Cincinnati Children's Hospital Medical Center, United States.
Nationwide Children's Hospital, United States.
Epilepsy Behav. 2023 May;142:109192. doi: 10.1016/j.yebeh.2023.109192. Epub 2023 Apr 15.
Adolescents with epilepsy are at heightened risk for suboptimal anti-seizure medication (ASM) adherence; however, there is a paucity of adherence interventions for this age group. The current study aimed to identify a comprehensive and novel set of predictors of objective, electronically-monitored ASM adherence in adolescents with epilepsy.
Participants included 104 adolescents (13-17 years old; M = 15.36 ± 1.40), diagnosed with epilepsy and their caregivers. Cross-sectional data were collected from adolescents, caregivers, healthcare providers, and medical chart reviews, including demographics (i.e., age, race/ethnicity, sex, insurance status), the COVID-19 pandemic (i.e., participation before versus during), seizure characteristics (i.e., presence and severity), ASM side effects (Pediatric Epilepsy Side Effects Questionnaire), adherence motivation (1-item 6-point Likert scale item), and adherence barriers (Pediatric Epilepsy Medication Self-Management Questionnaire). Electronically-monitored adherence data was collected via the AdhereTech pill bottle or the Vaica SimpleMed pillbox over 30 days.
Adolescents demonstrated suboptimal adherence at 78 ± 31.6%, despite high ASM adherence motivation (M = 4.43 ± .94) and minimal adherence barriers (M = 35.64 ± 3.78). Hierarchical multiple regression, which included non-modifiable sociodemographic and medical variables (Block 1) and behaviorally modifiable psychosocial variables (Block 2) was significant, F(12,87) = 3.69, p < .001. Specifically, having private insurance (versus Medicaid or public insurance; t = -2.11, p = .038) and higher adherence motivation (t = 2.91, p = .005) predicted higher objective ASM adherence.
Routine assessment of adherence predictors is vital for the promotion of adherence among adolescents with epilepsy. Adolescent adherence motivation may be an important element of multi-component interventions focused on improving ASM adherence in adolescents with epilepsy.
患有癫痫的青少年抗癫痫药物（ASM）依从性较差的风险较高；然而，针对这一年龄组的依从性干预措施却很少。本研究旨在确定一组全面且新颖的预测青少年癫痫患者客观、电子监测的 ASM 依从性的指标。
参与者包括 104 名青少年（13-17 岁；M=15.36±1.40）及其照顾者。从青少年、照顾者、医疗保健提供者和病历回顾中收集横断面数据，包括人口统计学信息（年龄、种族/民族、性别、保险状况）、COVID-19 大流行（参与前与参与期间）、癫痫发作特征（存在和严重程度）、ASM 副作用（儿科癫痫副作用问卷）、依从动机（1 项 6 分李克特量表项目）和依从障碍（儿科癫痫药物自我管理问卷）。通过 AdhereTech 药瓶或 Vaica SimpleMed 药盒电子监测 30 天的依从性数据。
尽管青少年的 ASM 依从动机较高（M=4.43±.94）且依从障碍较小（M=35.64±3.78），但他们的依从性仍为 78±31.6%，表明依从性较差。包括不可变的社会人口学和医学变量（第 1 块）和可改变的行为心理社会变量（第 2 块）的分层多元回归显著，F(12,87)=3.69，p<.001。具体而言，有私人保险（而非医疗补助或公共保险；t=-2.11，p=.038）和更高的依从动机（t=2.91，p=.005）预测更高的客观 ASM 依从性。
定期评估依从性预测因素对于促进青少年癫痫患者的依从性至关重要。青少年的依从动机可能是针对改善青少年癫痫患者 ASM 依从性的多组分干预措施的重要组成部分。
