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      Evaluation of self-reported medication adherence and its associated factors among epilepsy patients in Hospital Kuala Lumpur

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          Abstract

          Introduction:

          Reports on medication adherence and its associated factors in patients with epilepsy in South East Asian countries are lacking. The primary purpose of this study was to assess the degree of medication adherence and its relationship with patient's satisfaction, psychosocial factors, quality of life and mental health in a sample of Malaysian epilepsy patients.

          Methodology:

          It is a cross-sectional study and was carried out in the outpatient Neurology Department of Hospital Kuala Lumpur, Malaysia ( n=272). Data was collected by administering the structured questionnaire.

          Results and Discussion:

          Results showed that 49.3% of the epilepsy patients were non-adherent to their prescribed regimen. Univariate analysis showed significant associations between medication adherence and the following factors: race, seizure frequency, overall patient satisfaction, medication taste and smell, medication cost and physical appearance, medication effectiveness, complexity of medication regimen, patient barrier, patient understanding, patient role functioning, patient positivity, vitality and general interest. Multiple regression analysis indicated that factors that are influencing medication adherence are seizure frequency ( P = 0.048), overall patient satisfaction ( P = 0.043) and patient understanding about their illness ( P = 0.001). The model chosen for testing the relationship between medication adherence and its associated factors give an R 2 value of 25.2% with an adjusted R 2 of 21.4%. The F value was also significant ( P = 0.000). Based on the research findings, the researchers recommends that clinicians need to play a vital role in educating the patients on their disease conditions. By educating the patients on nature of epilepsy, different modalities of treatment and benefits of adherence to treatment will help in the better adherence and management.

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          Most cited references36

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          The global burden of disease in 1990: summary results, sensitivity analysis and future directions.

          A basic requirement for evaluating the cost-effectiveness of health interventions is a comprehensive assessment of the amount of ill health (premature death and disability) attributable to specific diseases and injuries. A new indicator, the number of disability-adjusted life years (DALYs), was developed to assess the burden of disease and injury in 1990 for over 100 causes by age, sex and region. The DALY concept provides an integrative, comprehensive methodology to capture the entire amount of ill health which will, on average, be incurred during one's lifetime because of new cases of disease and injury in 1990. It differs in many respects from previous attempts at global and regional health situation assessment which have typically been much less comprehensive in scope, less detailed, and limited to a handful of causes. This paper summarizes the DALY estimates for 1990 by cause, age, sex and region. For the first time, those responsible for deciding priorities in the health sector have access to a disaggregated set of estimates which, in addition to facilitating cost-effectiveness analysis, can be used to monitor global and regional health progress for over a hundred conditions. The paper also shows how the estimates depend on particular values of the parameters involved in the calculation.
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            Self-reported medication adherence and treatment satisfaction in patients with epilepsy.

            Reports about medication adherence and satisfaction in patients with epilepsy in Arab countries are lacking. The objective of this study was to assess medication adherence and its relationship with treatment satisfaction, number of antiepileptic drugs (AEDs) taken, and epilepsy control in a sample of Palestinian patients. This cross-sectional descriptive study was carried out at Al-Makhfya Governmental Outpatient Center in Nablus, Palestine, during the summer of 2010. A convenience sampling method was used to select patients over the study period. Medication adherence was measured using the eight-item Morisky Medication Adherence Scale (MMAS); treatment satisfaction was measured using the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4). Epilepsy was arbitrarily defined as "well controlled" if the patient had had no seizures in the last 3 months and was defined as "poorly controlled" if he or she had had at least one seizure in the last 3 months. A convenience sample of 75 patients was studied. On the basis of the MMAS, 11 patients (14.7%) had a low rate, 37 (49.3%) had a medium rate, and 27 (36%) had a high rate of adherence. Adherence was positively and significantly correlated with age (P=0.02) and duration of illness (P=0.01). No significant difference in adherence was found between patients with well-controlled and those with poorly controlled epilepsy. Similarly, there was no significant difference in adherence between patients on monotherapy and those on polytherapy. Mean satisfaction with respect to effectiveness, side effects, convenience, and global satisfaction were 73.6±20.7, 82.4±29.8, 69.5±15.5, and 68.4±18.3, respectively. There were significant differences in mean values in the effectiveness (P<0.01) and convenience (P<0.01) domains, but not the side effect (P=0.1) and global satisfaction (P=0.08) domains among patients with different levels of adherence. Patients on monotherapy had significantly higher satisfaction in the effectiveness domain (P=0.04) than patients on polytherapy. Similarly, patients with well-controlled epilepsy scored significantly higher in the Effectiveness (P=0.01) and Global Satisfaction (P=0.01) domains than those with poorly controlled epilepsy. In our convenience sample, we found that adherence to and satisfaction with AEDs were moderate and were not associated with seizure control or number of AEDs. Copyright © 2011 Elsevier Inc. All rights reserved.
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              The relationship between poor medication compliance and seizures.

              Predictors and consequences of inadequate compliance with seizure medications were assessed using a 10-item postal survey. Dose omissions were reported by 71% of the 661 respondents (2+/-2 doses of seizure medications), with 45% of patients reporting a seizure after a missed dose, at some time during treatment. Dose omission was more likely with longer use of seizure medications (more than 5 years, P<0.01). Having seizures after missed doses was associated with number of seizure medication doses (P=0.04) and number of seizure medication tablets/capsules (P=0.01). Odds ratios showed that each increase in dose frequency (one, two, three, or four doses daily) increased the likelihood of a seizure after a missed dose by 36%. Taking larger numbers of tablets/capsules increased the odds of having a seizure after missed doses by 43%. These data provide evidence that medication compliance remains an important issue in epilepsy treatment.
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                Author and article information

                Journal
                J Basic Clin Pharm
                J Basic Clin Pharm
                JBCP
                Journal of Basic and Clinical Pharmacy
                Medknow Publications & Media Pvt Ltd (India )
                0976-0105
                0976-0113
                September 2016-November 2016
                : 7
                : 4
                : 105-109
                Affiliations
                [1] Department of Pharmaceutical Technology, School of Pharmacy, Bukit Jalil, Kuala Lumpur 57000, Malaysia
                [1 ] Department of Life Sciences, School of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia
                [2 ] Department of Pathology, School of Medicine, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia
                [3 ] Department of Pharmaceutics, Faculty of Pharmacy, Asia Metropolitan University, 43200 Cheras, Selangor, Malaysia
                [4 ] Department of Pharmacy Practice, School of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia
                Author notes
                Address for correspondence: Dr. Nagashekhara Molugulu, Department of Pharmaceutical Technology, School of Pharmacy, International Medical University, No. 126, Jalan 19/155B, Bukit Jalil, Kuala Lumpur 57000, Malaysia. E-mail: nagashekhar@ 123456gmail.com
                Article
                JBCP-7-105
                10.4103/0976-0105.189430
                5153886
                27999469
                2e39bed3-d816-4446-90c1-52e8e42860b1
                Copyright: © Journal of Basic and Clinical Pharmacy

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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                Original Article

                associated factors,epilepsy,medication adherence,medication compliance

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