Adherence to antiepileptic medicines in children: A multiple-methods assessment involving dried blood spot sampling
Noraida Mohamed Shah
Clinical and Practice Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, Belfast, United Kingdom
Faculty of Pharmacy, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
Search for more papers by this authorAhmed F. Hawwa
Clinical and Practice Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, Belfast, United Kingdom
Search for more papers by this authorJeff S. Millership
Clinical and Practice Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, Belfast, United Kingdom
Search for more papers by this authorPaul S. Collier
Clinical and Practice Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, Belfast, United Kingdom
Search for more papers by this authorPaul Ho
Department of Pharmacy, National University of Singapore, Singapore Singapore
Search for more papers by this authorMui Ling Tan
Department of Pharmacy, National University of Singapore, Singapore Singapore
Search for more papers by this authorDeirdre Peake
Department of Neurology, The Royal Belfast Hospital for Sick Children (RBHSC), Belfast Health and Social Care Trust, Belfast, United Kingdom
Search for more papers by this authorSandya Tirupathi
Department of Neurology, The Royal Belfast Hospital for Sick Children (RBHSC), Belfast Health and Social Care Trust, Belfast, United Kingdom
Search for more papers by this authorJanice Bothwell
Epilepsy Clinic, Carlisle Health and Wellbeing Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
Search for more papers by this authorNicola Bailie
Department of Neurology, Antrim Area Hospital, Northern Health and Social Care Trust, County Antrim, Northern Ireland, United Kingdom
Search for more papers by this authorCharles Shepherd
Craigavon Area Hospital, Southern Health and Social Care Trust, Northern Ireland, United Kingdom
Search for more papers by this authorJohn Craig
Department of Neurology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
Search for more papers by this authorCorresponding Author
James C. McElnay
Clinical and Practice Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, Belfast, United Kingdom
Address correspondence to James C. McElnay, Clinical and Practice Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, U.K. E-mail: [email protected]Search for more papers by this authorNoraida Mohamed Shah
Clinical and Practice Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, Belfast, United Kingdom
Faculty of Pharmacy, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
Search for more papers by this authorAhmed F. Hawwa
Clinical and Practice Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, Belfast, United Kingdom
Search for more papers by this authorJeff S. Millership
Clinical and Practice Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, Belfast, United Kingdom
Search for more papers by this authorPaul S. Collier
Clinical and Practice Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, Belfast, United Kingdom
Search for more papers by this authorPaul Ho
Department of Pharmacy, National University of Singapore, Singapore Singapore
Search for more papers by this authorMui Ling Tan
Department of Pharmacy, National University of Singapore, Singapore Singapore
Search for more papers by this authorDeirdre Peake
Department of Neurology, The Royal Belfast Hospital for Sick Children (RBHSC), Belfast Health and Social Care Trust, Belfast, United Kingdom
Search for more papers by this authorSandya Tirupathi
Department of Neurology, The Royal Belfast Hospital for Sick Children (RBHSC), Belfast Health and Social Care Trust, Belfast, United Kingdom
Search for more papers by this authorJanice Bothwell
Epilepsy Clinic, Carlisle Health and Wellbeing Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
Search for more papers by this authorNicola Bailie
Department of Neurology, Antrim Area Hospital, Northern Health and Social Care Trust, County Antrim, Northern Ireland, United Kingdom
Search for more papers by this authorCharles Shepherd
Craigavon Area Hospital, Southern Health and Social Care Trust, Northern Ireland, United Kingdom
Search for more papers by this authorJohn Craig
Department of Neurology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
Search for more papers by this authorCorresponding Author
James C. McElnay
Clinical and Practice Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, Belfast, United Kingdom
Address correspondence to James C. McElnay, Clinical and Practice Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, U.K. E-mail: [email protected]Search for more papers by this authorSummary
Purpose
To evaluate adherence to prescribed antiepileptic drugs (AEDs) in children with epilepsy using a combination of adherence-assessment methods.
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.
Key Findings
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).
Significance
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.
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