The Effect Of Medication Education And Behavioral Intervention On Patients With Epilepsy Who Are Nonadherence

ObjectiveTo measure the effect on adherence, seizure control and knowledge of anti-epileptic drugs (AEDs) of medication education and behavioral strategies that combined with medication education. Then, to compare the difference between medication education and behavioral strategies that combined with medication education. Finally, to find the way to medication education and intervention fit for pharmacists in China.MethodsRecruit patients who missed AEDs at least once, had taken AEDs for six months, older than16and were diagonised as epilepsy from the outpatient clinic of the department of neurologist in hospital of Huashan, between September of2011and July of2012. Patients who met the inclusion and informed were randomly divided into control group or intervention group. After assessing the baseline of adherence seizure and knowledge of AEDs, control group were educated orally and with written material of general knowledge of drug therapy, according to the America Society of Health-system Pharmacist’guideline on pharmacist conducted patient education and counseling. Intervention group were conducted with behavioral strategies and medication education. Medication education were the same to control group, behavioral strategies were medication schedule and diary of epilepsy. During the six months duration of intervention, all patients were followed up by telephone every month. Adherence, seizure, knowledge of AEDs and quality of life were measured at the end of six month. Then, compare the differences on adherence, seizure and knowlwdge of AEDs after intervention, and compare the difference between control group and intervention group.Results1. There were124patients included.109patients were successfully followed up and completed all the questionnaires. The baseline level of control group and intervention group on adherence, seizure and knowledge of AEDs were similar. Details were listed as follow: Baseline level of adherence (control group vs intervention group):low (22.6%vs25.0%), medium (69.8%vs66.1%), high (7.5%vs8.9%), P=0.953;Number of seizure on baseline (control group vs intervention group):"0"(5.7%vs1.8%),"1～5"(54.7%vs39.3%),"6～23"(26.4%vs42.9%),"24～167"(9.4%vs12.5%),"more than168"(3.8%vs3.6%), P=0.315;Total score of knowledge of AEDs on baseline:1.4±1.0vs1.6±0.8, P=0.308;2. After intervention, adherence, seizure control, and knowledge of AEDs were all improved, and number of patients who forgot to take medications was also decrease in control group and intervention group. The difference in adherence, number of seizure, knowledge of AEDs and ratio of patients who forgot to take medications in control group and intervention group were also significant.1) Result for control group:Adherence:mean rank of baseline37.12vs mean rank of final69.88, P<0.001; Number of seizure:mean rank of baseline65.94vs mean rank of final41.06, P<0.001;Knowledge of AEDs (Total score):1.4±1.0vs3.3±1.2, P<0.001;Ratio of patients who forgot to take medications:71.7%vs45.3%, P=0.006).2) Result for intervention group:Adherence:mean rank of baseline38.58vs mean rank of final74.42, P<0.001;Number of seizure:mean rank of baseline70.36vs mean rank of final42.64, P<0.001);Knowledge of AEDs (Total score):1.6±0.8vs3.2±1.2, P<0.001;Ratio of patients who forgot to take medications:71.4%vs44.6%, P=0.004.3. After intervention, adherence, seizure and knowledge of AEDs were improved in control group and intervention group. But, no difference were found in improved adherence, seizure control, increased knowledge of AEDs, and quality of life between control group and intervention group.Improved adherence (control group vs intervention group):(62.3%vs64.3%, P=0.827);Sseizure control (control group vs intervention group):64.2%vs64.3, P=0.988;Increased knowledge of AEDs (control group vs intervention group):88.7%vs80.4%,P=0.231; Quality of life (overall quality of life)(control group vs intervention group):50.7±8.0vs49.2±7.8, P=0.319.Many patients took the missed medications, due to told to, but there was no difference too (control group vs intervention group):41.7%vs48.0%, P=0.656.ConclusionMedication education and follow-up by telephone can improve adherence, seizure control and knowledge of AEDs for patients with epilepsy who were nonadherence to AEDs. It also can decrease number of patients who forgot to take medications and decrease the number of medications missed by patients. However, compare to the effect of medication education, effect of behavioral strategies on adherence, number of seizure, knowledge of AEDs and quality of life were not significant or too little. Therefore, the behavioral strategies needs to improve, the intervention that medication education and follow-up by telephone every month, and focused on nonadherence patients, was an effective intervention for pharmacists in China.