Abstracts

Rationale: Studies suggest that 30-50% of people with epilepsy do not take their anti-seizure drugs (ASDs) as prescribed. Non-adherence increases risks of injury and death and health care costs. Ethnic minorities and patients with lower socioeconomic status report higher rates of ASD non-adherence. Electronic medication reminders, targeted education and individualized motivational interviewing (MI) can improve medication adherence in other chronic diseases. We examined the feasibility of using mobile health tools and MI to improve ASD adherence in ethnically and socioeconomically diverse adults with epilepsy and self-reported non-adherence. Methods: English or Spanish-speaking adults (≥ 18 yrs) with epilepsy who had self-reported non-adherence were recruited from the NYU Medical Center and Bellevue Hospital Center epilepsy clinics. Patients were randomized to one of three arms: 1) use of a custom smartphone application (APP) that delivered behaviorally-based daily medication reminders and epilepsy self-management tips (text and videos) and allowed subjects to log seizures, mood, and ASD taking for 3 months. 2) custom smartphone application plus 4 telephone MI sessions over 3 months with a certified MI counselor (APP+MI). 3) usual care (UC) received standard printed materials on epilepsy management. Self-reported medication adherence and secondary outcomes of quality of life, depressive symptoms, seizure frequency and severity, and medication beliefs were assessed at baseline and 3 months using validated scales. App usability was assessed at study completion. Group differences in baseline measures were assessed using a Kurskal-Wallis test for continuous variables or chi-square test for proportions. Intervention effects on adherence and secondary outcomes were assessed with mixed model ANOVA. Results: Thirty subjects were enrolled (mean 39.9 ± 12.1 yrs; 66% female, 60% minorities) and 10 subjects each were randomized to the UC, APP and APP+MI groups. There was no significant difference between groups in age, sex, duration of epilepsy, seizure severity or baseline PHQ-9 or adherence scores. Twenty-seven subjects completed the follow-up visit (UC, N=8; APP, N=10; APP+MI=9). APP and APP+MI subjects used the mobile app 85% of study days and APP+MI subjects completed 3.7 ± 0.7 MI sessions. All groups showed improved ASD adherence after 3 months (mean ± SD change in adherence score: UC= -1.1 ± 1.6, APP= -1.9 ± 1.9, APP+MI= -1.3 ± 2.2, F=15, p=0.001) but there was no significant effect of intervention (F= 0.4, p>0.05) and no differences in secondary outcomes between groups. 85.7% of patients in the APP and APP+MI groups stated that they found the medication reminders feature very/somewhat helpful. Conclusions: Our pilot study demonstrated feasibility of delivering mobile health medication reminders and education as well as MI interventions to ethnically and socioeconomically diverse adults with epilepsy and low ASD adherence. However, we did not find a significant effect of these interventions on self-reported adherence compared to usual care. Future studies are needed to identify targeted strategies to improve ASD adherence. Funding: UCB Pharma