Abstracts

Rationale: Medication nonadherence results in decreased morbidity, mortality and increased health care utilization. Patient related factors such as limited disease related knowledge, health literacy or reduced cognitive function can contribute to medication nonadherence. Cognitive difficulties are often a common concern among people living with epilepsy, although the extent to which cognitive difficulties in epilepsy contribute to medication nonadherence and healthcare utilization in these patients is not well established.  In this study, we leverage baseline data collected as part of the Home Based Self-Management and Cognitive Training Changes Lives program (HOBSCOTCH-3 RCT) to explore this. We hypothesize that epilepsy patients with higher levels of self-reported cognitive difficulties will have increased levels of medication nonadherence and healthcare utilization._x000D_
Methods: A total of 43 subjects consented to participate in HOBSCOTCH Georgia trial. 6 individuals were not included in the analysis because they asked to be removed from the study after consenting and, thus, data from 37 subjects were included in this analysis.  Prior to any intervention, patients completed baseline surveys which included (1) demographic data (2) medical history (3) cognitive function, measured through Quality of Life in Neurological Disorders (Neuro-QOL) v2.0-Cognitive Function form (4) medication adherence, measured through the medication adherence rating scale (MARS), and (5) health care utilization (HCU), measured through number of occurrences in the past 6 months for physician visits, emergency room visits, and overnight hospital stays. Data was collected and stored in REDCap research database.  Descriptive statistics and correlations between Neuro-QOL and MARS and HCU were computed using SAS 9.4._x000D_
Results: Demographic data is reported in Table 1. The mean age of subjects was 47.  Most subjects (70.2%) identified as female (Table 1). 59.5% of subjects identified as white, 37.8% as black and 88.9% as non-Hispanic. About half of the participants (51.4%) reported an income of greater than $50,000 per year and all participants had some form of health insurance. At baseline, the average Neuro-QOL score was 56.6 (theoretical maximum of 140). The average MARS score was 3.08 (theoretical maximum of 8). Participants averaged 2.9 physician visits, 0.2 ER visits and 0.05 overnight hospital visits over the past 6 months. The correlation matrix (Table 2) showed a negative correlation between ER visits and cognitive function (r=-0.341) and between medication nonadherence and cognitive function (r=-0.304)._x000D_ _x000D_ Conclusions: These findings support the hypothesis that higher levels of self-reported cognitive difficulties correlate to increased medication nonadherence and healthcare utilization for emergency room visits. Health systems should assess for cognitive difficulties and assist patients with epilepsy and their caregivers.  This could include providing available resources and referrals to self-management programs which help support medication adherence education and behaviors to potentially lower HCU.

Funding: CDC, 19-002 U48DP006377