Abstracts

Rationale: To examine beliefs about medication and the association between treatment perceptions and adherence to antiepileptic drugs (AEDs) among people with epilepsy (PWE). Methods: Thirty-four patients attending sub-specialty epilepsy clinics at SUNY Downstate Medical Center in Brooklyn, NY completed standardized questionnaires. The Beliefs about Medicines Questionnaire (BMQ) was used to assess perceptions about AEDs and medications in general. The Morisky 4-item scale was used to assess treatment adherence. Patients also rated their recent ability to take their AEDs as prescribed. Data analyses for this preliminary study focused on effect size estimates from t-test and Pearson’s correlations, as appropriate. Results: Participants (16 male; mean age 44, range 20-66) were predominantly minority (74% African American or African Caribbean, 18% White, 8% other; 24% Hispanic). 79% of patients were unemployed, 50% had an annual household income < $10,000 and 29% did not complete high school. Based on accepted criteria, 68% percent of subjects were nonadherent to AEDs. Reasons for nonadherence included forgetfulness (56%) and carelessness (27%). 15% of subjects reported stopping AEDs when feeling better and 12% when they feel worse. A medium effect size was found for the relationship between seizure frequency and medication adherence (r=-0.27); however, this fell short of significance due to small sample size. Patients with low ratings of adherence to AEDs had beliefs about medications that were significantly different from those with high ratings of adherence, in that they expressed stronger beliefs that medications may be intrinsically harmful (r=-0.41; p=0.02). Agreement with the statement “most medicines are poisons” significantly correlated with nonadherence (r=-0.41, p=0.02). Lower AED adherence ratings were also significantly associated with stronger beliefs that medicines have minimal benefits (r=0.35; p=0.05). In addition, PWE experiencing more frequent seizures tended to perceive less benefit of medications in general (r=-0.27), although this association did not reach significance. There was also a tendency among patients with higher self-reported nonadherence on the Morisky scale to view medicines in general as being overused by physicians (r=0.29). The relationship between concerns with regard to AED use and lower adherence ratings approached a medium effect size (r=-0.22). The expected relationship between stronger beliefs in the necessity of AEDs and higher levels of adherence was not found. Conclusions: Our findings indicate a high rate of AED nonadherence among economically disadvantaged, predominantly minority PWE. Misconceptions about medicines were common and were significantly associated with low AED adherence. In addition, many patients reported forgetfulness as a barrier to adherence. These findings suggest that a behavioral intervention addressing modifiable factors such as forgetfulness and misconceptions about medications may result in increased treatment adherence and improved seizure control in PWE. (Supported in part by NINDS K23NS46347 to ACG)