Early Dropout or Intervention Discontinuation (DD) Among Individuals with Epilepsy Participating in Epilepsy Self-Management Research Interventions
Abstract number :
3.367
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2021
Submission ID :
1826573
Source :
www.aesnet.org
Presentation date :
12/6/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:55 AM
Authors :
Martha Sajatovic, MD - Case Western Reserve University School of Medicine; Farren Briggs – Case Western Reserve University School of Medicine; Brittany Brownrigg – Case Western Reserve University School of Medicine; Kaylee Sarna – Case Western Reserve University School of Medicine; Tanya Spruil – New York University School of Medicine; Barbara Jobst – Geisel School of Medicine at Dartmouth; Elaine Kiriakopoulos – Geisel School of Medicine at Dartmouth; Cam Escoffery – Emory University; Erica Johnson – University of Washington; Robert Fraser – University of Washington; Mary Janevic – University of Michigan
Rationale: The Managing Epilepsy Well (MEW) Network, collectively, has over a decade of epilepsy self-management intervention development and testing and archival clinical trials data from the MEW Network integrated database (MEW DB) comprising over 1,800 individuals with epilepsy. In spite of developing, and now scaling up, multiple effective MEW Network self-management approaches, not all individuals with epilepsy are able to benefit from these evidence-based interventions due to dropping out of or prematurely discontinuing program participation. This analysis used MEW DB self-management clinical trials data to identify demographic and clinical predictors of intervention dropout.
Methods: Studies were included in the sample if; 1.) they were prospective trials testing an epilepsy self-management (ESM) intervention, 2.) results included baseline assessment and at least one post-intervention assessment, 3.) data on the early study termination time-point for each intervention or intervention arm was available and corresponded to a pre-set study assessment time. ESM interventions tested in the sample were SMART, TIME, PACES, HOBSCOTCH, UPLIFT and FOCUS. Dependent variables were all-cause drop out or discontinuation (DD), categorized as a binary variable (DD yes, DD no) and time to DD categorized as the ordinal categories of the interval between baseline and follow-up visit 1 (V1) and visit two (V2). Follow up visit time-points were harmonized for V1 (on/around 12 weeks) and V2 (on/around 24 weeks). Time-to-event (DD) was modeled using Kaplan-Meier estimation. A Cox proportional hazard model was fit on the same time-to-event, to assess what variables might be affecting dropout. Explanatory variables included age, gender, race/ethnicity, greater depressive symptom severity and higher seizure frequency.
Results: In this interim analysis of DD data, there were 6 MEW DB studies that fit inclusion criteria with a total of 627 people with epilepsy, including 330 in pooled study ESM arm and 294 in pooled study control arm. In the combined 6- month/V2 sample (n=526), there were 98 (16%) of individuals who did not complete study visit and were classified in the DD category, 59 in ESM arm (60% total DD) and 39 (40% total DD) in the control arm.
Conclusions: In spite of the growing and positive evidence-base for ESM, some individuals do not remain engaged. While overall retention is high in ESM clinical trials, individuals at high risk of dropping out of ESM programs may need additional or different approaches to help them access and benefit from care.
Funding: Please list any funding that was received in support of this abstract.: U.S. Centers for Disease Control and Prevention (CDC).
Health Services (Delivery of Care, Access to Care, Health Care Models)