Abstracts

Rationale: There are few studies assessing non-adherence to treatment in epilepsy. Partial or non-adherence (missing or stopping doses) can result in seizures and contribute to impaired quality of life and productivity. The purpose of this study is to assess neurologist and patient perceptions of adherence, factors underlying adherence, and treatment decisions due to non-adherence. The impact of non-adherence on the physician-patient relationship was also examined. Methods: Two cross-sectional surveys were conducted among adults with epilepsy and neurologists currently treating patients with epilepsy. Respondents with epilepsy were recruited from the Harris Interactive chronic illness panel and qualified with a diagnosis of epilepsy, currently taking an AED, and aged 18 - 64 years. These data were weighted to represent the general population of patients with epilepsy in the US. Physicians were recruited from the Harris Interactive Physician Panel, and the AMA master list with the following qualifying criteria: must be a neurologist or epileptologist; practicing at least 2 years; spend at least 50% of time in direct patient care; and treat patients for epilepsy or seizure disorder. Data were collected on seizure control, rates of adherence, and reasons for non-adherence. Results: Data were analyzed from 408 adults with epilepsy and 175 neurologists. Patients were 51% male, a mean age of 43, and 81% white. Neurologists were 85% male, practicing a mean of 14.6 years, and a mean of 92.5% of time in direct patient care. When asked about taking AEDs more or less often or same as prescribed in the past month, 84% of patients reported taking medication as prescribed when compared to 76% neurologists reporting on behalf of patients (p<0.05), however both reported similar rates of partial adherence. When asked to rank the most important reasons for non-adherence, both patients (72%) and neurologists (70%) cited forgetfulness or not having medication as the primary reason. Importantly, patients differed from neurologists in ranking respectively, cost (13% vs. 43%, p<0.05), side effects (9% vs. 60%, p<0.05), and dosing (3% vs. 33%, p<0.05) as secondary reasons for missing medication. Following loss of seizure control, patients and neurologists differed in citing top 3 actions taken: 70% of patients vs. 41% neurologists reported changing dosing (p<0.05); 61% reported switch to a new medication vs. 20% (p<0.05); and 56% cited adding a new medication vs. 21% (p<0.05). When asked about comfort level in discussing missing medications, 66% of patients reported having talked to a neurologist about adherence, whereas 57% of neurologists cited that their patients were comfortable discussing adherence (p<0.05). Conclusions: These findings indicate that neurologists and patients may consider adherence differently. Targeted programs and communication strategies are necessary to improve adherence involving patients, families, and physicians in order to avoid clinical consequences of poor seizure control and to improve overall patient care. (Sources of funding: GlaxoSmithKline)