Abstracts

Rationale: Experience has demonstrated that when epilepsy patients are given advice about changes to their drug regimen, only a portion follow it. The objective of this project was to determine why epilepsy patients do or do not follow suggested advice to change their drug therapy.Methods: A brief survey about decision-making was developed. Adult epilepsy patients who were able to complete the survey, were taking at least one antiepileptic drug and had at least one change to their current drug regimen at their routine clinic visit were asked to be part of this cross-sectional study. Four weeks after their clinic visit where a drug regimen change was recommended, patients were sent a survey to be completed anonymously. The survey asked about the prescriber-recommended drug regimen changes (dose increase/decrease, drug added, folic acid supplementation, etc), whether the patient followed that advice, and the main reason(s) why they did or did not follow the advice. Patients were also asked about facilitators and barriers in making drug changes. For every completed survey, $5 was donated to the Epilepsy Foundation of Central Ohio by the investigators.Results: To date, 60 patients have been recruited with 55 survey invitations sent out. One mailed survey was returned undeliverable. Thirty responses have been received for a response rate of 55.5%. Most patients were female (71%) with an average age of 41.3 years. One-third of the patients were on AED monotherapy. Patients had varying degrees of seizure burden (33% with seizures in the last 30 days, 37% with seizures between 1 and 6 months ago and 30% with no seizures in the last 6 months. Nearly all (27/30, 90%) respondents reported that they DID follow the suggested advice for changes in their drug regimen. Most of the main reasons reported were to have less seizures (32%), less side effects (27%) or I trust my practitioner (28%). When asked about aspects of care that facilitated following suggested changes, many respondents chose they are Epilepsy specialists (n=25), they took time to listen (n=23), they have my best interest in mind (n=21) and they took time to explain the changes (n=20). Only a few barriers to change were identified with the most prevalent one being cost. Of the 3 patients who stated they DID NOT follow the prescriber s advice, the primary reason was concern over side effects (n=2). Patient recruitment is ongoing. The entire dataset (100 patients) will be presented at the meeting. Study limitations include less than complete response, incomplete data from those that responded, a cross-sectional approach, the use of a non-validated survey, and all the data collected are from patients seen at a single Epilepsy Center.Conclusions: By asking patients to provide anonymous feedback, we have learned that 'being heard by' and 'trust in' their epilepsy specialist along with the desire to lessen seizures and side effects have great influence in patient decision making regarding changes to drug therapy. We know more about facilitators and barriers and plan to use this knowledge to continue to improve patient care in our Epilepsy Center.