epilepsy Program. Their average age is 40.2 yrs (range 20-70). Their monthly seizure burden ranged from seizure-free (n=23) to “daily” seizures. Patients were taking an average of 1.64 AEDs (range 1-4) as well as other prescription medications (mean=4.05 ± 3.39). Most of the patients (n=34) reported no toxicity at their clinic visit. Based on their Morisky Score, patients fell into either the Low (n=2), Medium (n=27) or High (n=21) medication-taking behavior categories. The mean overall ESMS score was 3.72 ± 0.41. The ESMS subscale scores for patient management of medication, information, safety, seizure and lifestyle were 4.42, 2.65, 3.93, 4.00 and 2.62, respectively. The Morisky and ESMS medication management subscale scores correlated with each other. Medication taking behavior did not solely predict positive therapeutic outcomes. Patients scored the lowest on the information and lifestyle management subscale scores.

CONCLUSION: In our convenience sample of patients with epilepsy, we have found that self-management skills, beyond medication-taking behaviors, should be an area of emphasis during patient interactions.