Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
Epilepsia. 2011 Feb;52(2):370-6. doi: 10.1111/j.1528-1167.2010.02789.x. Epub 2010 Nov 18.
Study aims were (1) to document and examine associations between parent-report and electronic monitoring (EM) of pediatric antiepileptic drug (AED) adherence, (2) to determine the sensitivity and specificity of parent-reported adherence, and (3) to develop a correction factor for parent-reported adherence.
Participants included 111 consecutive children with new-onset epilepsy (M(age) = 7.2 ± 2.0; 61.3% male; 75.8% Caucasian) and their primary caregivers. AED adherence was electronically monitored for 3 months prior to the 4-month clinic follow-up visit. Parent-reported adherence captured adherence 1-week prior to the clinic visit. For specificity/sensitivity analyses of parent-reported adherence, cut points of 50%, 80%, and 90% were used with electronically monitored adherence calculated 1-week prior to the clinic visit as the reference criterion.
Electronically monitored adherence (80.3%) was significantly lower than parent-reported adherence (96.5%; p < 0.0001) 1-week prior to the clinic visit, but both were significantly correlated (rho = 0.46, p < 0.001). The 90% parent-reported adherence cut point demonstrated the most sensitivity and specificity to electronically monitored adherence; however, specificity was still only 28%. A correction factor of 0.83 was identified as a reliable adjustment for parent-reported adherence when compared to electronically monitored adherence.
Although EM is the gold standard of adherence measurement for pediatric epilepsy, it is often not clinically feasible to integrate it into routine clinical care. Therefore, use of a correction factor for interpreting parent-reported adherence holds promise as a reliable clinical tool. With reliable adherence measurement, clinicians can provide adherence interventions with the hope of optimizing health outcomes for children with epilepsy.
本研究旨在（1）记录并检查父母报告与电子监测（EM）在评估儿科抗癫痫药物（AED）依从性方面的关联，（2）确定父母报告依从性的敏感性和特异性，以及（3）开发父母报告依从性的校正因子。
本研究纳入了 111 例新发癫痫患儿（M（年龄）=7.2±2.0；61.3%为男性；75.8%为白种人）及其主要照顾者。在 4 个月的临床随访就诊前，使用电子监测方法监测 AED 依从性 3 个月。父母报告的依从性在就诊前 1 周内进行评估。为了对父母报告的依从性进行特异性/敏感性分析，使用了 50%、80%和 90%的依从性作为截断值，以就诊前 1 周的电子监测依从性作为参考标准。
电子监测的依从性（80.3%）明显低于就诊前 1 周父母报告的依从性（96.5%；p<0.0001），但两者均显著相关（rho=0.46，p<0.001）。90%的父母报告依从性截断值在电子监测依从性方面具有最高的敏感性和特异性；然而，特异性仍只有 28%。与电子监测依从性相比，发现 0.83 的校正因子是父母报告依从性的可靠调整值。
虽然 EM 是儿科癫痫患者依从性测量的金标准，但在临床实践中常常无法将其纳入常规临床护理。因此，使用校正因子来解释父母报告的依从性具有成为可靠临床工具的潜力。有了可靠的依从性测量，临床医生可以提供依从性干预措施，以期优化癫痫患儿的健康结局。
