Adherence to antiepileptic medicines in children: A multiple-methods assessment involving dried blood spot sampling

Noraida Mohamed Shah, Ahmed F. Hawwa, Jeff S. Millership, Paul S. Collier, Paul Ho, Mui Ling Tan, Deidre Peake, Sandya Tirupathi, Janice Bothwell, Nicola Bailie, Charles Shepherd, John Craig, James C. McElnay

Research output: Contribution to journalArticle

Abstract

Purpose: To evaluate adherence to prescribed antiepileptic drugs (AEDs) in children with epilepsy using a combination of adherence-assessment methods.
Methods: A total of 100 children with epilepsy (=17 years old) were recruited. Medication adherence was determined via parental and child self-reporting (=9 years old), medication refill data from general practitioner (GP) prescribing records, and via AED concentrations in dried blood spot (DBS) samples obtained from children at the clinic and via self- or parental-led sampling in children's own homes. The latter were assessed using population pharmacokinetic modeling. Patients were deemed nonadherent if any of these measures were indicative of nonadherence with the prescribed treatment. In addition, beliefs about medicines, parental confidence in seizure management, and the presence of depressed mood in parents were evaluated to examine their association with nonadherence in the participating children.
Key Findings: The overall rate of nonadherence in children with epilepsy was 33%. Logistic regression analysis indicated that children with generalized epilepsy (vs. focal epilepsy) were more likely (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.37-15.81) to be classified as nonadherent as were children whose parents have depressed mood (OR 3.6, 95% CI 1.16-11.41).
Significance: This is the first study to apply the novel methodology of determining adherence via AED concentrations in clinic and home DBS samples. The present findings show that the latter, with further development, could be a useful approach to adherence assessment when combined with other measures including parent and child self-reporting. Seizure type and parental depressed mood were strongly predictive of nonadherence.
Original languageEnglish
Pages (from-to)1020-1027
Number of pages8
JournalEpilepsia
Volume54
Issue number6
Early online date28 Feb 2013
DOIs
Publication statusPublished - Jun 2013

Fingerprint

Anticonvulsants
Epilepsy
Seizures
Parents
Odds Ratio
Confidence Intervals
Generalized Epilepsy
Medication Adherence
Partial Epilepsy
General Practitioners
Pharmacokinetics
Logistic Models
Regression Analysis

Bibliographical note

Copyright 2013 Elsevier B.V., All rights reserved.

Cite this

Shah, Noraida Mohamed ; Hawwa, Ahmed F. ; Millership, Jeff S. ; Collier, Paul S. ; Ho, Paul ; Tan, Mui Ling ; Peake, Deidre ; Tirupathi, Sandya ; Bothwell, Janice ; Bailie, Nicola ; Shepherd, Charles ; Craig, John ; McElnay, James C. / Adherence to antiepileptic medicines in children: A multiple-methods assessment involving dried blood spot sampling. In: Epilepsia. 2013 ; Vol. 54, No. 6. pp. 1020-1027.
@article{fc87e4e4e21844b992aa267cc812b806,
title = "Adherence to antiepileptic medicines in children: A multiple-methods assessment involving dried blood spot sampling",
abstract = "Purpose: To evaluate adherence to prescribed antiepileptic drugs (AEDs) in children with epilepsy using a combination of adherence-assessment methods. Methods: A total of 100 children with epilepsy (=17 years old) were recruited. Medication adherence was determined via parental and child self-reporting (=9 years old), medication refill data from general practitioner (GP) prescribing records, and via AED concentrations in dried blood spot (DBS) samples obtained from children at the clinic and via self- or parental-led sampling in children's own homes. The latter were assessed using population pharmacokinetic modeling. Patients were deemed nonadherent if any of these measures were indicative of nonadherence with the prescribed treatment. In addition, beliefs about medicines, parental confidence in seizure management, and the presence of depressed mood in parents were evaluated to examine their association with nonadherence in the participating children. Key Findings: The overall rate of nonadherence in children with epilepsy was 33{\%}. Logistic regression analysis indicated that children with generalized epilepsy (vs. focal epilepsy) were more likely (odds ratio [OR] 4.7, 95{\%} confidence interval [CI] 1.37-15.81) to be classified as nonadherent as were children whose parents have depressed mood (OR 3.6, 95{\%} CI 1.16-11.41). Significance: This is the first study to apply the novel methodology of determining adherence via AED concentrations in clinic and home DBS samples. The present findings show that the latter, with further development, could be a useful approach to adherence assessment when combined with other measures including parent and child self-reporting. Seizure type and parental depressed mood were strongly predictive of nonadherence.",
author = "Shah, {Noraida Mohamed} and Hawwa, {Ahmed F.} and Millership, {Jeff S.} and Collier, {Paul S.} and Paul Ho and Tan, {Mui Ling} and Deidre Peake and Sandya Tirupathi and Janice Bothwell and Nicola Bailie and Charles Shepherd and John Craig and McElnay, {James C.}",
note = "Copyright 2013 Elsevier B.V., All rights reserved.",
year = "2013",
month = "6",
doi = "10.1111/epi.12126",
language = "English",
volume = "54",
pages = "1020--1027",
journal = "Epilepsia",
issn = "0013-9580",
publisher = "Wiley-Blackwell",
number = "6",

}

Shah, NM, Hawwa, AF, Millership, JS, Collier, PS, Ho, P, Tan, ML, Peake, D, Tirupathi, S, Bothwell, J, Bailie, N, Shepherd, C, Craig, J & McElnay, JC 2013, 'Adherence to antiepileptic medicines in children: A multiple-methods assessment involving dried blood spot sampling', Epilepsia, vol. 54, no. 6, pp. 1020-1027. https://doi.org/10.1111/epi.12126

Adherence to antiepileptic medicines in children: A multiple-methods assessment involving dried blood spot sampling. / Shah, Noraida Mohamed ; Hawwa, Ahmed F.; Millership, Jeff S.; Collier, Paul S.; Ho, Paul; Tan, Mui Ling; Peake, Deidre; Tirupathi, Sandya; Bothwell, Janice; Bailie, Nicola; Shepherd, Charles; Craig, John; McElnay, James C.

In: Epilepsia, Vol. 54, No. 6, 06.2013, p. 1020-1027.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Adherence to antiepileptic medicines in children: A multiple-methods assessment involving dried blood spot sampling

AU - Shah, Noraida Mohamed

AU - Hawwa, Ahmed F.

AU - Millership, Jeff S.

AU - Collier, Paul S.

AU - Ho, Paul

AU - Tan, Mui Ling

AU - Peake, Deidre

AU - Tirupathi, Sandya

AU - Bothwell, Janice

AU - Bailie, Nicola

AU - Shepherd, Charles

AU - Craig, John

AU - McElnay, James C.

N1 - Copyright 2013 Elsevier B.V., All rights reserved.

PY - 2013/6

Y1 - 2013/6

N2 - Purpose: To evaluate adherence to prescribed antiepileptic drugs (AEDs) in children with epilepsy using a combination of adherence-assessment methods. Methods: A total of 100 children with epilepsy (=17 years old) were recruited. Medication adherence was determined via parental and child self-reporting (=9 years old), medication refill data from general practitioner (GP) prescribing records, and via AED concentrations in dried blood spot (DBS) samples obtained from children at the clinic and via self- or parental-led sampling in children's own homes. The latter were assessed using population pharmacokinetic modeling. Patients were deemed nonadherent if any of these measures were indicative of nonadherence with the prescribed treatment. In addition, beliefs about medicines, parental confidence in seizure management, and the presence of depressed mood in parents were evaluated to examine their association with nonadherence in the participating children. Key Findings: The overall rate of nonadherence in children with epilepsy was 33%. Logistic regression analysis indicated that children with generalized epilepsy (vs. focal epilepsy) were more likely (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.37-15.81) to be classified as nonadherent as were children whose parents have depressed mood (OR 3.6, 95% CI 1.16-11.41). Significance: This is the first study to apply the novel methodology of determining adherence via AED concentrations in clinic and home DBS samples. The present findings show that the latter, with further development, could be a useful approach to adherence assessment when combined with other measures including parent and child self-reporting. Seizure type and parental depressed mood were strongly predictive of nonadherence.

AB - Purpose: To evaluate adherence to prescribed antiepileptic drugs (AEDs) in children with epilepsy using a combination of adherence-assessment methods. Methods: A total of 100 children with epilepsy (=17 years old) were recruited. Medication adherence was determined via parental and child self-reporting (=9 years old), medication refill data from general practitioner (GP) prescribing records, and via AED concentrations in dried blood spot (DBS) samples obtained from children at the clinic and via self- or parental-led sampling in children's own homes. The latter were assessed using population pharmacokinetic modeling. Patients were deemed nonadherent if any of these measures were indicative of nonadherence with the prescribed treatment. In addition, beliefs about medicines, parental confidence in seizure management, and the presence of depressed mood in parents were evaluated to examine their association with nonadherence in the participating children. Key Findings: The overall rate of nonadherence in children with epilepsy was 33%. Logistic regression analysis indicated that children with generalized epilepsy (vs. focal epilepsy) were more likely (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.37-15.81) to be classified as nonadherent as were children whose parents have depressed mood (OR 3.6, 95% CI 1.16-11.41). Significance: This is the first study to apply the novel methodology of determining adherence via AED concentrations in clinic and home DBS samples. The present findings show that the latter, with further development, could be a useful approach to adherence assessment when combined with other measures including parent and child self-reporting. Seizure type and parental depressed mood were strongly predictive of nonadherence.

UR - http://www.scopus.com/inward/record.url?partnerID=yv4JPVwI&eid=2-s2.0-84874377004&md5=014b31088d47d9e5294e2ca006b36786

U2 - 10.1111/epi.12126

DO - 10.1111/epi.12126

M3 - Article

AN - SCOPUS:84874377004

VL - 54

SP - 1020

EP - 1027

JO - Epilepsia

JF - Epilepsia

SN - 0013-9580

IS - 6

ER -