Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland; FutureNeuro SFI Research Centre, The Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland.
School of Nursing and Midwifery, Trinity College, Dublin 2, Ireland.
Epilepsy Behav. 2020 Mar;104(Pt A):106896. doi: 10.1016/j.yebeh.2019.106896. Epub 2020 Jan 25.
Although 70% of people with epilepsy (PWE) achieve seizure freedom following an appropriate antiepileptic drug (AED) regime, evidence suggests that adherence to AEDs by PWE is suboptimal. Nonadherence to AEDs is associated with increased morbidity, mortality, emergency department visits, and hospitalizations, with reduced adherence also correlating to a lower quality of life, decreased productivity, and loss of employment. Furthermore, research indicates that medication errors which are widespread in chronic disease are less well studied in epilepsy but are likely also to contribute to avoidable disease morbidity and mortality. The goals of this project were to determine rates of medication adherence by self-reported questionnaire and its links to perceived medication error in a cohort of PWE attending a general epilepsy outpatient clinic. Following a plan-do-study-act cycle, it was found that the most appropriate methodology for conducting was in the form of a bespoke 9-item self-administered questionnaire. One hundred eighty-six PWE completed a nine-question questionnaire asking patients about their own medication adherence habits and their perception that they were previously exposed to medication error. This study found that 41% of respondents reported suboptimal adherence to AED therapy, while 28.5% of respondents self-reported that they unintentionally do not take their AED medication on an occasional, regular, or frequent basis. A 5.9% of respondents self-reported that they intentionally do not take their medication as prescribed. A 6% of respondents self-reported that they are both unintentionally and intentionally nonadherent to their AED therapy. No significant associations were demonstrated between age, sex, perceived effectiveness of medication, feelings of stigma/embarrassment, adverse effects or additional neurological comorbidities, and unintentional or intentional nonadherence. A 28.5% of respondents to the questionnaire reported that they perceived themselves to have been subjected to medication error. Prescribing errors were the most common form of perceived medication error, followed by dispensing errors, then administration errors. Significant associations were found between ineffective medication and feelings of stigma or embarrassment about epilepsy with perceived prescribing errors. Intentional nonadherence to medication was significantly associated with perceived dispensing errors.
尽管 70%的癫痫患者（PWE）在适当的抗癫痫药物（AED）治疗后能实现无癫痫发作，但有证据表明，PWE 对 AED 的依从性并不理想。不遵医嘱与发病率和死亡率增加、急诊就诊和住院治疗增加有关，而遵医嘱率降低也与生活质量降低、生产力下降和失业有关。此外，研究表明，在慢性病中广泛存在的药物错误在癫痫中研究较少，但也可能导致可避免的疾病发病率和死亡率。该项目的目标是通过自我报告问卷确定服药依从率，并确定其与在普通癫痫门诊就诊的 PWE 中感知到的药物错误之间的关系。在计划-执行-研究-行动循环之后，发现最适合的方法是采用专门设计的 9 项自我管理问卷。186 名 PWE 完成了一个九项问题的问卷，询问患者自己的药物依从习惯以及他们是否曾接触过药物错误。这项研究发现，41%的受访者报告 AED 治疗依从性不佳，而 28.5%的受访者报告他们偶尔、经常或频繁不按规定服用 AED 药物。5.9%的受访者报告他们故意不按规定服用药物。6%的受访者报告他们无意和有意不遵守 AED 治疗方案。年龄、性别、对药物有效性的看法、耻辱感或尴尬感、不良反应或其他神经共病与非依从性之间没有显著关联。28.5%的问卷受访者报告他们认为自己曾遭受过药物错误。处方错误是最常见的感知药物错误类型，其次是配药错误，然后是给药错误。无效药物与对癫痫的耻辱感或尴尬感之间存在显著关联，与感知的处方错误有关。故意不遵医嘱与感知的配药错误显著相关。
