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Predictors of nonadherence in children and adolescents with epilepsy: A multimethod assessment approach
Mervat Alsous1, Imad Hamdan2, Mohammad Saleh3
1Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan.
Insights
High nonadherence to antiepileptic drugs (AEDs) in children with epilepsy was identified using multiple measurement methods. Longer disease duration and parental beliefs about AEDs predicted nonadherence, highlighting the need for targeted interventions.
Area of Science:
- Pediatric Neurology
- Pharmacology
- Adherence Research
Background:
- Standardized tools for measuring adherence to antiepileptic drugs (AEDs) are lacking in epilepsy patients.
- Previous studies reported variable adherence rates in children with epilepsy, ranging from 50% to 96.5%.
Purpose of the Study:
- To identify predictors of nonadherence to AEDs in Jordanian children and adolescents with epilepsy.
- To compare two different methods for adherence measurement in this population.
Main Methods:
- A cohort of 63 children and adolescents with epilepsy and their caregivers participated.
- Adherence was assessed using subjective (Medication Adherence Report Scale - MARS) and objective (plasma AED levels) methods.
- The Beliefs about Medicines Questionnaire (BMQ) was used to evaluate the association between beliefs and nonadherence.
Main Results:
- Objective measurement of plasma AED levels identified the highest nonadherence rate (36.2%).
- No significant agreement was found between plasma levels and MARS (parent or child) self-reports.
- Overall nonadherence, combining both methods, was 44.4%.
- Predictors of nonadherence included longer disease duration, lower parental AED Necessity scores, and higher parental AED Concerns.
Conclusions:
- A multimethod approach enhances the detection of nonadherence to AEDs in pediatric epilepsy.
- Disease duration and parental beliefs about AEDs (necessity and concerns) are significant predictors of nonadherence.
- High nonadherence rates underscore the need for interventions to improve AED adherence in children with epilepsy.
Background:
There is a lack of a standardized tool for adherence measurement in patients with epilepsy. Studies in children with epilepsy have reported adherence in 50-96.5%. The primary objective of this study was to identify predictors of nonadherence to antiepileptic drugs (AEDs) using two different methods in Jordanian children and adolescents with epilepsy.
Methods:
Participants included 63 children and adolescents with epilepsy and their primary caregivers. Adherence measures included a subjective approach (using parent and child self-reports via Medication Adherence Report Scale (MARS)) and an objective method (measuring plasma levels of AEDs coupled with the application of population pharmacokinetic models to predict AED concentrations in the children). The Beliefs about Medicines Questionnaire (BMQ) was used to examine the association beliefs about medicines with nonadherence in the participating patients.
Results:
Measuring AEDs in plasma samples captured the highest percentage of nonadherence (36.2%). No significant agreement was found between the AED plasma level method and both the MARS (parent) and MARS (child). The overall nonadherence (combined methods) to AED therapy in children with epilepsy was 44.4%. Logistic regression analysis indicated that children with longer duration of disease were more likely (odds ratio [OR]: 1.54, 95% confidence interval [CI]: 1.16-2.04) to be classified as nonadherent as were children whose parents have lower AED Necessity scores (OR: 0.68, 95% CI: 0.53-0.87) and higher AED Concerns (OR: 1.6, 95% CI: 1.26-2.04) as measured by the BMQ.
Conclusion:
The use of a multimethod approach for assessing adherence increases sensitivity for detection of nonadherence to AEDs. Disease duration and parental necessity beliefs and concerns assessed by the BMQ-specific questionnaire were significant predictors of nonadherence to the AED therapy. The need for the development and implementation of interventions that can be employed to improve adherence within this pediatric population has been highlighted by the high levels of nonadherence identified.
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