Abstracts

RATIONALE: Medications are the most common treatment for epilepsy with regimens that vary from once per day dosing to several pills several times per day. More complex regimens have been associated with lower adherence rates. To date medication complexity has been measured by the number of pills and the number of times per day the pills are taken. However, complexity also includes special instructions (e.g., take at a separate time than other medications) and the specific administrative actions (e.g., take pill). The purpose of this presentation is to describe the development of an instrument designed to measure the complexity associated with epilepsy treatment regimens. The medication complexity tool developed by Kelly for use with the elderly was modified. The Epilepsy Medication and Treatment Complexity Index (EMTCI) is composed of four sections: name of medication, dosing schedule, special instructions, and administration actions. Points are given for dosing schedules, special instructions, and administrative actions. A total complexity score is calculated by adding points for each section.
METHODS: The development of the EMTCI included a review by epilepsy experts. It was then subjected to pilot testing among people with epilepsy followed by revisions. Three rounds of interrater reliability testing was conducted. (Kendall[ssquote]s coefficient of concordance (W); Round 1 W=.927; Round 2, W=.948; Round 3, W=.975). Next the EMTCI was administered to adults with epilepsy as part of a larger study of self-management in people with epilepsy recruited from two epilepsy centers (Atlanta and Boston). Data analysis will be conducted and presented for total sample of approximately 300 participants. Analysis of the first 156 baseline assessments is presented below.
RESULTS: Results: Participants range in age from 19-75 (mean=42). The sample is 59% female and 84% white. The mean number of medications per regimen was 1.93, SD=1.06 (range 1 to 6). Lamotrigine was the medication taken most frequently (n=42, 26.9%), followed by Phenytoin (n=37, 23.7%). Tiagabine and Ethosuxamide were the most complex medications, both with mean complexity scores of 10.5 (SD=4.8 and 0.7, respectively). The mean total complexity score was utilized to perform cross tabulations with chi-square analysis for total medication complexity by age, sex, race, income, and study site. No significant proportional differences were found within any of these variables.
CONCLUSIONS: The EMTCI is a reliable and valid tool to describe the medication complexity of epilepsy medication regimens in much greater detail than has been done previously for this population. This information will be useful in describing the treatment and adherence issues for persons with epilepsy.
Support: NINR, R01 NR04770