Relationship Between Treatment Compliance And Effect And Influencing Factors In Patients With Epilepsy

Epilepsy is a common disease, the prevalence rate of epilepsy in developed countries, countries with economies in transition, developing countries and least developed countries were 5.0‰, 6.1‰, 7.2‰, 11.2‰according to the World Health Organization report, it was estimated about 50 million patients with epilepsy all over the world. The prevalence rate was 7‰by national epidemiological survey, the country had about nine million patients with epilepsy, most studies showed that the annual incidence of epilepsy was between 24/100000 and 53/100000,each year about 400000 new cases , found in all age groups, 80% of patients with epilepsy received formal treatment through long-term control, about 20% of patients were now recognized as refractory epilepsy. The reasons of refractory epilepsy, with the exception of the primary disease, the non-formal treatment could not be ignored.Domestic research on compliance focused on the drug treatments of high blood pressure, diabetes, coronary heart disease and other chronic diseases. Chronic disease was usually life-long disease, illness and high medical costs not only seriously affected the quality of life of patients with epilepsy, but also brought the heavy burden on the economy and society. Epilepsy was a stigmatizing neurological disorder that often produced significant physical, psychological, and economic burden on individuals and families. Patients with epilepsy had a higher rate of suicide, anxiety, depression, sudden unexplained death and accidental. And abroad it had been reported: non-compliance to anti-epileptic drugs associated with reduced seizure control, lowered quality of life, and decreased job-related productivity. Notably, non-adherence was also strongly related to seizure-related job loss and motor vehicle accidents. Patients with epilepsy in our country occupies a certain proportion, and above the harm, we should pay attention to the treatment in patients with epilepsy to improve its treatment which has great significance. At present, the treatment effect of patients with epilepsy in our country is relatively poor, which associate with its informal treatment. Informal treatment of patients with epilepsy may be related to the inadequate understanding of epilepsy to patients and their families, which was the influencing factors of treatment compliance. Therefor we carried out the investigation of treatment compliance and treatment prognosis in outpatients with epilepsy, and investigated the influencing factors of treatment compliance.Objective: Evaluating the relationship between treatment compliance and effect in patients with epilepsy, analyzing the influencing factors of treatment compliance, further exploring the treatment of patients with epilepsy to improve compliance measures, so as to improve the effect in patients with epilepsy, improve their quality of life.Methods: The use of self-designed questionnaire in our hospital the out-patient with epilepsy (102 cases ) which had been diagnosed in other hospitals and come to our hospital the first time, we conducted a questionnaire survey from November 2006 to November 2008 , we retrospectived evaluation the relationship between treatment compliance and the effect in patients with epilepsy in the two years, and analyzed the impact factors of treatment compliance from the awareness of the self-diagnosis and treatment in patients with epilepsy(records of epileptic seizures, regular follow-up visits, fixed doctors guiding treatment), type of seizures, self-factors (educational level, age), external environment factors (economic conditions, living environment, medical insurance).Among the patients with epilepsy , male 49 cases, female 53 cases; 43 cases of children aged between 12 months and 16 years old, 59 cases of adults aged between 17 and 69 years old; course of disease between 1 and 21 years; the years of education (adult patients refers to the education extent of themselves, children patients refers to the education level of their parent ): 71 cases above the high school education, 31 cases below the high school education, the years of education 7±2.5 years; type of seizures: simple partial seizures 22 cases, complex partial seizures 36 cases, secondary tonic-clonic seizures 28 cases, primary generalized tonic-clonic seizures 16 cases; the types of antiepileptic drug : one drug 70 cases, two kinds of drugs 22 cases, more than two kinds of drugs 10 cases.According to international league against epilepsy in 1981 and 1989, the classification and diagnosis of seizures and epilepsy syndrome to all selected objects mainly based on clinical data and the electroencephalogram of attack period and inter-attack period. There must be more than 2 times the typical history of epileptic seizures in all the patients; all the patients had the history of diagnosis and treatment in epilepsy for more than a year, febrile seizures or only neonatal seizures could not be diagnosed with epilepsy; seizures clearly caused by certain brain diseases acute phase could not be included in the diagnosis of epilepsy;clinical diagnosis by exclusion of the heart, liver, lung, kidney, blood system diseases and chronic diseases of metabolic system; except for intracranial space-occupying lesions and brain vascular malformations through the head CT or MRI ; and except for hysteria and other non-epileptic seizures; at the same time, except for patients with mental retardation or dementia.The detail include gender, age, age at onset, diagnosis time, type of seizures, frequency of seizures (the primary, now), antiepileptic drugs used before , antiepileptic drugs taken now , whether there were records of epileptic seizures; whether regular follow-up visits; whether there were fixed hospital /doctors guiding treatment ( which the hospital level); whether taken the medication on time; the satisfaction of effect (very satisfied, satisfied, not satisfied); the costs of antiepileptic drugs/month; the costs of other drugs/month;additional expenditures than normal costs (living, education, other);the understanding degree of epilepsy-related knowledge (to ask questions: understanding ,not understanding), educational level, economic status, living environment (urban community, rural community), health insurance, the demand and hope to doctors, hospitals, society and the Government.The criteria of treatment prognosis: it was divided into the following groups according to Engel's classification: aggravate group (increase in the frequency of seizures > 25%); ineffective group (reduction in the frequency of seizures≤50%); effective group (75%> reduction in frequency of seizures > 50%); excellent group (reduction in frequency of seizures≥75%); the control group (without clinical seizures).The criteria of treatment compliance: whether taken medicine as directed by the doctor to determine their treatment compliance. In the investigation patients with epilepsy taking medication on doctor's orders was good treatment compliance group, not taking medication on doctor's orders was poor treatment compliance group. The compliance judged by compliance rate, compliance rate calculated as follows: compliance rate = the numbers of good compliance in patients with epilepsy / the total numbers of different groups of patients×100%.Results: During the investigation a high level of education referred to adult patients or parent of children with high school and above, low education level referred to adult patients or parent of children below high school level ; adult referred to the age greater than or equal to 16 years old, the survey of children referred to the age less than 16 year old; the income of good economic situation was greater than or equal to 600 yuan in the household per capita monthly, the income of poor economic conditions was less than 600 yuan in the household per capita monthly; medical insurance referred to whether there were provincial health insurance, municipal health insurance. Analyzing the relationship between treatment compliance in patients with epilepsy and effect, and analyzing the influencing factors of the treatment compliance .1) The treatment compliance and effect was directly related in patients with epilepsy,good treatment compliance in patients with good effect (P <0.05), on the contrary poor treatment compliance with poor effect. 2) There were relationship between treatment compliance and the awareness of self-diagnosis and treatment in patients with epilepsy: patients in relatively high awareness of self-diagnosis and treatment with good compliance (P<0.05). 3) There were relationship between treatment compliance and type of seizures in patients with epilepsy: patients of generalized tonic-clonic seizures with good compliance (P<0.05), while patients of partial seizures with relatively poor compliance. 4) There were relationship between treatment compliance and their own reasons in patients with epilepsy: patients in high education level with good treatment compliance (P <0.05), and children patients with good treatment compliance compared to adult patients (P<0.05). 5) There were relationship between treatment compliance and the external environmental factors in patients with epilepsy: patients in good family economic condition, living in the city, having medical insurance with good compliance (P all <0.05).Conclusion: 1.The treatment compliance in patients with epilepsy was directly related to effect , patients in good treatment compliance with good effect; 2. The factors of influencing treatment compliance were many, including type of seizures, educational level, age, economic status, living environment, health insurance obviously impacted on treatment compliance; 3.The general awareness of self-diagnosis and treatment in patients with epilepsy were relatively poor, response of patients with epilepsy in the lack of the formal and educational guidance. Therefore, we suggest to strengthen the scientific knowledge of epilepsy, and improve the diagnosis and treatment of the doctors, call on the society to pay more attention to patients with epilepsy, in order to improve the effect and improve their quality of life.