One-Month Adherence in Children With New-Onset Epilepsy: White-Coat Compliance Does Not Occur

Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Adherence and Self Management, MLC-3015, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA.
PEDIATRICS (Impact Factor: 5.47). 05/2008; 121(4):e961-6. DOI: 10.1542/peds.2007-1690
Source: PubMed


Adherence to antiepileptic drug therapy plays an important role in the effectiveness of pharmacologic treatment of epilepsy. The purpose of this study was to use an objective measure of adherence to (1) document patterns of adherence for the first month of therapy for children with new-onset epilepsy, (2) examine differences in adherence by demographic and epilepsy variables, and (3) determine whether treatment adherence improves for a short time before a clinic visit (eg, "white-coat compliance").
Participants included 35 children with new-onset epilepsy (mean age: 7.2 years; 34% female; 66% white) and their caregivers. Children had a diagnosis of partial (60%), generalized (29%), or unclassified (11%) epilepsy. Adherence to treatment was electronically monitored with Medication Event Monitoring System TrackCap, starting with the first antiepileptic drug dose. Adherence was calculated across a 1-month period and for the 1, 3, and 5 days before and 3 days after the clinic appointment.
Adherence for the first month of treatment in children with new-onset epilepsy was 79.4%. One-month adherence was higher in children of married parents and those with higher socioeconomic status but did not correlate with child's gender, age, epilepsy type, prescribed medication, seizure frequency, or length of time since seizure onset. Adherence across the entire 1-month period was not different from adherence for the 1, 3, or 5 days before or 3 days after the clinic visit.
Poor adherence seen for children with new-onset epilepsy during the first month of antiepileptic drug therapy is a cause for concern. Several demographic variables influence adherence to treatment, whereas the proximity to a clinic visit does not. Additional studies are needed to document whether this trend continues longitudinally and determine the clinical impact of poor adherence.

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    • "Little is known about the extent of adherence and factors that affect adherence in children with epilepsy. A study in the United States on adherence of 35 children with new-onset epilepsy, over a 1 month period, indicated an adherence level of 79.4%, as assessed using the Medication Event Monitoring System, TrackCap (Modi et al., 2008). "
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    ABSTRACT: To evaluate adherence to prescribed antiepileptic drugs (AEDs) in children with epilepsy using a combination of adherence-assessment methods. A total of 100 children with epilepsy (≤17 years old) were recruited. Medication adherence was determined via parental and child self-reporting (≥9 years old), medication refill data from general practitioner (GP) prescribing records, and via AED concentrations in dried blood spot (DBS) samples obtained from children at the clinic and via self- or parental-led sampling in children's own homes. The latter were assessed using population pharmacokinetic modeling. Patients were deemed nonadherent if any of these measures were indicative of nonadherence with the prescribed treatment. In addition, beliefs about medicines, parental confidence in seizure management, and the presence of depressed mood in parents were evaluated to examine their association with nonadherence in the participating children. The overall rate of nonadherence in children with epilepsy was 33%. Logistic regression analysis indicated that children with generalized epilepsy (vs. focal epilepsy) were more likely (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.37–15.81) to be classified as nonadherent as were children whose parents have depressed mood (OR 3.6, 95% CI 1.16–11.41). This is the first study to apply the novel methodology of determining adherence via AED concentrations in clinic and home DBS samples. The present findings show that the latter, with further development, could be a useful approach to adherence assessment when combined with other measures including parent and child self-reporting. Seizure type and parental depressed mood were strongly predictive of nonadherence.
    Epilepsia 02/2013; 54(6). DOI:10.1111/epi.12126 · 4.57 Impact Factor
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    • "The impact of sociodemographic and family factors on adherence have been studied in other chronic childhood illnesses (Marhefka, Tepper, Brown, & Farley, 2006; Mellins, Brackis-Cott, Dolezal, & Abrams, 2004; Modi, Morita, & Glauser, 2008). Higher income levels have been associated with higher levels of adherence in pediatric HIV (Marhefka et al., 2006), chronic pediatric renal disease (Brownbridge & Fielding, 1994), epilepsy (Modi et al., 2008), and asthma (Blais et al., 2006), whereas poverty has been associated with unstable living environments, in which caregiver concern for long-term goals such as a child's adherence to a prolonged treatment regimen may be overridden by concern for more immediate needs, such as providing food and shelter, and maintaining a safe environment for the family (Marhefka et al., 2006; Wolff et al., 1998). "
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    ABSTRACT: Children and adolescents with acute lymphoblastic leukemia (ALL) receive treatment that relies on daily self- or parent/caregiver-administered oral chemotherapy for approximately 2 years. Despite the fact that pediatric ALL is uniformly fatal without adequate treatment, nonadherence to oral chemotherapy has been observed in up to one third of patients. Little is known about the reasons for nonadherence in these patients. This study used Straussian grounded theory methodology to develop and validate a model to explain the process of adherence to oral chemotherapy in children and adolescents with ALL. Thirty-eight semistructured interviews (with 17 patients and 21 parents/caregivers) and 4 focused group discussions were conducted. Three stages were identified in the process of adherence: (a) Recognizing the Threat, (b) Taking Control, and (c) Managing for the Duration. Doing Our Part was identified as the core theme explaining the process of adherence and involves the parent (or patient) taking responsibility for assuring that medications are taken as prescribed. Understanding the association between taking oral chemotherapy and control/cure of leukemia (Making the Connection) appeared to mediate adherence behaviors.
    Journal of Pediatric Oncology Nursing 06/2011; 28(4):203-23. DOI:10.1177/1043454211409582 · 0.90 Impact Factor
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    ABSTRACT: Purpose: The objective of this retrospective claims study was to describe antiepileptic drug (AED) treatment patterns and burden of illness in children with epilepsy. Methods: Data were administrative claims from a US commercial health plan. Patients were between 2 and 17 years of age and had one or more pharmacy claims for an oral AED from July 1, 2005, to November 30, 2009. The index date was defined as the first AED claim. Patients had one or more medical claims for epilepsy (ICD-9-CM 345.xx) during the 6-month pre-index period and were continuously enrolled for 12 months post index. Of the 17 AED medications used to identify patients, eleven medication cohorts had more than 100 patients: (1) carbamazepine (CAR); (2) clonazepam; (3) gabapentin (GAB); (4) lamotrigine (LAM); (5) levetiracetam (LEV); (6) oxcarbazepine (OXC); (7) phenobarbital; (8) phenytoin (PHY); (9) topiramate (TOP); (10) valproate (VAL); and (11) zonisamide (ZON). Results: There were 3889 children who met the inclusion criteria. There were some differ-ences in patients across the eleven AED treatment cohorts based on index therapy in age, gender, geographic location, Charlson comorbidity score, AHRQ comorbid conditions, as well as epilepsy-related risk factors and comorbidities. Of the 17 AEDs examined, the most frequently prescribed were OXC (21%) and LEV (19%); the least prescribed AED was GAB (1%). Their respective mean post-index pharmacy and total costs were as follows: OXC, US$2095 and US$5556; LEV, US$3025 and US$9121; and GAB, US$917 and US$1597. The overall post-index mean pharmacy costs were US$2637, and mean total costs were US$6813. Conclusion: Study results demonstrate differences in patient demographic and clinical characteristics across AED medication cohorts. Some cohorts have greater odds of a switch, or augmentation than the reference comparator CAR cohort. Variation was also observed in brand or generic medication use. LAM and TOP had the highest annual pharmacy costs of all the drugs.
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