Abstracts

Rationale: Imperfect adherence is by far the most common cause of preventable seizures in people with epilepsy (PWE) and is believed to have a greater impact on seizure control than any specific AED adjustment. At our center the patient population is primarily of low socioeconomic status (SES), and Caribbean-American and African-American. This population group is understudied in adherence research in general, and in adherence research in PWE specifically. Factors contributing to non-adherence, and therefore interventions to improve adherence, are likely to differ between patients of different SES, culture, and ethnicity.

To research adherence an objective measure is necessary, and several exist, e.g. medication event monitoring system (MEMS) devices, pill counts, and smart phone apps. Each of these measures has its own advantages and disadvantages. In 2013 New York State established a required prescription monitoring program (NYS PMP) for scheduled drugs, including several AEDs (e.g. benzodiazepines including clobazam, brivaracetam, cenobamate, lacosamide, phenobarbital). Pharmacies are required to report, for all patients prescribed scheduled drugs, the date a prescription was filled and the number of pills dispensed. To our knowledge the NYS PMP Registry has not yet been used as an objective measure of medication adherence.

Methods: 27 adult patients taking at least one scheduled AED were prospectively enrolled from epilepsy clinics at our center. Demographic and clinical data, perceived barriers to adherence, a validated self-report of adherence over the past 4 weeks (from ‘1-very poor’ to ‘6-excellent’) and data from the NYS PMP Registry for all scheduled AEDs were recorded. If patients were taking > 1 scheduled AED the medication prescribed first was used for the analysis. We used the NYS PMP data to record the dates of prescription refills and the number of pills dispensed going back a maximum of six months.

Results: Two subjects were excluded because their pharmacies were not reporting prescription data to the State Registry. Of the remaining 25 subjects (age range 25 – 66) the NYS PMP data revealed the mean number of days per month without medication to be 7.4 (range 0 – 27). There was a significant correlation between self-reported adherence for the past month and objective adherence (Pearson correlation, p = .036). The most frequently cited barriers to adherence were forgetfulness (17 patients), followed by physical separation from the medication when it was due to be taken, and “business.”

Conclusions: The NYS PMP Registry of scheduled AEDs provides a unique objective measure of adherence, and revealed clinically significant nonadherence among the majority of our low SES minority patients. The objective data correlated significantly with a subjective adherence measure. Health-care providers can use PMP registries on an ongoing basis to monitor adherence and educate patients. These data can be used to help design and monitor the effectiveness of education and interventions to improve adherence.

Funding: Please list any funding that was received in support of this abstract.: None.